Patient Of The Week!
Who: Chase, Michelle: "Patient Of The Week" (non-player character); closed.
Where: Exam room 1 in clinic.
What: *fanfair* Patient of the Week!
When: Friday 31st, 2006; 3.30PM.
Sucking absently on the end of his pen, Chase looked down at the file in his hand, the last patient for the day before his shift in clinic was over. He was very much ready to finish this shift so he could sit in peace for at least five minutes. He’d been run off his feet in clinic due to the amount of sick people that had been coming in and being short-staffed. Covering some of the shifts that House got out of doing because of those classes meant extra work for Chase, too. While it was better than having nothing to do, he’d had enough for the day. No more sick kids or students, thank you very much; his quota had been filled.
Moving towards the door, he pulled it open and, as he stepped out he pulled his pen from his lips and clasped it in his hand, peering around the clinic. “Michelle Stevens,” he summoned, poising the pen back towards his mouth.
An anxious-looking woman abruptly stood up, giving Chase a nervous smile before she turned and reached for her daughter’s hand. “Come on, Michelle,” the woman urged, tugging on her hand. The girl promptly stood, though she did so lethargically.
The first thing Chase noticed was she looked rather pale. Maybe that was just her complexion. Stepping back into the clinic treatment room, Chase clamped the pen back between his teeth, hearing the girl give a chesty cough as both daughter and mother entered the treatment room. Pulling the pen from his mouth again, he gave them both a brief smile as he shut the door after them, remarking in greeting as he looked over his shoulder at the girl, “That’s a bit of a nasty cough you’ve got there, Michelle.”
“She’s had it for over a week,” the mother explained in a quick voice. “I thought I’d bring her in because she’s looking a bit pale.”
“Hmm,” Chase replied, eyeing the girl before he looked back down to the treatment notes. “You do look a bit pale, Michelle.” Eyes cast back up to her again, he stepped towards Michelle, gesturing to the treatment bed. “Hop up there for me, Michelle. Let’s take a look at you.”
Coming to a stop in front of the girl, he asked, "How old are you, Michelle?"
"Twelve."
"Right." Looking down, Chase was reading the notes again, sucking on the pen once more as he frowned. “You was here seven days ago,” he continued around his pen, “with upper respiratory tract infection.” Pulling the pen from his mouth, he looked back up. “And was prescribed amoxicillin, aspirin for the temperature and bed rest. Is that right?”
The girl nodded as she coughed again and the mother likewise nodded, replying, “Yes, she had a cough, runny nose and a fever. The fever’s gone and so has the runny nose, but her cough… She’s been coughing up blood.”
Chase glanced at the mother, cocking his eyebrow. “Blood?” He looked back to Michelle. “How long have you been coughing up blood for, Michelle?”
The girl coughed again and then replied in a slightly weak voice, “Since Monday.”
“Monday?” He cast a cursory glance at the mother, thinking briefly with distaste to himself how ignorant some parents were before he glanced back down to the file again as he set it on the treatment bed beside her. He clicked his pen so he could write. “Lots of blood?” he asked, scrawling hemoptysis and pallor down in her notes.
“It’s all snotty,” Michelle said.
“Red blood?”
The girl shook her head weakly. “Well… it was red. But now it’s like…” She paused to cough again, chestier and longer for a moment. “It’s like, coffee-coloured,” she finished in a raspy voice.
Coffee-coloured? He glanced at the mother again warily before he set his pen down and reached for her neck, repeating, “Coffee-coloured?” Fingers upon her throat, he tilted her chin up so he could palpate her glands along the junction of her neck. They were raised. “Your throat sore?” She shook her head. “You had any other recent illnesses, Michelle? Apart from the chest infection?”
“She was here,” the mother replied hastily, wringing her hands together anxiously, “about a month ago. With, um, a skin… condition. On her face. A red blistery skin… thing.”
Chase looked back down to her notes and flicked backwards through them. “Impetigo,” he remarked.
“Yes.”
He skimmed the notes -- she had bullous impetigo mainly on her face and was given a prescription of mupirocin ointment and oral penicillin. He glanced back up to her. The impetigo had indeed cleared itself up. “And the symptoms cleared up after running the course of antibiotics?” he asked.
“Yes,” the mother said again. “Everything was fine until this chest infection showed up.”
He scrawled a few more things on her notes, saying, “Any other symptoms, Michelle?” He looked up to her. “Anything else happening?”
