Medicine Grand Rounds

1
Medicine Grand Rounds

• Case Vignette
• Dr. Samuel Rougas

2
Chief Complaint and HPI

• CC 44 year old Russian speaking male who
  presents with a chief complaint of I cannot
  control my infidelity.
• HPI Medicine is my lawful wife, and literature
  is my mistress. When I get fed up with one, I
  spend the night with the other. Though it is
  irregular, it is less boring this way, and
  besides, neither of them loses anything through
  my infidelity

3
Case presentation Continued . . .

• PMH Consumption, Social Indiscretion
• PSH None
• All NKDA
• Social History
• Multiple cigarettes per day for many years
• Infrequently Champagne, very frequently Vodka
• The pt. denies intravenous drugs
• The pt. works as a medical physician and author
• FH Consumption

4
Physical Exam

• General Middle aged gentleman appearing older
  than his stated age, cachectic, hunched shoulders
  that reveal he is no stranger to suffering.
• Vital Signs 112/67 104 14
• HEENT Keen eyes that denote a subtle though
  deep understanding of human pathophysiology,
  coupled with a wry grin that betrays both a sense
  of superiority and self doubt.
• Lungs Decreased Breath Sounds RUL
• Extremities Calloused right forefinger and
  thumb with a slight tremor that dissipates only
  with the rhythmic motion of a feather dabbed in
  ink. No clubbing.

5
Radiographic and Laboratory Data

• Unfortunately, radiographic and laboratory data
  were not available on this patient as modern
  serum analyses and modern imaging was not yet
  invented.

6
Assessment and Plan

• 44 y/o male w/ a likely diagnosis of TB and an
  overwhelming need to take lifes dramas and
  conflicts and document them in an aesthetically
  pleasing manner that transcends the barriers of
  language and time. This was of course
  complicated by a physically and mentally
  demanding career that offers both the substrate
  and fodder for literary genius but cruelly
  occupies the very time necessary to put forth
  such works
• Respiratory Isolation
• Continue to encourage Mr. Anton Chekhov and other
  physician/writers to write