At first glance, he looked like any other patients I usually come across during my daily practice in the wards. He was admitted via the emergency department with a suspected pneumonia and signs of meningism. While walking to him, I was trying to associate these 2 major problems.
"What could cause meningism in pneumonia? Streptococcus pneumoniae? Is it a primary lung tumour with secondaries to the brain?"
As I entered the room, I saw an ill-looking gentleman in his 30s. He is not satisfying the epidemiological criteria for age regarding cases of community-acquired pneumonia. I greeted him and while he started relating his problems I was checking his oxygen saturation and pulse. I Noticed tattoos on the dorsal aspect of his hand, more specifically at the level of the middle phalanges.
"Viral hepatitis or HIV?"
He was quite cooperative but coughing from time to time. I did not have any mask on.
"Will I be catching any infections from him?"
Continuing with the history taking, I noticed that he is not having any running nose nor any sore throat. His main complaints were high grade fever, chest pain, occipital headache, photophobia and cough with yellowish-white sputum.
"Influenza A virus? H1N1? H3N2?" I asked myself.
He says he works as a helper in truck loading, never smoked and never consumed alcohol. So gullible am I. Proceeding to the clinical examination of the respiratory system, I noticed many linear marks all over the abdomen, chest wall and also on the left arm. Those are definitely self-inflicted. Based on the pattern of injuries I deduced that he must also be having his right hand as the dominant hand.
"What happened to you? How did you get those scar marks?" I asked hesitantly.
"Oh! Those are just some scar marks from injuries during my childhood when I fell on glasses" He replied convincingly.
I behaved as if I was satisfied with the answer he gave me, when actually I was not. After the clinical examination I fortunately came across his partner, a much older woman. She asked me whether information regarding my patient's ex inmates would be of any use regarding his current illness.
My patient was actually a prisoner who was just released 2 weeks ago. He was convicted for robbery, rape and murder.
The mood changes completely.
"What am I supposed to do as a doctor? Should I be influenced by his vicious act? How should I behave with him? Should I be scared of him? Can I wear my expensive watch or answer to a call on my recently bought mobile phone when I am in his room?"
SALUS AEGROTI SUPREMA LEX!!!! All I should do and I will do will be in the best interest of my patient....
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