Michelle broke into another bout of coughing with her hand over her mouth, this cough lasting longer than all the others had and he heard the tell-tale sign of phlegm expelling from the back of her throat. Slowly pulling her hand away with a look of distaste on her face, she peered at her hand, and Chase seized her wrist, pulling it towards her so he could look at the sputum she’d expelled. It was indeed mucusy, streaked with clots of coffee ground-coloured blood.
Quickly stepping away from the treatment table, he snatched up the tissues from the desk and grabbed a few out of the box before handing them to her, saying, “Here.”
“My pee,” she said weakly, taking the tissues.
Chase peered at her as he unlooped the stethoscope from around his neck, frowning. “What about it?”
She was wiping her hand with the tissues as she replied, “My pee… it’s funny-coloured.”
“Your urine is funny-coloured?” he echoed. He pointed to the waste paper basket by the treatment bed for her to discard the tissues before he continued, “What do you mean, funny-coloured?”
“Coloured like the stuff I’m coughing up.”
Chase looked alarmed. That meant possible kidney dysfunction, or even the onset of renal failure. He glanced to the mother, who looked as bewildered as Chase -- she obviously didn’t know of that symptom -- before he turned his attention back to Michelle again. “You mean coffee-coloured?” She nodded. “How long’s it been like that for?”
“Since Tuesday, I think.”
He quickly noted that down in her files, mentally going through potential causes of her urine being coffee-coloured. Smoothing his expression out into a half-smile, he then said, “Well, let’s take a look at this chest of yours first, shall we?” Wedging the buds of the stethoscope into his ears, he said as he took the chestpiece in his hand. “Sit forward for me,” he instructed. Once she’d done that, Chase said, “I’m just going to slip this--” he presented the chestpiece to her “--on your chest to listen to it, okay?” She nodded. “Might be a bit cold,” he added as he slipped it up under her shirt and pressed the bell side of the chestpiece to her chest.
Instructing her to breathe in deeply, he repeated the process across her chest before flipping the chestpiece over to the flat, diaphragm side and listened again as she breathed in and out. He could hear bubbling and crackling with each inhalation. He repeated the process across her back, had a quick listen to her heart and then pulled the stethoscope from his ears.
“Your chest is congested,” he informed her, taking his pen up.
“What’s wrong with her?” the mother asked anxiously.
Maybe if you’d had the common sense to bring her in earlier, you’d know and she wouldn’t be so sick, he thought irritably to himself. “We’ll take Michelle’s vitals,” he remarked calmly as he scribbled on her notes that there was good aeration bilaterally of her lungs, but that he could hear bibasilar inspiratory crackles; no wheezing detected. He dropped the pen to the file and looked up to the mother. “And take it from there.”
Stepping away from the treatment bed towards the sphygmomanometer as Michelle started coughing again, Chase asked, to try and engage her into conversation, “You play any sports?”
She nodded as she continued to cough, the coughing seeming more exerted now. “Yeah,” she replied in a scratchy voice when the coughing subsided. “I swim.”
“Oh, cool,” Chase remarked, smiling at her as he wheeled the sphygmomanometer towards her. “On the swim team at school?”
She nodded again as he rolled her sleeve up on her left arm. “Yeah. Though, I haven’t been feeling very well lately. Too tired to swim. And all the kids on the team, they all made fun of me when I had that im-- impe… That stuff on my face.”
“Impetigo,” Chase prompted as he wrapped the cuff around her upper arm. Considering impetigo was a highly infectious skin virus, he hoped the mother wasn’t that stupid to let Michelle swim, exposing other kids to the infection. That she didn’t have the common sense to bring her in when she started coughing up blood spoke for itself, really, he thought. God, some parents were idiots. He studied Michelle’s face, noting how pale she looked. “Kids can be cruel. Bet they’re not as good at swimming as you are, though.”
Her mother piped up, “She’s the best on her team.”
“Ah, well,” Chase grinned at Michelle as he placed the stethoscope buds back in his ears and positioned the diaphragm of the chestpiece over where the brachial artery in her arm was. “There you go. They’re all probably just jealous, anyway,” he continued, taking the pump up in his other hand.
Michelle blushed in spite of herself and Chase gave her another smile before glancing down to the manometer, watching the gage rise as he inflated the cuff on her arm. Slowly releasing the air, he measured her systolic at 145 and her diastolic at 78, released the rest of the air and then tugged the cuff off.
