99.9 times out of 100, it may be what it looks like. This piece is about the times when it wasn't.
These stories are from an AskReddit thread. Link on the last page.
1. That's why you study *everything*.
The emergency doctor referred a guy to me who had a platelet count of 2. The guy looked bloody sick, abdominal pain, rash, feverish, diaphoretic, a bit confused and drowsy too.
Talked to my boss who said to give him prednisolone and he'd see him tomorrow, but I was convinced this guy had a really rare condition called TTP (Thrombotic Thrombocytopenic Purpura). Basically, it causes random tiny blood clots all over your body.
So I called the major hospital in my area and sent him to their ICU for a procedure called plasma exchange. I ordered a test to prove the condition, still have a paper copy of the result because it's the best diagnosis I've ever made. It helped save his life!
2. Urine luck.
We had a strange case a few years ago. An otherwise healthy, 40-year-old migrant worker from Central America started coughing up blood intermittently. Everything suggested tuberculosis: history, chest x-ray looked like tuberculosis, illness script looked like tuberculosis... but his tests for it were all negative.
I decided to test his urine on a whim to rule out pulmonary-renal pathologies. Ding, ding, ding! Blood. Lots of blood. The patient never noticed it, and his kidney function was superb, so this was a tricky diagnosis. Turns out he had granulomatosis with polyangiitis. Basically, this rare disease randomly cuts off blood flow to organs. I’m glad we caught it before it caused irrevocable damage to his organs.
3. Ticking time bomb.
Patient came in with an itchy rash that would not go away for weeks and swelling of the mouth and tongue. She had "hives" all over her body and the only thing that had helped was repeated steroids. The patient was a mid 40s female who worked with dogs, so we assumed that she had a new allergy to pet dandruff, fragrance in a shampoo, flea medicine, something.
We discharged her home with an appointment for the dermatologist to do a biopsy of the lesions.
Later that day, she turns back up in the Emergency Department with swollen lips, increased rash, and trouble breathing. She started having these problems 15 minutes after eating a roast beef sandwich. Luckily, someone on the team remembered that she works with dogs. Otherwise she might have been in a lot of trouble. (continued...)