Wacker Revisited

A sharp pain in the back of my neck and left shoulder blade one morning led to a quick trip to the hospital and a ventilation-perfusion scan. The next thing I knew, I was in a hospital bed with a heparin drip.

In the next few days, I found myself trying to adjust to the role of hospital patient. I had my Doppler and my venogram. My prothrombin time and partial thromboplastin time were measured regularly. There were the inevitable glitches. The ward nurse, while changing my IV, dropped my Hep-lock on the floor and casually brushed it off. Seeing my look of concern, she said, “Don't worry, the tip is covered.”

It was early July, and the new house staff had just arrived. One of the interns, struggling to draw blood at dawn, seemed visibly relieved when I gently suggested that he call for help. When I was naive enough to ask for pain medication in the middle of the night, I received a rambling lecture from a sleepy intern about the evil effects of Tylenol on the kidney. I will not dwell on my chagrin at being abandoned in a drafty corridor by a harried radiology technician after a routine chest x-ray. And I cannot imagine how anyone can master the logistics of showering with an IV taped to one arm and a heparin drip teetering precariously outside the shower curtain. My past life as a physician seemed increasingly remote.

One morning, my doctor was making rounds with the new recruits, discussing how to make a diagnosis.

“A patient is admitted with acute thrombophlebitis. On the third hospital day he develops a tachycardia, has an elevated LDH, a rising bilirubin, and a normal SGOT.”

“And a normal CPK and MB fraction?” a young woman asked.

The doctor nodded. There was a pause.

“Wacker's triad!” I blurted out.

There was a stunned silence. I suddenly felt very foolish. My doctor beamed.

“The reference is a little archaic, and the concept is in dispute, but you're correct. We'd have to rule out a pulmonary embolus.”

His entourage prepared to move on. My doctor stepped back for a moment and leaned toward me.

“You're on the road to recovery, my friend.”

George N. Braman, MD

Bronx, NY 10471

• Copyright ©2004 by the American College of Physicians