Free Sensing Light by Mark A. Jacobson Page A

Marina.”
    Dana arched her eyes in feigned surprise. City Hospital patients rarely came from this upscale neighborhood.
    According to a friend who discovered Mr. Miller yesterday on the kitchen floor of his apartment, he had been well until a week ago when he began complaining of fatigue and headache. Then he stopped coming to the office or answering his phone. Per the friend, Miller was gay. He didn’t use drugs or frequent bathhouses.
    Dana’s physical exam findings were identical to Kevin’s. The blood test results were unremarkable except for anemia and an extremely low lymphocyte count. Dana’s intern had done a spinal tap which showed no white blood cells to suggest meningitis or red blood cells to suggest a brain hemorrhage.
    Kevin was pleased by Dana’s presentation—fluent, precise, thorough yet succinct enough to communicate in less than five minutes all the elements he required in deciding what to do next. She had clearly mastered one important skill for leading an inpatient medicine team. She could sift through massive amounts of information, discard the dross, and communicate the essential data in the minimum time necessary without sounding manic.
    â€œI think the white stuff in his mouth is thrush,” Dana concluded. “That and his low lymphocyte count fit with GRID.”
    â€œWhat’s thrush? What’s GRID?” asked the student, a frumpy young woman who wore thick-lens glasses.
    â€œThrush is like athlete’s foot but in the mouth,” said Dana. “It’s a superficial fungal infection caused by Candida. And GRID is Gay-Related Immune Deficiency.”
    Turning to Kevin, she added, “Here’s the expert.”
    â€œThat’s OK,” he said deferentially. “Let’s hear you explain it.”
    Dana eagerly accepted the challenge. She talked about the clusters of gay men in New York, Los Angeles, and San Francisco recently diagnosed with a rare form of skin cancer, Kaposi’s sarcoma, or Pneumocystis pneumonia.All had been previously healthy. Since Pneumocystis only caused disease in people with profoundly impaired immune systems, the syndrome had been named Gay-Related Immune Deficiency. A preliminary investigation by the Centers for Disease Control identified two common denominators among GRID patients—past gonorrhea and syphilis infections and a lifetime history of hundreds of sexual partners.
    Dana looked to Kevin. He nodded with approval.
    â€œKevin has seen, what, ten Pneumocystis cases here?”
    He nodded, less enthusiastically.
    â€œAnd in his clinic he’s seeing lots of gay men who have enlarged lymph nodes and thrush. A couple of them have gone on to develop Kaposi’s or Pneumocystis.”
    â€œHave you biopsied their lymph nodes?” asked the student.
    Noting the name on her ID badge, he answered, “Good question, Gail. We did, at first. But the results have been negative—no underlying infection or malignancy.”
    Dana chimed in, “Kevin just gave grand rounds. Didn’t you say the number of new patients coming to City Hospital with the pre-GRID lymph node syndrome has doubled in the last four months?”
    He nodded somberly.
    Gail frowned as she considered the implications of that fact.
    Returning to the case at hand, Kevin said, “The low lymphocyte count is a good pick-up, Dana. And that’s definitely thrush in his mouth. So he’s got pre-GRID, if not GRID itself. But why’s he confused and barely arousable? What’s wrong with his brain?”
    â€œHe could be septic. He has a temperature of a hundred and two. Blood cultures are cooking. I already started him on broad-spectrum antibiotics.”
    â€œThat’s good. No downside to covering him for sepsis. But why would he have bacteria in his blood?”
    â€œI don’t know. His spinal fluid showed no cells, so it’s not meningitis. The chest x-ray and brain scan are