“Your blood pressure’s a bit high,” he remarked, tugging the stethoscope from his ears and letting it hang clasped around his neck. Pushing the sphygmomanometer from him, he then quickly scribbled her blood pressure down in her notes. He was swift in checking the rest of her vitals -- her pulse was at a normal rate; both her pupils were equal and reactive; moist mucus membranes; no oral lesions or infections; neck presented as supple; abdominal palpation presented as benign; no rash or lesions detected on her extremities.
The last thing he checked was her oxygen saturation by clipping a pulse oximeter to her right forefinger, and after getting a reading of 93 percent -- below normal rate in room air -- Chase quickly packed everything up and then faced to Michelle and her mother. He was beginning to wonder if this was a potential case. It probably wasn’t “interesting” enough for House, he thought wryly to himself.
“I’m going to admit you as an inpatient,” he began.
“Why, what’s wrong with her?” the mother asked in a panicked voice.
Chase patiently explained to Michelle, “We need to run tests. Blood test, urine test, probably test what you’re coughing up. We need to find out the cause of the bloody mucus and what’s causing your discoloured urine.” Michelle, in spite of how tired she was, looked anxious. Chase paused, wondering whether to tell her he was worried about the beginnings of renal failure, and then decided against it. “We’ll find out what’s wrong and before you know it, you’ll be able to go home.” To try and end the examination on a positive note, he added brightly, “And then you can go back to your swim team.”
“Are you sure?” Michelle asked, the look of pleading in her eyes seeming as though she was asking Chase to promise her.
He hesitated before nodding. “I’m sure.”
“You promise?” She began to launch into another bout of coughing.
He glanced at the mother and then hesitantly nodded again. “I promise.” Sign it in blood, why don’t you, Chase? he thought to himself. “I’ll get triage to organize a bed for you,” he continued, gathering the file up and snapping it shut.
About to head out of the room, Michelle’s mother stopped him, asking, “Will she be alright?”
Hand braced on the door handle, he found himself hesitating again before replying non-committally, “Michelle will be monitored closely and we’ll keep a close eye on her. Start treatment straight away once we get results back from the lab.”
Leaving it at that, he opened the door for them, telling Michelle he’d probably see her later, and then headed out after them to speak to triage, nibbling thoughtfully on the end of his pen.
Within an hour of being admitted and after all her tests were performed, Michelle started coughing again, violently, and started coughing up not only coffee-coloured clumps of mucus but gushes of bright red blood.
She was having a large-scale pulmonary haemmorhage.
Where: Exam room 1 in clinic.
What: *fanfair* Patient of the Week!
When: Friday 31st, 2006; 3.30PM.
Sucking absently on the end of his pen, Chase looked down at the file in his hand, the last patient for the day before his shift in clinic was over. He was very much ready to finish this shift so he could sit in peace for at least five minutes. He’d been run off his feet in clinic due to the amount of sick people that had been coming in and being short-staffed. Covering some of the shifts that House got out of doing because of those classes meant extra work for Chase, too. While it was better than having nothing to do, he’d had enough for the day. No more sick kids or students, thank you very much; his quota had been filled.
Moving towards the door, he pulled it open and, as he stepped out he pulled his pen from his lips and clasped it in his hand, peering around the clinic. “Michelle Stevens,” he summoned, poising the pen back towards his mouth.
An anxious-looking woman abruptly stood up, giving Chase a nervous smile before she turned and reached for her daughter’s hand. “Come on, Michelle,” the woman urged, tugging on her hand. The girl promptly stood, though she did so lethargically.
The first thing Chase noticed was she looked rather pale. Maybe that was just her complexion. Stepping back into the clinic treatment room, Chase clamped the pen back between his teeth, hearing the girl give a chesty cough as both daughter and mother entered the treatment room. Pulling the pen from his mouth again, he gave them both a brief smile as he shut the door after them, remarking in greeting as he looked over his shoulder at the girl, “That’s a bit of a nasty cough you’ve got there, Michelle.”
“She’s had it for over a week,” the mother explained in a quick voice. “I thought I’d bring her in because she’s looking a bit pale.”
“Hmm,” Chase replied, eyeing the girl before he looked back down to the treatment notes. “You do look a bit pale, Michelle.” Eyes cast back up to her again, he stepped towards Michelle, gesturing to the treatment bed. “Hop up there for me, Michelle. Let’s take a look at you.”
Coming to a stop in front of the girl, he asked, "How old are you, Michelle?"
"Twelve."
"Right." Looking down, Chase was reading the notes again, sucking on the pen once more as he frowned. “You was here seven days ago,” he continued around his pen, “with upper respiratory tract infection.” Pulling the pen from his mouth, he looked back up. “And was prescribed amoxicillin, aspirin for the temperature and bed rest. Is that right?”
