A Hidden Infection?
The doctors at South County weren’t sure what was going on, either. The patient felt sick: She was tired, her back was killing her and she felt weak all over. She looked sick too: pale and frail. On exam, her temperature was up and her blood pressure was down. She had a faint rash on much of her body, and she was confused. But her white-blood-cell count — an indicator of infection — wasn’t elevated, and the doctors couldn’t see any obvious source of infection. Blood tests showed no signs of the most common tick-borne diseases. A chest X-ray was normal. An ultrasound of her abdomen was, too. Blood was also analyzed to see if any bacteria would grow, and she was admitted to the hospital team, under the care of Caroline Jenckes, an experienced nurse practitioner.
Jenckes spent the next few days looking for an infection she was certain was there. She ordered an M.R.I. of the spine in search of an abscess, but found nothing. The patient’s gallbladder was carefully evaluated; inflammation can trigger a fever and pain that travels to the back. A couple of days in, a CT scan of the patient’s chest suggested the possibility of pneumonia. Dr. Fred Silverblatt, the infectious-disease doctor Jenckes consulted, didn’t think the subtle findings could be the cause of her symptoms. And the patient’s fever was already coming down. Still, he agreed to start her on broad-spectrum antibiotics.
A Joke Turns Serious
Finally the medical team saw what seemed significant evidence that the patient was getting better. Her fever came down, and her blood pressure returned to normal. Her back pain was subsiding.
From the son’s perspective, his mother was not really recovering. He and his wife had been taking turns staying with her, day and night, and she was nothing like her old self; she still…