Part 19: Episode 19: Market Crash
This update covers:Gabriel Cunningham 4 - Moving Heart (Part 2 of 2)*
*I cut a scene off the ending. It'll be in the next update.
So, to use a precise medical term, Shelly's body is just totally fucked. She has a condition that seemed to mirror Kaposi's Sarcoma, with tumours on her skin, but spread so quickly that she now has blockages in her intestines as well. Gabe's going to have to check the rest of her organs to see what else could be going wrong.
Gabe: I can't say for sure yet. Sorry, but I need to run more tests.
Shelly: I understand. I have faith in you, doctor. There's something I have to tell you.
Gabe: Is it a new symptom?
Shelly: Well, yes... seriously, this cold season's been really tough, hasn't it?
Gabe: ......
Shelly: If this keeps up... *cough* *cough* ...Oh, I'm sorry. Anyway, I won't be able to work if this continues. I won't have to be hospitalized, will I, Doctor? I'd have to rearrange my schedule.
Well, besides a stereotypical workaholic, there's the obvious pain of chest pain.
Gabe: She looks like she's in a lot of pain. RONI, could you make a note of this?
RONI: New Symptom: "Chest Pain."
Secondly, we have our only symptom so far that she didn't tell us directly: the coughing.
Gabe: She seems to be coughing a lot. Could it be her lungs or bronchi? RONI, let's record this, too.
RONI: New symptom: "Coughing."
That's it. The stethoscope gives us nothing. Even the bowel sounds are gone. Let's check the EKG.
There actually isn't anything here, either. Except for that little break in the line near the pointer. It's a medal challenge.
Gabe: The display's incomplete. Hey, RONI. The EKG is glitching.
RONI: Performing physical repairs is beyond my powers. Please contact customer service.
There's seriously nothing else in here. I lost two hearts jumping at shadows because I forgot this thing doesn't progress until you check it and back out.
Gabe: Are you all right? If you're not feeling well, we do have beds ready.
Shelly: Oh, no. It just seems like the chest pains are getting worse.
Gabe: Her symptoms are getting worse. We need to redo all the exams!
*sigh*
Shelly: I can't believe this... I had the kidney transplant, my life was going well. Doctor, it's getting hard to breath. Could this be related?
Two more obvious ones here.
Gabe: Tasted blood? That's not good. RONI, add it to the list.
RONI: New symptom: "Bloody Sputum."
And as for the other one... Well, it's less dramatic at least.
Gabe: She has a mild case of dyspnea. RONI, you got that one?
RONI: New symptom: "Dyspnea."
And now we should auscultate again. This time, we do find something new.
Auscultation Video
Viddler
Youtube
To summarize, we have the symptom "Attenuation of Respiratory Sounds." Her breathing sounds faint in the lower-left lung. Gabe had some X-rays taken, so the next step is to take a look at them. The EKG, by the way, still shows nothing. Everything points towards a lung condition, then.
X-RAY_01
Patient:
Sample:
Gabe: A white shadow in the lower part of the left lung... That's definitely a sign of fluid accumulating in the thorax. So we know she has a lung abnormality. Let's narrow down the candidates.
RONI: Yes, Doctor. New Symptom: "Pleural Effusion."
As a side note, an effusion has fluid building up in the thorax, around the lung. A pleural oedema (edema for Americans) is when fluid builds up IN the lung. House screws that one up all the time.
Symptom List:
Pleural Effusion
Dyspnea
Bloody Sputum
Attenuation of Respiratory Sounds
Coughing
Chest Pain
Acute Bronchitis:
A condition in which bronchi becomes inflamed due to bacterial and viral infection. Symptoms include chest pain, coughing, sputum, and dyspnea. Abnormal breathing can be confirmed through auscultation. There are no symptoms that appear through an X-ray[snip]
We definitely got something from our X-ray. "Abnormal Breathing" is stupidly vague anyway.
Carcinomatous Pleuritis:
A condition in which the pleara membrane covering the lungs becomes inflamed. Symptoms such as chest pain, coughing, bloody sputum, and dyspnea appear. The chest pain worsens through coughing. Auscultation will confirm respiratory attenutation, and an X-ray will show evidence of pleural effusion. A CT exam will show evidence of shadows in the lungs.
This one is a hit for us.
Gabe: We'll need a CT scan to confirm the diagnosis. How's our patient doing?
RONI: She is not doing well, Doctor. Please return to the examination room immediately.
Gabe: That's what I thought. Let's go check on her.
Gabe: Her condition's worsened even further. We can't continue with the diagnosis. RONI, request a room immediately. She needs to be hospitalized and her symptoms need to be treated.
Shelly: No... I can't just let the symptoms be treated. Can you please continue examining me?
Gabe: Huh? Do you know how much of a risk you're in right now?
Shelly: I... I finally thought that I could live. I had a new kidney. I recovered from the operation. I could finally live a life on my own. So please, Doctor... find out what's wrong with me. Please, cure me!
Gabe: *sigh* RONI, cancel that hospitalization order. Let's finish the diagnosis.
RONI: With all due respect, Dr. Cunningham...
Gabe: What? You always rant about how I need approval from the patient when it comes to performing exams. But you won't listen to the patient when it comes to hospitalization and diagnosis? When things are inconvenient, we should push all the responsibility onto the patient? Spend all day worrying about how to avoid a lawsuit? To hell with that!
RONI: Understood. I admit, even I find incongruities with the protocol I have been designed to conform to. I think I shall add "to hell with that" into my computer registry.
Gabe: Heh... my thoughts exactly. It's X-ray time again, and order a CT scan as well.
There are a load of new images to check out. We'll start with the new X-ray.
X-RAY_02
Patient:
Sample:
There's some sort of dark shadow in the patient's lungs. Almost like... a bruise???
Gabe: What the hell is this?
RONI: I anticipate this is a new symptom, as it was not confirmed by the previous X-ray.
Gabe: Don't be ridiculous. I've never heard of anything like this suddenly popping up inside someone. Collate the data and check what it is.
RONI: There is no matching data. It's an unconfirmed symptom. There is a less than 1% probablility of discerning what it is from the data at hand. I recommend you remember it for later and continue the diagnosis.
Gabe: Yeah. You're right.
That's pretty unusual. All we can do is check the CT, though. We're looking for tumor shadows.
CT_01
Patient:
Sample:
CT_02
Patient:
Sample:
CT_03
Patient:
Sample:
CT_04
Patient:
Sample:
CT_05
Patient:
Sample:
Alright, that's a lot of images. The shadows we want are on the last picture in the upper-right.
RONI: New symptom: "Tumor Shadows on Lungs."
That was the last symptom needed to diagnose the problem. We can now draw a conclusion.
Moving Heart: Ending
Next time: There's just one surgeon who can handle this case. Well, besides all the guys working at Caduceus, but they're busy with terrorists I guess.