Indiana University School of Medicine - Caduceus Yearbook (Indianapolis, IN)

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At last---1 think. 19 I matched as janitor at IUMC!

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Senior Day April 14, 1972 Do I know anybody here? Didn't think it was BYOB.

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Clinical-Pathologic Conference, I.U.M.C. Clinical Presentation: Dr. John T. Scutdoer, MCCH boy April 14, 1972 Case Discussants: Dr. David O. Challenger, Almost-a-Chairm an and Healer-at-Large Dr. Stanley Battered. Chairman Emeritus, National Committee for the Bewildered Dr. Walter J. Dildo, Alleged Chairman of Medicine, BON VI- VANT Dr. Roscoe E. Killerfiller, Renowned Rectal Ra- diologist Dr. Joshua You-Know, Physician in Chief of you-know-what DR. SCUTDOER: This is the first Indiana University admission for this forty-four year old, semi-retired, known veteran, whose chief complaint was. I been trampled. For several years this patient has suffered from paroxysmal attacks of rectal wheezing. The recurrent nature of these attacks lead him to consult a physician who diagnosed his case as that of being Congenital Flatus Imperfectus and recom- mended a diet fortified with cabbage and milk. This regimen has minimized the sequelae of this process. On 1 April, 1972, the patient noticed the sudden onset of retrobulbar pain on micturition, PRURITIS DENTII. and fluorescent stools. This symptom complex prompted the patient to seek assistance at the Indiana University Medical Cen- ter. Unable to obtain assistance, he was thereupon seen at the Veteran's Hospital. While seated in the corridor, the patient stated he suddenly heard hoofbeats which progressed in intensity and lasted a total of thirty to forty-five seconds and gradually faded away. At the peak of intensity, the patient experienced a sud- den. severe chest pain in his mid-sternal area which was characterized by a feeling like he had been kicked by a mule. This lasted approximately 10 seconds during which time the patient was violently pushed back to the floor. Unfortunately no one actually witnessed this episode, but several physicians, nurses, and VA assistant assistants stated that they had heard the hoofbeats, and it was observed that a new pile of fecal matter was present some feet from where the patient was found. Specimens of this material were sent to the laboratory where ultracentrifugation was performed and viral and bac- terial isolates were prepared. The fecal chloride was one hundred and one, the sodium was one hundred and forty-two, the potassium was 1.8, the calcium was 9.1, the urobilinogen was less than two Ehrlich units, and undigested Mother's Oats were noted in the sediment. The total sample weighed 1.1 kilograms. The patient was admitted immediately to the medicine ICU. On physical examination, nasal obstruction was present, much more marked on the left, with a slight, bloody mucoid discharge. At this point surgical consultation was obtained to remove the patient's finger. Other pertinent physical find- ings at this time included the peripheral stigmata of the routine veteran's syndrome. Also there were three small horse- shoe-shaped bruises in the mid-sternal area with erythematous purpuric lesions symmetrically arranged at the periphery. Stains of the sputum revealed numerous Gram-positive cocci, Gram-negative rods, and one AFB which was seen on the fifteenth sjide prepared by the junior medical student. Laboratory studies at this time included electrolytes, BUN, CBC. Australia antigen, Five-hydroxy-indole-acetic acid, C.omer activating substance titers, pregnancy test, and supine stool velocity (because of the emergency nature of the sit- uation. ) All orifices were intubated and flushed on a fifteen minute emergency basis. Despite the repeated laying on of hands and Gregorian chants performed by the intern, the patient followed a rapidly uphill course terminating in RIGOR MORTIS. DR. DILDO: Thank you very much, Dr. Scutdoer. We have today for our perusal an exceptionally, I would say an extra- ordianrily, I would say a supremely interesting case of a middle-aged, semi-retired veteran who died suddenly after an episode of paroxysmal prostration accompanied by hoofbeats. May we review the X-rays and the Electro-seismograph?