31. The Christmas
I was on call that Christmas evening. I didn’t mind actually. The hospital looked so heartwarming at Christmas. All the decorations and lights, I loved it.
It was a quiet day. I had seen some patients but they were all stable. I was eating the meal I had brought to the hospital. I didn’t really like it, but my mom insisted on cooking it for me. Christmas food. And even though I didn’t love the taste of the food, I loved Christmas. And Christmas food is part of it, so I loved the feeling of it.
The next morning I had a patient to see. It was Mr. Gregory Roberts. He was a 65-year-old male with hypertension and diabetes, both poorly controlled. He came to the emergency department last night - Christmas eve - because of shortness of breath and weakness for the past few days. It got so bad he decided he needed to go to the hospital on the best day of the year.
When he arrived, he had a fever. They ordered him a few lab tests to screen for infection and now he was my patient. I went to talk to him before I could check his lab results.
‘Merry Christmas, Mr. Roberts!’
He opened a big smile to me. He was a big guy, seemed very strong. So strong it was a little hard to believe he was feeling weak.
‘Merry Christmas, doctor! Don’t you love Christmas?’
‘It’s literally the best part of the year.’ I reached for his hand to say hi. ‘My name is Lisa Diaz and I’m going to be your doctor from now on.’
‘Nice to meet you, doctor.’
We talked a little about what he felt before coming to the hospital. He said he had been feeling weak for a few days by then, and couldn't help his wife to decorate the house. But the day before it got worse. When he and his family were waiting for dinner, he started to feel so weak he was afraid of passing out. His son was worried and decided to take him to the hospital right away. Now his son was out buying bagels.
When I examined him, he was feverish again. Besides that, he was a little pale and slightly icteric. I told Mr. Roberts I would check his labs and be back soon.
Through his labs, it was clear he had hemolytic anemia and thrombocytopenia. His hepatic enzymes were also a little high. Cultures were running and the chest x-ray was clean. I was a little uncreative that day to come up with a long list of differentials. I went to discuss the case with the Chief Resident, Phillip Brandt.
‘You said he had a fever? Sorry I missed that part.’
‘Yes, he had a fever.’
‘So what syndrome are we talking about here?’
‘I don’t know. Fever plus hemolytic anemia plus thrombocytopenia.’
He laughed.
‘Yes, Lisa. We call that acute febrile illness, or maybe he could even have a hemorrhagic fever, but I’m not sure yet.’
‘Right.’
‘So, what is the most important question we should ask when we suspect that? Besides what you already told me about him of course.’
Then I understand what he meant.
‘Of course.’ I smiled happy that I got it. ‘I need to know where he was.’
‘Exactly.’
‘But he is from Brooklyn.’ I said with a little disappointment.
‘It’s Christmas, Lisa. We all travel to see family.’
I went to ask Mr. Roberts where he was spending Christmas.
‘Oh, we were at our family ranch. It’s not far from here actually, a couple of hours. Beautiful place, doctor. We always celebrate Christmas there.’ He thought about it for a moment. ‘What about you, where did you spend your Christmas eve?’
‘You’re looking at it.’ I laughed.
So he was in the Northeast. Fever, malaise, and hemolytic anemia. Babesia came to my mind. The symptoms fit, and he could’ve been bit by a tick while he was outdoors at his ranch.
We ordered a peripheral blood smear that did the trick. We could see intraerythrocytic parasites, even the commonly described Maltese cross.
We discharged him on atovaquone and azithromycin orally and scheduled a follow-up to check if everything was okay.
‘Merry Christmas again, Doc.’ He gave me a card with Joy to the World written on it.
‘The Lord is come.’ I completed.
I was finally done with my shift, on my way to see my mother. She flew in to have dinner with me on the 25th.
‘How was it darling?’
‘Great, mom. How are you?’
‘I’m fantastic. Where do you want to eat today?’
‘Home maybe?’ I said with a shy smile. ‘I’m sorry mama, I know you flew in just to see me, I’m just so tired.’
‘No problem, honey! It’s not where we spent Christmas that I care about, It’s with whom.’ She winked at me.
‘Yes.’ I remembered Mr. Roberts. ‘But actually, where you spend it can be very important too.’ I laughed. ‘You pray or I do?’
...
Want to read more about Babesiosis?
https://rarediseases.org/rare-diseases/babesiosis/
Want to read a real case of Babesiosis?
https://westjem.com/case-report/a-walk-in-the-park-a-case-of-babesiosis-in-the-south-bronx.html
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