The girl nodded as she coughed again and the mother likewise nodded, replying, “Yes, she had a cough, runny nose and a fever. The fever’s gone and so has the runny nose, but her cough… She’s been coughing up blood.”
Chase glanced at the mother, cocking his eyebrow. “Blood?” He looked back to Michelle. “How long have you been coughing up blood for, Michelle?”
The girl coughed again and then replied in a slightly weak voice, “Since Monday.”
“Monday?” He cast a cursory glance at the mother, thinking briefly with distaste to himself how ignorant some parents were before he glanced back down to the file again as he set it on the treatment bed beside her. He clicked his pen so he could write. “Lots of blood?” he asked, scrawling hemoptysis and pallor down in her notes.
“It’s all snotty,” Michelle said.
“Red blood?”
The girl shook her head weakly. “Well… it was red. But now it’s like…” She paused to cough again, chestier and longer for a moment. “It’s like, coffee-coloured,” she finished in a raspy voice.
Coffee-coloured? He glanced at the mother again warily before he set his pen down and reached for her neck, repeating, “Coffee-coloured?” Fingers upon her throat, he tilted her chin up so he could palpate her glands along the junction of her neck. They were raised. “Your throat sore?” She shook her head. “You had any other recent illnesses, Michelle? Apart from the chest infection?”
“She was here,” the mother replied hastily, wringing her hands together anxiously, “about a month ago. With, um, a skin… condition. On her face. A red blistery skin… thing.”
Chase looked back down to her notes and flicked backwards through them. “Impetigo,” he remarked.
“Yes.”
He skimmed the notes -- she had bullous impetigo mainly on her face and was given a prescription of mupirocin ointment and oral penicillin. He glanced back up to her. The impetigo had indeed cleared itself up. “And the symptoms cleared up after running the course of antibiotics?” he asked.
“Yes,” the mother said again. “Everything was fine until this chest infection showed up.”
He scrawled a few more things on her notes, saying, “Any other symptoms, Michelle?” He looked up to her. “Anything else happening?”
Michelle broke into another bout of coughing with her hand over her mouth, this cough lasting longer than all the others had and he heard the tell-tale sign of phlegm expelling from the back of her throat. Slowly pulling her hand away with a look of distaste on her face, she peered at her hand, and Chase seized her wrist, pulling it towards her so he could look at the sputum she’d expelled. It was indeed mucusy, streaked with clots of coffee ground-coloured blood.
Quickly stepping away from the treatment table, he snatched up the tissues from the desk and grabbed a few out of the box before handing them to her, saying, “Here.”
“My pee,” she said weakly, taking the tissues.
Chase peered at her as he unlooped the stethoscope from around his neck, frowning. “What about it?”
She was wiping her hand with the tissues as she replied, “My pee… it’s funny-coloured.”
“Your urine is funny-coloured?” he echoed. He pointed to the waste paper basket by the treatment bed for her to discard the tissues before he continued, “What do you mean, funny-coloured?”
“Coloured like the stuff I’m coughing up.”
Chase looked alarmed. That meant possible kidney dysfunction, or even the onset of renal failure. He glanced to the mother, who looked as bewildered as Chase -- she obviously didn’t know of that symptom -- before he turned his attention back to Michelle again. “You mean coffee-coloured?” She nodded. “How long’s it been like that for?”
“Since Tuesday, I think.”
He quickly noted that down in her files, mentally going through potential causes of her urine being coffee-coloured. Smoothing his expression out into a half-smile, he then said, “Well, let’s take a look at this chest of yours first, shall we?” Wedging the buds of the stethoscope into his ears, he said as he took the chestpiece in his hand. “Sit forward for me,” he instructed. Once she’d done that, Chase said, “I’m just going to slip this--” he presented the chestpiece to her “--on your chest to listen to it, okay?” She nodded. “Might be a bit cold,” he added as he slipped it up under her shirt and pressed the bell side of the chestpiece to her chest.
Instructing her to breathe in deeply, he repeated the process across her chest before flipping the chestpiece over to the flat, diaphragm side and listened again as she breathed in and out. He could hear bubbling and crackling with each inhalation. He repeated the process across her back, had a quick listen to her heart and then pulled the stethoscope from his ears.
“Your chest is congested,” he informed her, taking his pen up.
“What’s wrong with her?” the mother asked anxiously.
