Matt's Snowstorm Patient (1/07/03) 

Matt dialogue fic: There's a snowstorm brewing in San Francisco and Matt has been cornered by a female patient. He's puzzled by her problem, but a bit of sleuthing during the snowstorm enables him to solve his patient's mystery illness. 

One of Matt's patients (Eilish) explains her problem: she's bloated and always parched but doesn't know why. Matt's perplexed by Eilish's problems as well and he wants to pass her off to Harriet. Eilish has gone through most of a large bottle of mineral water.  

M: "We have a gynecologist on staff." 

E: "This thirst and bloating is not a gynecological problem. I've been to nine gynecologists over the last six months and none of them can figure out what is wrong with me." 

M: "Doctor Lanning is very experienced." 

E: "An ocean of water isn't enough. I'd drink this snowstorm if I could. The gynecologists didn't understand." 

M: "The thirst is that bad?"  

E: "Yes. That's why I want other tests done than what I've had done. Heard you were the man to do them." (She ticks off the tests on her hand). "I've had urinalysis, pregnancy tests, hormone tests, vaginal ultrasounds--and do you know how embarassing vaginal ultrasounds are?--allergy tests, blood tests, barium enemas." (She sips from the water bottle she holds).  

M: "Diabetes test included in that?" 

E: "Every time." (She folds her arms across her chest).  

M: (frowning) "Negative for diabetes?" 

E: "Every time. What other tests are there?" 

M: "We can think of some. Have you been to a nutritionist?" 

E: "They sent me to a dietician. I tried following the diet--or as she puts it, a food intake program--but with my hectic schedule, I'm prone to going to Mickey D's." 

M: "I'll make another appointment for you next Wednesday and in the meantime I'll scour the medical databases. What you can do is to keep a food diary for the next week, noting down what you had to eat each day."  

E: "That I can tell you now. Breakfast is usually one of those high-protein shakes. Lunch is take-out Chinese food, or something from Mickey D's. Dinner is also Chinese take-out or one of those frozen dinners."  

M: "Ah, well. There does seem to be a problem with your diet. You wouldn't happen to be following the Atkins high protein diet, would you?"  

E: "Not exactly. But I do eat a lot of protein." (She again sips from the water bottle she holds).  

M: "Too much protein can cause bloating. Try cutting back on the protein shakes and the Chinese take out and replace those foods with grains. And eat more bread." 

E: (nodding) "Increase the carbohydrates. Will that work?" 

M: "I have my suspicions. Keep a note of how bloated you feel over the next week while boosting your intake of carbohydrates." 

E: (relieved) "Thank you!  

M: (in a warning tone) "If you want to find out what's wrong with you, you must ensure you increase your carbohydrates."  

E: "I'll try." 

M: (looking sternly at Eilish) "You will." 

E: "Aye aye sir." (she salutes Matt, then sips from her water bottle again)  

The next day, snow is falling heavily and it's a slow day with patients cancelling. Matt has been combing through the PDR and other medical resources. He's in the library when Nicholas walks in. 

N: "Matt! How are you?"  

M: "Frustrated at the moment. And you?" 

N: "As well as can be expected. Interesting case came through the surgery. Fellow fell through a glass door. Piece of glass embedded in his heart." 

M: "He died?" 

N: "Survived. I want to see how many other patients survived with extensive heart wounds." 

M: "Mine's obscure: bloating and extreme thirst." 

N: "Diabetes?" 

M: "That's what I thought. But the tests came back negative. Again." 

N: (shakes his head) "You're on your own." 

M: "Tell me. (he chuckles) "See you later. 

Nick walks off towards the tall book stacks; Matt watches him pass the computer banks. Matt has a eureka moment and he stands up and walks to the computer banks. Sitting down he types in the following: "Bloating, high protein diet, and extreme thirst." Up pops a site on: 

M: "Diabetes insipidus.Water diabetes."  

Matt reads through the site's information. He prints out what he needs, then goes back to the office through the thickly falling snow.  

M: (brushing off the snow from his hair). "Norman, please phone Eilish McNamara and tell her I found the answer to her problem. She'll need to be admitted this afternoon so have her come into the office." 

Norman: "There's a snowstorm!"  

M: "This won't wait." 

Norman: "All right."  (he phones Eilish as Matt walks into his office. An hour later Eilish comes into his office, water bottle in hand and shaking off snow from her hair.) 

E: "You summoned?"  

M: (chuckling) "Yes. Sit down." (Eilish is looking a bit scared). "It's nothing life threatening."  

E: "What is it? What do I have?" (She sips from her water bottle)  

Matt pushes the stack of printed material about diabetes insipidus towards Eilish. 

M: "Ever heard of diabetes insipidus?" 

E: "Water diabetes? I was tested for diabetes." 

M: "You were tested for diabetes mellitus. There is a different test for diabetes insipidus."  

E: "And you think that's my problem?"  

M: "I'm sure of it. 

E: "What is it? Water diabetes?" 

M: "An inadequate production of an anti-diuretic hormone produced by the pituitary gland." 

E: "But I had hormone tests." 

M: "Probably not this one. Oh, and you'll have to stay on a low-protein diet." 

E: "You said too much protein can cause bloating." 

M: "Yes. One of the managing techniques for diabetes insipidus is a low-protein diet."  

E: "So if I'm in a hurry to eat, it's a noodle bowl and bread?" 

M: "Yes. I'll set you up with another nutritionist who's aware of your special dietary needs." 

E: "Now for the next question: how long will I be in the hospital?" (She sips again from her water bottle)  

M: "Until tomorrow afternoon. I need to run a water deprivation test to make certain of my diagnosis." 

E: (looking shocked) "Water deprivation? But I'm already parched!" (she cocks an eyebrow at her water bottle). "This bottle is so much a part of me, I don't think I can part with it for very long." 

M: "The actual test will run only six hours." 

E: "All right but I'll be awful thirsty! And when I'm thirsty, I'm like a bear." 

M: "Nothing we haven't heard." 

E: "You might want to wear ear plugs around me." 

Matt chuckles.  

M: "Let's get you admitted." 

E: "I'm packed: portable DVD player, a selection of movies, my law books." 

M: "You're a lawyer?" 

E: "Planning on it."  

Matt and Eilish leave his office. Outside, the city is gently blanketed by a coating of snow and snowflakes are swirling down thickly.