An Old-School Solution to a New Epidemic

Featured in Op-Med, a collection of original articles contributed by Doximity members.

“We don’t know what else to do, so we’re calling you,” is what the PA said when she called me to the ER.

“I don’t think anything but a surgery can tell us what is wrong with this patient,” said the ED MD when I got there.

The patient in question was a 53-year-old man whose official weight, recorded in the computer, was 546 pounds and (I’m not making this up) 4.8 ounces — as if that last 4.8 ounces made all the difference. He filled out a bed like bread dough fills a tray. Just lying there, he was dependent on a home BiPAP to assist his breathing. One look at him, and I knew if he went to the OR, it would be a long and risky recovery.

“I woke up and was sitting on the side of the bed and then this horrible pain started,” he told me as he gestured to his whole abdomen with his right hand. “It’s a 100,” he said when I asked him to describe the pain. “I’ve had gallbladder and appendix surgeries, but this is way worse.” “It always hurt, but it gets really bad at times,” he gasped between hits from his BiPAP, “and the morphine doesn’t touch it.”

When I first examined him, he was exquisitely tender all over his abdomen, but not focal. But his belly was soft. The exam was inconsistent, so I went…