It had been a great party, and it was wonderful to see everyone again. He hadn’t seen Karen or Ethan since graduate school, and it was a fun time catching up. Now, cognizant on the overindulgence of grilled chicken and hard root beer, Dr. Ian Ho was stirring his third cup of coffee of the morning.
Mondays are always slow, and this Monday seemed to be standard. As he reached for the creamer, his cell phone rang. A quick look revealed an unfamiliar number, and he considered letting it go to voicemail. “Hello?” He answered. It was Evan Smith, a pediatric resident at the medical center. Evan had been at the festivities the day before, as had many of his coworkers. Ian had sat listening to some of the bizarre case files that were being discussed by Ian Ho and his friends, and it prompted his memory, and thus this call. Evan began, “I’m wondering if I could buy you lunch today and pick your brain?” Ian did not have lunch plans, however, he preferred to eat at his desk and catch up on his reading. As he was about to ask his colleague if another day my work, Evan said, “It’s important.”
Ian Ho was about to bite into his BLT sandwich when he saw Evan Smith come to the door of the medical center cafeteria. He looked around, and spotting Dr. Ho, quickly came over. As he pulled out a chair to sit down, the Epidemiologist asked if he wanted to order his lunch first? Evan remarked that he wasn’t hungry, and Ian Ho simply shrugged and began eating. Looking at Evan, Ian Ho swallowed and said, “What can I do for you?” Evan explained that he had a very weird situation. It was his aunt. She was 56 years old, and she lived alone. He continued. “I tried to get by to see her as often as possible, but you know how things are here at the medical center. I almost feel selfish with whatever time I have to myself.” Ian Ho shrugged, and reached for his ever-present cup of coffee. He motioned to Evan saying, “Go on.” Evan explained that, he had been contacted by the cleaning lady who had found his aunt lying unconscious on the kitchen floor. She had been taken to the emergency department, and as Evan was listed as the closest relative, he had kept abreast of her condition.
Ho nodded, and then asked “sounds like everything is under control? What can I do?” Evan scratched his head. “I remember you and some of the others at the barbecue talking about really crazy weird cases that you had. Well this is shaping up to be a weird case as well.” Ian Ho had finished at the top of his class for both the MPH and PhD programs. This was due to one simple character flaw: Ian Ho was compulsive about figuring things out. In fact, the chairperson for his dissertation committee compared him to a bulldog. “Once he got a hold of a problem, ” She had aid, “It was virtually impossible for him to simply let it go unanswered.” This had served him well in both academics and as the clinical epidemiologist at the medical center. Although his current position was focused on improving patient outcomes, he was always available to physicians for consultation for the seldom-encountered oddity.
The physicians and staff at the medical center were among the best he had ever seen. He himself came to an internist on staff. So he was somewhat puzzled that Evan had come to him. “Have you spoken to the ED director about this?” Dr. Ho asked. Evan replied that he had not only spoken to the director, but also to the director of the lab, and at least two internists on staff. All had scratched their heads.
By this time, Ian Ho had become very interested in whatever was going on with Evan’s aunt. “What did the lab results indicate?” He asked Evan. “Extremely low potassium, cholesterol was high, and she suffered from arrhythmia, and diarrhea.” Dr. Ho suggested, with her current age, they should look at hormone imbalance, in combination with an imbalanced diet. Evan responded that blood tests had ruled out hormone imbalance, and that her appetite was good. Dr. Ho took a bite of this now soggy sandwich and thought to himself what would be at the basis of this odd condition? “Has she had an EKG?” He asked, to which Evan replied that she had, and the results were normal. “All of her test results are just weird,” Evan remarked, “which is why I thought to speak with you.”
Dr. Ho asked what room she was in, and was told that she had been discharged on Friday. Evan further stated that she had been in the medical center for 3 days while tests were being run. In that time, her health improved dramatically, to the point that her doctors felt she could be discharged. As Dr. Ho was about to ask why he was having a non-lunch with Evan if everything was fine, Evan remarked, “They failed to find any problems.” Dr. Ho stated that “perhaps the problem resolved itself, and that would be the end of it.” Evan looked at Dr. Ho and asked, “Do you think that’s the end of it?” Dr. Ho thought for a moment, and replied “No.” Ho knew there was always a chance that the diarrhea, the arrhythmia, the high cholesterol, and low potassium could be just coincidental. However, he doubted it. In his experience, coincidences simply did not exist.
