Read Online Sensing Light by Mark A. Jacobson - Free Book Online

the answer.
    â€œYou are serious about coming back if you’re here for an update on septic shock. That’s not outpatient medicine.”
    â€œI’ve been interviewed,” Gwen said, unable to contain her excitement. “There aren’t openings for this July, but there will be next year. They all but offered me a position.”
    â€œGreat! I’ll still be here. Flagler’s taking me on as a fellow.”
    â€œFantastic!”
    Once they were seated inside, Kevin said, “I was going to call you. Larry Winton’s autopsy report is done.”
    â€œWhat did it show?” Gwen whispered as the lecturer stepped to the podium.
    â€œIt’s complicated. Don’t worry, we didn’t miss anything reversible. I’ll explain later.”
    After grand rounds, Kevin hailed Herb and told both of them about the autopsy findings. In addition to the lung destruction caused by Pneumocystis pneumonia, every one of Larry Winton’s lymph nodes from his neck to his pelvis was shrunken and scarred.
    â€œThat fits with the low lymphocyte count in his blood,” said Herb. “And having no immune system left would be why he got Pneumocystis. But what wiped out his immune system?”
    â€œThere’s no smoking gun,” Kevin lamented. “All the slides were negative, except for some cytomegalovirus inclusions in the liver and gut. Thepathologist said that was more likely a result of immune suppression than the cause. He’s seen the same thing in transplant patients.”
    â€œSorry, Kevin. I’m afraid the Winton case is going to remain a mystery. It happens.”
    â€œI tried to reach his family,” said Gwen. “I called the phone number we had and went to the last address he used. No luck. If I’d been able to contact a relative, I could have found out about his family history. Most immune deficiency syndromes are inherited, aren’t they?”
    â€œGood thought, Gwen,” Herb said.
    â€œI’d like to write up the case for publication,” Kevin volunteered. “I’ll put it together if you’ll edit the draft.”
    â€œKevin, I would love to help you publish something, but a single case of unexplained immune deficiency won’t appeal to any broadly read journal. If there was an identifiable cause, like a toxin that hasn’t been reported before, you could easily get it accepted. Or if you had a series of patients like this one tied together by a common thread, even if it was only geographic location. You could sell that to reviewers. But one case with a mysterious cause won’t be perceived as advancing knowledge.”
    â€œYeah,” Kevin reluctantly agreed.
    â€œYou’ll be here another two years. I’m sure Pneumocystis will be the first thing we think of if someone with progressive pulmonary disease and no obvious diagnosis is admitted. And if we do find more patients with Pneumocystis, you could investigate family histories and environmental exposures and get one of the immunologists on the Hill to figure out what’s behind it.”
    Gwen gave Kevin’s shoulder a fist-bump.
    â€œI’ll help if you lead the charge,” she said.
    â€œThat’s right,” said Kevin, his mood upbeat again, “Gwen will be here. She’s going to finish her medicine residency.”
    Herb met Gwen’s eyes. Though he was well aware of how attractive she was, he limited his regard to other virtues he esteemed in house staff. She wouldn’t have come to the ICU twice while Winton was dying if she didn’t feel responsible for her patient, didn’t care deeply about what was happening to him.
    â€œYour clinic experience will be a big plus here,” Herb said. “We have attendings greener than you.”
    Flushing, Gwen asked, “Kevin told you about me?”
    â€œNo, Flagler. I ran into him right after he interviewed you. He was impressed. But don’t expect him