Maybe if you’d had the common sense to bring her in earlier, you’d know and she wouldn’t be so sick, he thought irritably to himself. “We’ll take Michelle’s vitals,” he remarked calmly as he scribbled on her notes that there was good aeration bilaterally of her lungs, but that he could hear bibasilar inspiratory crackles; no wheezing detected. He dropped the pen to the file and looked up to the mother. “And take it from there.”
Stepping away from the treatment bed towards the sphygmomanometer as Michelle started coughing again, Chase asked, to try and engage her into conversation, “You play any sports?”
She nodded as she continued to cough, the coughing seeming more exerted now. “Yeah,” she replied in a scratchy voice when the coughing subsided. “I swim.”
“Oh, cool,” Chase remarked, smiling at her as he wheeled the sphygmomanometer towards her. “On the swim team at school?”
She nodded again as he rolled her sleeve up on her left arm. “Yeah. Though, I haven’t been feeling very well lately. Too tired to swim. And all the kids on the team, they all made fun of me when I had that im-- impe… That stuff on my face.”
“Impetigo,” Chase prompted as he wrapped the cuff around her upper arm. Considering impetigo was a highly infectious skin virus, he hoped the mother wasn’t that stupid to let Michelle swim, exposing other kids to the infection. That she didn’t have the common sense to bring her in when she started coughing up blood spoke for itself, really, he thought. God, some parents were idiots. He studied Michelle’s face, noting how pale she looked. “Kids can be cruel. Bet they’re not as good at swimming as you are, though.”
Her mother piped up, “She’s the best on her team.”
“Ah, well,” Chase grinned at Michelle as he placed the stethoscope buds back in his ears and positioned the diaphragm of the chestpiece over where the brachial artery in her arm was. “There you go. They’re all probably just jealous, anyway,” he continued, taking the pump up in his other hand.
Michelle blushed in spite of herself and Chase gave her another smile before glancing down to the manometer, watching the gage rise as he inflated the cuff on her arm. Slowly releasing the air, he measured her systolic at 145 and her diastolic at 78, released the rest of the air and then tugged the cuff off.
“Your blood pressure’s a bit high,” he remarked, tugging the stethoscope from his ears and letting it hang clasped around his neck. Pushing the sphygmomanometer from him, he then quickly scribbled her blood pressure down in her notes. He was swift in checking the rest of her vitals -- her pulse was at a normal rate; both her pupils were equal and reactive; moist mucus membranes; no oral lesions or infections; neck presented as supple; abdominal palpation presented as benign; no rash or lesions detected on her extremities.
The last thing he checked was her oxygen saturation by clipping a pulse oximeter to her right forefinger, and after getting a reading of 93 percent -- below normal rate in room air -- Chase quickly packed everything up and then faced to Michelle and her mother. He was beginning to wonder if this was a potential case. It probably wasn’t “interesting” enough for House, he thought wryly to himself.
“I’m going to admit you as an inpatient,” he began.
“Why, what’s wrong with her?” the mother asked in a panicked voice.
Chase patiently explained to Michelle, “We need to run tests. Blood test, urine test, probably test what you’re coughing up. We need to find out the cause of the bloody mucus and what’s causing your discoloured urine.” Michelle, in spite of how tired she was, looked anxious. Chase paused, wondering whether to tell her he was worried about the beginnings of renal failure, and then decided against it. “We’ll find out what’s wrong and before you know it, you’ll be able to go home.” To try and end the examination on a positive note, he added brightly, “And then you can go back to your swim team.”
“Are you sure?” Michelle asked, the look of pleading in her eyes seeming as though she was asking Chase to promise her.
He hesitated before nodding. “I’m sure.”
“You promise?” She began to launch into another bout of coughing.
He glanced at the mother and then hesitantly nodded again. “I promise.” Sign it in blood, why don’t you, Chase? he thought to himself. “I’ll get triage to organize a bed for you,” he continued, gathering the file up and snapping it shut.
About to head out of the room, Michelle’s mother stopped him, asking, “Will she be alright?”
Hand braced on the door handle, he found himself hesitating again before replying non-committally, “Michelle will be monitored closely and we’ll keep a close eye on her. Start treatment straight away once we get results back from the lab.”
Leaving it at that, he opened the door for them, telling Michelle he’d probably see her later, and then headed out after them to speak to triage, nibbling thoughtfully on the end of his pen.
Within an hour of being admitted and after all her tests were performed, Michelle started coughing again, violently, and started coughing up not only coffee-coloured clumps of mucus but gushes of bright red blood.
She was having a large-scale pulmonary haemmorhage.