Thursday, November 16, 2006

Blood-vomiting patients

...are annoying.
Especially when they vomit all over my sports coat and make me change my clothes.

The case is interesting, however.
Patient is 28 and suffers from epigastric pain that goes away with consumption of food, hematemesis (to speak from my own experience), difficulty in eating and steatorrhea.
Cameron now tests the gastrin level, Chase is doing a secretin stimulation and calcium infusion test and Foreman was occupied with an abdominal CT scan.

I think it might be Zollinger-Ellison syndrome.
Well, I don't think, I'm quite sure.
I discussed this with James and we were handed the results of Foreman's scan:

Pancreatic cancer, for sure. Another evidence for Zollinger-Ellison.

We were busy studying the scan when I saw Stacy walking by from the corner of my eye.
Suddenly there was a knock at the door - Stacy.
We synchronously turned our heads and nodded.
Stacy came in and hesitated.
Synchronously again we both raised an eyebrow. "Hey, Stacy", I greeted her and James nodded and smiled.
I waited a few minutes, but she just stared at us.
"What is on your mind?" I asked her.
"Um....", she began.
James put his hands on his hips. (He looks so cute when he does that!) "Everything alright, Stacy? Is there something wrong with Marc?"
She shook her head. "All's well...I...I just saw you standing there...."
I sighed. "Isn't that interesting? I bet you see us fairly often here!"
James pointed to the whiteboard where the scan was fixed. "We're discussing a scan. It's cancer."
She nodded and seemed a bit moony. "I just thought you looked so...close...Maybe I'm barking up the wrong seem really on intimate terms..."
She blushed and I knew she was highly embarassed.
I grinned. "Does that surprise you?"
James couldn't help smiling and seemed to gloat over Stacy's uneasiness.
She shook her head again. "As I know you are friends it should not surprise me. But this just looked different. You were always close and there were times I was even jealous in a silly way... but now you you..." She took a deep breath. "I don't think we've been that close to each other, Gregory."
I shrugged. "Maybe you're right..."
James grinned at her. "What do you mean, Stacy?"
She examined her shoes. Uncomfortable high heels - as always. "You look like you belong together", she finally said and looked up to us.
James put his arm around my hip and I leaned against him.
"Well,..we do", he said.
She gasped. "You fool me, don't you?!"
"No", I said with a smile. "Didn't I tell you I'm gay?"
" was meant as a joke!", she cried out.
I shook my head and put my arm around James' shoulder. "We are what you call a twosome."
She went pale. "My're not kidding..."
"We're not. Not at all", James replied and placed a kiss on my temple.
" happy for you", she just launched out and turned on her heels.
I looked at James. "Did that really surprise her?"
He grinned. "Seems so."
Then he grabbed my collar and pulled me closer to kiss me. Several passers-by stopped to look at us but we didn't care.
We smiled at each other and had to return to earth.
"So, how will you treat him?", James asked and nodded to the scan.
I shrugged. "If the gastrin level is increased and both the secretin stimulation test and the calcium infusion test are positive, there's no doubt it's Zollinger-Ellison... The tumor has to be removed and I think he'll need Proton pump inhibitors and H2 blockers to slow down acid secretion."
James nodded. "Omeprazole and lansoprazole?"
"Mhm...They also provide relief of abdominal pain and diarrhea."
"Fine", he smiled. "I'll pick you up in about twenty minutes at your office, okay?"


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