That's the biggest...

There are a few key phrases that are uttered repeatedly throughout the day by doctors here:

"That is the biggest ... I've ever seen"

"I've never seen anything like that before"

"That is the worst case of... I've ever seen"

"What is that?"

Here are a few personal examples from the past two weeks:

 

First clinic case of the day. "What is that?" And "Biggest jaw mass I've seen...so far"

Biggest leg mass in a teenage girl

 Its not always the biggest...sometimes it is the lowest or highest...or both.

Hypertension and severe anemia?!

This is one of our outpatient clinic cards. If you look closely, you will see that the patient's hematocrit (blood level) is 12%. Normal is about 40%. Often we transfuse if the hematocrit is less than 21%, sometimes if it is less than 30%.  Where I trained, a hematocrit of 12% was pretty rare and would cause a flurry of frantic activity. Admission to the ICU, extensive work-up for bleeding, immediate transfusion. Here, its almost routine. I think this was the third or fourth patient I saw in clinic this week with a hematocrit of less than 15%. The amazing thing about this woman was her blood pressure. It was high. 160/90. With a hematocrit of 12%. It makes you wonder if the blood pressure was accurate...but I wouldn't be too surprised if it was. I've seen stranger things around here. She was walking and talking.  She also had one of the biggest abdominal masses I have ever seen. It was pushing her whole liver up into her chest. We aren't sure what it is, but we are planning to operate next week.

Her CXR with the liver up in the chest pushing her heart over the the left side (arrow)