A hockey player’s fate

To be 18, a professional athlete, and loved–who wouldn’t envy such an existence. Unless, luck suddenly turns on you, and in an unfortunate turn of events, you fall seriously ill.

At 9 p.m. on a Wednesday evening, Steve, a member of a hockey team on a training tour through several states in the Northeast U.S., felt sick to his stomach. He initially thought it was something he ate two hours prior at dinner with his team members at George’s Grill and Bar in downtown Atlanta. But at 11 p.m., when symptoms got worse–he was throwing up and having diarrhea at the same time–an image he didn’t want any of his team members to see, for that would diminish his sex-appeal and overall “cool”–his coach took him, despite Steve’s initial protest, to the nearest emergency room. His blood pressure was normal at the time. His pulse was slow–which wasn’t surprising for an athlete–and a CAT scan showed nothing specific to worry about. The doctors made no particular diagnosis.

“It might be something that you ate,” one of them said in a doctorly tone, “I hope it will all go away the way it came about.”

Over the next two weeks, though, Steve’s symptoms shifted like his mood, from pain to short-lived hope, then to despair. His pain felt like a punch in the right lower side of his abdomen and he had slight fever. The pain and fever later diminished, even his diarrhea resolved, but then the pain returned with a vengeance. It was still on the right side, but this time, it ran along his lower back. And, perhaps even more worrisome, Steve’s stool turned bloody, red, and thick, like in a horror movie. His fever spiked too. He had no appetite.

“This isn’t the Steve we know,” his friends said, “something must be wrong.”

Back in another emergency room (the team was now in Detroit, Michigan, on their way home), the doctors seemed more concerned. Steve looked tired, even exhausted. He had fever and his heart was pounding at 122 beats per minute. His abdomen was tender. His stool continued to be bloody. Another CT was ordered, and it, too, showed, that “the appendix looks A-Okay, and there is nothing to write home about.”

Steve was admitted to the hospital. In the evening, his temperature spiked to 40.6 degrees Celsius, and he started to shake like a leaf on a tree. Susan from the laboratory called to report that the blood culture taken upon admission grew a bacteria called Klebsiella pneumonia, and later, she called again, telling the doctor that a second type of bacteria had grown as well.

Dr. Novick sat at his desk looking at the computer screen, searching for clues. He wore glasses. He had a long, dark, carefully-trimmed beard that started at his sideburns, and not even one hair on his head. Novick was brilliant. At home, he entertained himself by solving mathematical problems. At the hospital, relying on an encyclopedic medical knowledge, he typically made a diagnosis in seconds. Steve’s case, though, was challenging. And when encountered with a difficult riddle, either mathematical, or medical, Novick did what he always did in such situations: he tapped on his forehead with one finger, and then pushed his glasses along his nose with another. This, everyone knew, was a sign he was thinking deeply, and that he was very close to reaching a solution.

It could have been an appendicitis, Novick thought, but the pain in the right lower abdomen did not start at the belly button, and it didn’t get worse by coughing or by shaking of the patient’s bed–findings typical of appendicitis. Besides, the imaging studies did not reveal a swollen, inflamed appendix.

Using a similar thought process, Novick considered, and then eliminated other causes of abdominal pain: It could have been a case of diverticulitis but that typically appears on the left side and would show on imaging studies; or inflammatory bowel disease, but there was no family history of such a disease and, again, no sign for such a disease on the imaging studies. It might have been an infection causing colitis like in a salmonella infection, but Susan from the lab indicated otherwise; or ischemic colitis, even colon cancer–none of these diagnoses made sense to Novick. It must be something else, he thought.

As Novick reviewed the imaging studies of Steve, he noticed something that had been overlooked before: a small collection of fluid mixed with gas just next to the sigmoid colon and close to a blood vessel that supplies the sigmoid colon. Novick smiled to himself. Yet another problem made easier if you just knew a bit of Mathematics, he told himself.

What was the diagnosis? How was Mathematics helpful in reaching the correct diagnosis? Was Steve cured? I shall return with a story about my own mentor, Professor Weissberg, and with a conclusion to Steve’s story.