That Friday evening, Dr. Ho was invited to visit Evan’s aunt, whom he learned was named Sarah. Evan had promised to come by, and used this as an excuse to introduce Dr. Ho, and get his impressions. Ian Ho found Sarah to be a very sweet and kind woman who kept an immaculate home. She lived alone, apart from a large gray cat named Max.
Evan, over coffee, explained that Dr. Ho was an epidemiologist and an expert in odd medical occurrences. This seemed to fascinate Sarah, who asked about the some of the cases he had worked on. After discussing a few truly weird instances, one involving parasitical infection, and one involving a brain injury that had gone undiagnosed, Evan interrupted and confessed that he had asked Dr. Ho to come by to try to figure out her own odd case.
Sara began “I thought the mystery was solved? I spent 3 1/2 days in that place, and they sent me home. Doesn’t that mean I am OK?” Evan remarked that she had been sent home because her symptoms had subsided. “Isn’t that a good thing?” She asked, looking at Dr. Ho. He replied, “It’s a very good thing yes, but there was still the mystery of what caused the symptoms in the first place.”
Over the next 45 min, Sarah had charted the history of her parents, grandparents, and even one eccentric aunt that had been committed to a mental hospital. None of which explained any of her symptoms. Dr. Ho was perplexed. Seldom had any medical case come to him that he could not, in fairly quick order, solve. He felt like an undergraduate. What was he missing? Barely discernible potassium levels were clearly responsible for the arrhythmia and the muscle cramps. However, no structural abnormalities were found in her heart or lungs. Further, her cholesterol was off. Way off. It was probably not environmental, she didn’t work around chemicals or headers materials, in fact, and she had not worked since the age of 22, having married her father’s business partner. She had been well provided for with his passing 11 years ago.
Now, she chose to live alone, except of course for Max, and enjoyed her hobbies and her television programs. Dr. Ho thought to himself, “there doesn’t seem to be any cause for any of this. Maybe it was just a transient issue that’s resolved.” Almost as soon as the thought had come into his mind, he dismissed it. “Nonsense” he said aloud, “That’s not how things work.” He looked up to see the confused faces, saying, “Sorry, just thinking out loud.” Sarah offered to get the coffee as the evening began to wind down. Evan was clearly annoyed that Dr. Ho had not made some amazing and inescapable conclusion about his aunt’s seemingly previous condition. As Evan brought in the coffee cups, he asked Ho if he used sugar? “No thank you, just some milk or cream please.”
When Evan reached the kitchen, he opened the refrigerator and said aloud “good Lord aunt Sarah, don’t you think all that sugar is bad for you?” Sarah announced that she knew all about added sugar, and that the soda she drank was diet. “Still,” Evan added, “that’s a lot of chemicals to be consuming. Do you really need that much soda?”
Dr. Ho turned to Sarah and, offhandedly asking about how much diet soda did she drink in a day? Her answer was like revelation. “It depends,” she said, some days more than others if it’s hot, or if I’m thirsty. But probably no more then twenty-five or thirty.” Dr. Ho smiled and said that it was a serious question; he was curious as to how much he actually drank? “I am being serious” she replied, but stated that it was fine because the water in the condominiums tasted funny, and besides, it was diet.
Dr. Ho explained to Sarah that drinking this much diet cola draws excessive water into the bowels. Having that much water in the digestive track leeches potassium and calcium from the body. The high amounts of caffeine in the nearly two gallons of diet cola that she consumed everyday, along with the aspartame would further imbalance her system.
After that discussion, and realization by Evan as to exactly how much diet cola his aunt was consuming, Sarah switch to seltzer water. Flavored of course, she couldn’t bear the taste of plain water any longer. Even make certain she understood that she could drink no more than 96 ounces per day. Today, nearly 3 months later, Sarah is feeling like her old self. She has been attending services at a local place of worship, and volunteers to read at the nursing home. Now that she is away from her television and chair, she finds herself less bored, and not surprisingly, less thirsty.