A 73-year old female presented to St Vincents Emergency Department, with a 3 week history of progressive dyspnoea, cough, and lethargy, on a background of a 6-year history of Multiple Myeloma. Just prior to presentation, she had also developed a fever.
In terms of her presenting complaint, she described herself as an active lady, who ran her own pub, but her recent symptoms rendered her unable to carry out her normal activities, such that her husband recommended she should go to hospital.
Following subsequent investigations, she was diagnosed with bilateral pneumonia and empyema, and was admitted. Once stabilized, she underwent a left thoracotomy with decortication. As a result 2 drains were inserted, with each draining serosanguinous fluid. The plan is to remove these once they have drained < 20 ml in 24 hours.
Past medical history:
• Multiple Myeloma
Past surgical history:
• Autograft bone marrow transplant
• Fibroidectomy
Medications:
• No known drug allergies
• Dexamethasone
• Cenalidamide
• Zolpiden
• Valiclovir
• Paracetamol
• Oxynorm
Social history:
• ...
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning on urination, and decreased urine output for three days.
A 54 year old female was presented with complaints of lethargy, excessive thirst and diminished appetite. Given the fact that these symptoms are very broad and could be the underlying cause of various diseases, the physician decided to order a urinalysis by cystoscope; a comprehensive diagnostic chemistry panel; and a CBC with differential, to acquire a better understanding on his patient health status. The following abnormal results caught the physician’s attention:
She had a two week history of feeling generally unwell, complaining of tiredness and lethargy. She had no other significant symptoms. Her past history includes well controlled asthma and anxiety. She was a smoker of 20 cigarettes per day. She was taking amitriptyline, Symbicort (budesonide and formoterol inhaler). She had no significant family history of medical illness and had no clinical findings on examination. Blood tests showed corrected calcium of 4.22mmol/L (NR 2.20 -2.60) with suppressed paired PTH of 1.45pmol/L (NR1.60- 6.9). Her renal function was initially impaired, but normalized with rehydration. Her liver function tests, full blood count, vitamin D, myeloma screen and serum ACE levels were all within normal limits. Ultra sound scan (USS) of kidneys, USS of parathyroid and computerized tomography (CT) of thorax, abdomen and pelvis were all reported as normal with no cause found for her
The heroine of this tale knows that she is not well, and the fact that medical authorities contradict her self-diagnosis frustrates her. She concedes that her husband should be more knowledgeable than her about her condition. This undermines her self-confidence in being able to evaluate herself.
The patient was first placed in the lithotomy position and underwent right ascending pyelography to confirm the diagnosis (typical image in the form of a hook or S-shaped (Figure 1). A right JJ catheter was then placed. After that, the patient was placed in right- side-up flank position and a transperitoneal approach was used.
When she was younger her father left to a sanitarium in Virginia to deal with his drinking problem, Eleanor missed him so much. Later her mother became sick. She had painful headaches, sometimes for hours.
Mrs. Jones, An elderly woman, presented severely short of breath. She required two rest periods in order to ambulate across the room, but refused the use of a wheel chair. She was alert and oriented, but was unable to speak in full sentences. Her skin was pale and dry. Her vital signs were as follows: Temperature 97.3°F, pulse 83, respirations 27, blood pressure 142/86, O2 saturation was 84% on room air. Auscultation of the lungs revealed crackles in the lower lobes and expiratory wheezing. Use of accessory muscles was present. She was put on 2 liters of oxygen via nasal canal. With the oxygen, her O2 saturation increased to 90%. With exertion her O2 saturation dropped to the 80's. Mrs. Jones began coughing and she produced large amounts of milky sputum.
Mary was seen today following her redo bronchoscopy. Unfortunately, there was not much mucus seen and as such I suspect that the right middle lobe collapse and the lingular collapse are going to be a chronic change. Despite this though, Mary does seem to be coping well with this and up until ten days ago was only coughing very occasionally and was not describing any issues with breathlessness. Ten days ago though, she had a viral infection that progressed to a green cough and she did start seven days of doxycycline that completely cleared things up. She stopped this three days ago and has started to have a return of the green sputum, but without any other significant symptoms. I have suggested she complete another seven days. It is likely
The patient was a 34 year old female that was admitted during the night shift to the Transitional Care Unit (TCU) through the emergency department for nausea and vomiting times three (3) days. In the emergency department, she was treated with fluid resuscitation of Normal
The narrator is being completely controlled by her husband. The narrator's husband has told the her over and over again that she is sick. She sees this as control because she cannot tell him differently. He is a physician so he knows these things. She also has a brother who is a physician, and he says the same thing. In the beginning of the story, she is like a child taking orders from a parent. Whatever these male doctors say must be true. The narrator says, "personally, I disagree with their ideas" (480), and it is clear she does not want to accept their theories but has no other choice. She is controlled by her husband.
Learning of her nervous condition, known today as anxiety, and depression leads her to seek help. Seeing that her husband is a doctor, he happens to know that rest is the perfect cure. Not only that, he also knows what is favorable, along with what is unfavorable for her condition. John as a high standing physician of his time warns his wife, the narrator, that talking about it will affect her condition. Keeping in her thoughts along with her feelings cannot be healthy. "Repression cannot be healthful and as the protagonist grows quieter, she is becoming more and more mad" (Wagner-Martin 291). Her husband does mean well. He loves her, but he is overbearing. John feels the need to be in control of everything she does to make sure her condition does not worsen. To him, he believes that talking about her illness will cause it to worsen. Nevertheless, he does not want that. To combat that, he enforces that she does not talk about it. Although bottling up feelings can cause explosive consequences when done for an extended period of time. She has been in that house for three months, so the whole time she was getting restless.
... appearances which is why I think she does what her husband and brother prescribe. She even says, “If a physicican of high-standing, and one’s own husband, assures friends and relatives that there is really nothing the matter with one but temporary nervous depression – a slight hysterical tendency—what is one to do?” This brings me to the point that women in those times had to follow their husbands orders. Anything else was unheard of!
First of all, her husband John, and her brother are both physician in a high standing, which both of them suggest that the woman isn’t sick but is only having a temporary nervous depression. It will be hard for the woman to deny these statements made by his husband and brother even she disagrees with them inside her heart. Secondly, the woman wishes to work and she thinks that congenial work with excitement and change will be good for herself, however, her husband doesn’t think the same way. He forbids her to work or even socializing with others, not even her own children:”it is fortunate Mary is so good with the baby, Such a dear baby! And yet I cannot be with him, it makes me so nervous” (Gilman, 928), until she gets well. How can a mother be not nervous without her babies with her? Her husband, as well as his status and knowledge as a physician, has been the most powerful force confining her. She cannot find evidence, nor she has the knowledge to prove his husband wrong. It will sound dumb for her not listening to her husband who loves her and is a physician of high
The patient has experienced fever, chills on body, headaches and anorexia as well as sweating especially during the night. The patient has also been feeling fatigued, muscle aches and nausea as well as vomiting especially after eating (WHO, 2010, p. 117). These symptoms started forty eight hours ago, and the patient has not taken any medication except for some aspirin.