17. The Family Farm
‘Come on Kate, we are late!’
She laughed. ‘Lisa, you know I love you, but we are definitely not late.’
I checked my watch. ‘Fine. But can we go please?’ I gave her my best pretty-please look.
‘You are the worse.’ Kate rolled her eyes. ‘Fine. But tomorrow we’ll do my time.’ She got her coat and wrapped a donut to eat on the way.
Living with Kate was a pleasant surprise. In a short time, we had become not only roommates but very good friends. In many ways Kate is my opposite, and somehow that worked well.
We got to the floor laughing about something I can’t remember anymore. It had been a good week in the hospitalist service.
‘Anderson.’ We heard Jake the nurse calling behind us and we both turned.
‘Yes?’ Kate answered.
‘I have an admission for you.’
‘Good morning to you too, Jake.’ She smiled and Jake laughed. ‘I’ll take care of it.’
I went to check on my patients and saw Kate about two hours later pacing in circles inside the resident's room.
‘What happened?’ I asked walking into the room.
‘Nothing.’
‘Not true. You’re pacing like crazy. What’s going on?’
Kate scratched her head. ‘It’s just this admission. I feel like I’m missing something. And I want to figure it out before rounds.’
I checked my watch. ‘Ok, we have time. Sit.’ She obediently sat on the chair. ‘Now tell me.’
‘Quincy Jones, a 32-year-old male with a history of headache, fever, and cough. He had ronchi in his left lung and got a workup in the ED which was consistent with pneumonia.’
‘Ok.’ I nodded. ‘What’s the catch?’
‘Well, his workup also showed increased transaminases. Both ALT and AST were through the roof, so they decided to admit him for further investigation.’
‘Interesting. What else?’
‘Nothing else! That’s the problem. The Viral Hepatitis panel was normal. He still complains of headaches and I don’t know what’s up with his liver.’
‘Right. So let’s take a look at this again. Now present it like a real doctor.’
Kate laughed. ‘Sorry, fine. A-hem.’ She cleared her throat before proceeding.
‘Mr. Quincy Jones, 32 years old. Presented to the ED yesterday with severe headaches, fever, and cough for one week. On physical exam, he had ronchi in the left lung and minimal hepatomegaly. His initial workup showed a pattern suggestive of pneumonia on chest x-ray and a 10-folded increase in AST and ALT, with no apparent changes in liver function so far.’
I nodded for her to continue.
‘Mr. Jones was previously healthy until 2 weeks ago when he started with malaise and then developed the rest of the symptoms in the past week. He has no comorbidities, takes no medications, has no allergies, and doesn’t drink or smoke.’
‘Right.’ I said and waited for her to continue but she just stared at me silently.
‘So?’ Kate asked.
‘Come on, Anderson! Give me more.’
‘But that’s it!’ She laughed.
I crossed my arms. ‘No way. If you want my help, I want everything. Family history?’
‘Nothing much. Mother has hypertension, Father had a recent diagnosis of endocarditis, and siblings are healthy.’
‘Huh.’ I said smirking. ‘One more question then: Where does he live? What does he do for a living?’
‘That’s actually two questions.’
I rolled my eyes this time. ‘Smartass.’
‘He is a farmer. He lives with his family in Iowa, they work with cattle and stuff there. Quincy came to New York to visit a friend.’
I couldn’t help but smile.
‘What?’ Kate saw it in my face. ‘Am I stupid?’ I started laughing. ‘Don’t answer that.’ She said pointing at me and it just made me laugh more.
‘You’re not stupid.’
‘That’s reassuring.’
‘Shut up and listen. Headache, fever, pneumonia, hepatitis.’
‘Yes.’
‘In a farm boy.’
‘Yes.’
‘Whose farm father had endocarditis.’
‘Oh my God.’ Kate stood up startled. ‘I am stupid. Q Fever! They both inhaled Coxiella spores from the farm animals. Quincy got the acute Q Fever, which explains the headache with lung and liver involvement. And papa Jones got the chronic endocarditis form. Quincy even told me his father’s blood cultures were all negative.’
I raised my hand in an inviting high five. Kate slapped my hand and left excited.
We met again in rounds. Kate presented the case to Dr. Rivers and told him the hypothesis we had come up with. He listened carefully to everything she told him and raised his right eyebrow at the end.
‘I’m impressed, girls. Good job. So what do you want to do now, Dr. Anderson?’
‘I think we should order a PCR for Coxiella in his blood. And start him on Doxycycline.’ Kate answered confidently.
‘Sounds like a plan to me.’ Joe got up satisfied. ‘See you tomorrow then. If you need anything else, call me.’
I got up the next day and found Kate in the kitchen sitting with the breakfast table all set.
‘Morning, Liz.’ She smiled when she saw me. ‘Come sit.’
I checked my watch out of habit.
‘No no.’ She pointed her index finger at me. ‘There’s time for everything under the sun. Now it’s time to eat. Tomorrow we leave at your crazy timing. Today it’s my day.’ She extended her palm. ‘Give me that watch.’
I sighed and gave in.
Although I’d never said it to her, I enjoyed her mandatory breakfasts.
…
Want to know more about Q Fever?
https://rarediseases.org/rare-diseases/q-fever/
Want to read a real case of Q Fever?
https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-1-154
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