Intellectual curiosity

Tropical medicine is fascinating because of the scope of illnesses you see in the wards, the broad differential for many patients, and the interesting physical exam findings and work-up (when the work-up is available). However, the treatment possibilities are often limited, the same no matter the specific diagnosis, or frustratingly not feasible given lack of resources. This discrepancy between interesting cases and frustrating inability to care for patients has stood out to me the most, even from the first day on the wards. For example, we have a 31 year old female patient, initially unresponsive who came in with abdominal pain, found to have 2 large liver masses on ultrasound, no risk factors for hepatocellular carcinoma. Labs revealed a very high LDH, elevated uric acid and potassium. Physical exam and history was not revealing for a primary malignancy and she had no lymphadenopathy. Our leading diagnosis became lymphoma, however, the patient needed a biopsy. It has been 5 days and still the patient has not come up with the money for one, once she does it will take several days for the biopsy to occur, and once it is done it routinely takes 2-4 weeks for the pathology to return. So while the patient’s case is interesting and the differential originally very broad, the actual inability to diagnose her and then to treat her is incredibly frustrating.