22. The Mary
It was around 5:50 am when I heard the knock on the door.
I looked at Jax in the kitchen.
‘Are you expecting someone?’
‘At this time? No way.’
I went to look through the peephole and let out a probably too loud scream while opening the door.
‘Mom!’ I said as I hugged her.
‘Hi, honey.’ She hugged me back even more firmly. ‘I missed you.’
‘Me too! How come you didn’t tell me you were coming?’
‘Well, this way is more fun.’ She smiled. ‘Come here Jackson and give me a hug.’
‘Mrs. Diaz! It’s so nice to see you again!’ Jax hugged her and lifted her from the floor. They were really good friends. One day, I got home from high school and they were both having coffee without me.
‘Mom, I am so happy you are here! But I have to go to the hospital in a few minutes.’
‘I know, Liz! Don’t worry about me. You two can go save some lives.’
One of my patients that day was Ekon, a 30 year old immigrant from Africa. We were seeing him for two days and still hadn’t figured out what he had. He was admitted for a persistent fever lasting two weeks by then. He also had some abdominal pain that improved partially with acetaminophen.
We turned him upside down and noticed he had right upper quadrant tenderness. In fact, his liver enzymes were a little high, but not the acute hepatitis-high, and his serologies were negative anyway. Total bilirubin was also a little elevated along with alkaline phosphatase. His blood cultures weren't growing anything, his chest was clean and the rest of his blood workup too.
Something was going on with Ekon. But what?
That morning when I went to see him before the rounds he was still the same thing. High fevers and the pain controlled by the meds. He also said his stool was a little loose after he was admitted in the Hospital, ‘Maybe it’s the food.’ he said.
I decided to ask him everything again.
‘Since when are you in the US?’
‘Oh, 10 years at least.’ he said scratching his head.
‘And never again went back to Africa?’
‘No! I have been there many times since. I visit my parents in Ghana almost every year.’
‘Really?’ I was surprised how I’d missed that before. ‘Were you there recently?’
‘Yeah! I came back 3 weeks ago.’
I shut my eyes.
During rounds, we took some time struggling with the next steps on Ekon’s case. Lucy brought up that Jane had noticed some reddish spots on his abdomen, so the three of us went to Ekon’s bed to check on it. Indeed there was a slight rash beginning to form, although that didn’t ring us any bell then. I pointed out the fact that the patient had been in Ghana 3 weeks before, a little ashamed I hadn’t got that info sooner.
‘That’s interesting.’ Lucy said. ‘Well, he is stable. I am tending to order another blood culture to increase our sensitivity if he is infected after all, and then we study his case more until tomorrow. What do you two think? Suggestions?’
‘I agree.’ I said.
‘Me too.’ said Peter. ‘Can’t think of another thing to do today.’
After I finished all my paperwork I went straight home and found mom waiting for me with coffee and cake on the table. I smiled.
‘What’s on your mind, honey?’ she said while we ate. ‘You have that look on your face.’
‘What look?’
‘That worried look.’
I laughed. ‘It’s a patient of mine. We don’t know what’s going on with him.’
‘Want to talk about it?’
‘Well, he has these high fevers for a couple of weeks now. Abdominal pain and now some red spots on his belly.’
She put her hand on mine. ‘You’ll figure it out, Liz.’
‘Thanks, mom.‘
‘It sounds like that Mary story you sent me.’ she said while pouring more coffee.
‘What story?’
‘That Mary who was a cook. Wherever she worked people got sick, remember? Got fever, rash and the whole deal. You know, I actually read the books you send me.’ She winked.
Typhoid fever. I thought for a moment. It fit in every way you could think about it. He had even traveled to an endemic region.
‘Oh my God, mom, you are a genius.’
The next day I shared this idea of enteric fever with Lucy who promptly agreed to start the treatment. We started him on ciprofloxacin, to which he responded very well. And, happily for us, his second sample of blood culture came back positive for Salmonella typhi. It’s always so much more satisfying when we can actually find the bug. Ekon got better and better and we discharged him home not long after that.
Mom was right after all. As usual.
...
Want to know more about Typhoid Fever?
https://www.mayoclinic.org/diseases-conditions/typhoid-fever/symptoms-causes/syc-20378661
Want to read more about Mary Mallon?
https://www.smithsonianmag.com/history/the-frightening-legacy-of-typhoid-mary-180954324/
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