Defying the Laws of Nature

When my friends are on call and I'm in emerg, I feel less hesitant about asking them my stupid questions. Which is lucky for me, since I have many of them. The other night a friend of mine from med school was on call for general surgery, and was hanging around the ER after a consult. So I decided to bounce a case off him-- a kind of unofficial consult, as it were.

Dr. Couz: What are the chances that my 46-year-old female patient presenting with right upper quadrant pain and nausea is suffering from cholecystitis?

Surgery Resident: Pretty Good.

If she's had it before?

Even better.

If she was previously treated with a cholecystectomy for recurrent cholecystitis?

Um... well, it's still possible that she retained a stone.

And if she had a follow-up ERCP 3 months later for removal of a retained stone?

Hm. Pretty much nil.

Are you sure?

Yup. It's gotta be something else.

So, as per Murphy's Law, an hour later my patient's bloodwork comes back with elevated liver enzymes, including the one that serves as a somewhat specific marker for gall bladder obstruction.

Sigh.

Consult surgery.

This month's career-related goal and personal growth experience? Becoming comfortable with uncertainty and discharging patients without having any clue what the hell is wrong with them.