Going forward, expect the unexpected. Not all patients will be children. Paul Natterson, MD, was very sick — and scared. One day, the 26-year-old intern was seeing patients at a county hospital and attending a concert at the Hollywood Bowl. The next morning, he was so fatigued he could barely walk. High fevers, a burning throat, and a throbbing headache soon followed — but no rash.
Natterson’s first emergency department (ED) visit revealed normal labs and an unremarkable chest x-ray. He was quickly discharged with the vague, discomfiting diagnosis of a “viral syndrome.” Once back home, he worried he might actually die in his bed. A day later, Natterson’s sister (also an MD) brought him back to the ED. Now tachypneic and hypoxic, the intern’s x-ray still held no clues. Given the year (1989), a new idea surfaced among his colleagues: Might the young trainee have occult Pneumocystis pneumonia? Natterson, who lacked HIV risk factors or other immune compromising conditions, politely declined treatment with pentamidine.