I am admittedly a Zebra Hunter. In my defense, I worked acute care pediatrics in world famous children’s hospital when nearly all 300 of the kids were zebras of some sort. If not, they were more easily cared for in the community hospitals. For the years I worked there, I was surrounded by the most brilliant minds, amazing caregivers trying to puzzle out the most complex children. I had no idea that it was possible for so many chromosomes to be off just a little.
Everyday things were life threatening. Sinus infections and ear infections somehow had turned into empyema of the brain. The rarest cancers, the most complicated neuro surgeries. Once when Infectious disease and neuro surgery looked at images together, the neuro surgeon picked up that baby to RUN him to surgery.
So, when I first saw kids in the community with an ear infection or sinus infection, I would want to make sure it wasn’t going to be more serious. Are those bruises on that toddler ” non accidental trauma.”? In the hospital, everything was figured out immediately- it was like magic- Any image, MRI, MRA, or weird lab was just done almost immediately. Work ups were quick, often intense, but things were figured out before the child went home.
The “real world” isn’t like that at all. It is full of mostly horses. Sometimes some pretty fancy horses, but mostly mundane. Except for the past few weeks, when I have learned more about endocrine that I had no idea that I didn’t know. I am weirdly excited about it all. I mean, it is fascinating when it is something so unusual.
I think I find the weird stuff in part because I worry about missing something. I also tend to listen to patients. I like to hear their stories. I like to try to put the pieces of the puzzle together. I am endlessly curious about everything.
What is so very interesting these past few weeks is that these are things that one would think would be noticed long before I meet the patient. I don’t know how someone else didn’t think it odd that the 40 year old patient with palpitations was so weirdly bendy. Not yoga bendy but something unusual, that makes me ask if they can touch the floor with their palms, encircle their wrist with pinky and thumb, touch their thumb to their wrist. Can I see your palate? Yeah, no one every asked or looked.
I am not a physician, so I didn’t have much exposure to radiology in school. Well, actually NONE. So I don’t just read the radiology report “impression” I read the whole report. I look up words. I pull out one of my radiology texts. I read, read, read. I question. I want the answers. I need the answers, so next time I will know. More times than I can count, what I read in the “Impression” doesn’t completely match what is in the body of the report. This is probably a reflection of those dreaded “pre clicks” on computer programs. I ask about that nodule or cyst mentioned.
These past few weeks I have been in the middle of a whole herd of Zebras! Strange lung stuff that we are still working out. Pheochromocytoma in that “anxious” patient. Some things that are so unusual that HIPPA’s ears will perk up if I think it too loud, but really, really strange endocrine stuff that is fascinating.
The term Zebra Hunter isn’t a compliment really. It would be more of insult, if I didn’t nearly always get that Zebra. As often as I might say that I long for less interesting practice, I find the hunt makes me look forward to getting to work. It is like turning the pages in a mystery novel. This next week, the pieces of at least 5 very odd cases will come together.