This week I have listened to Doctored Evidence by Donna Leon. I have read a couple of her mysteries previously, but found these CDs at the library. Some books are better read, and some books are better heard. I think this one would work well either way.
Her main detective - Guido Brunetti - is a thoughtful man with a brilliant wife. Their discussions at home inform his thinking on the job. Donna Leon does a wonderful job writing interrogation scenes, and makes me think about my own questioning skills.
At one point in the book, Guido chides himself for the sin of premature closure. While I cannot remember the exact words he expresses embarrassment that he tried to make the evidence fit his hypothesis rather than making his hypothesis fit the evidence.
Yesterday morning at morning report we discussed a very interesting patient in whom the attending and intern made this same mistake. The patient presented with one rigor and drenching night sweat, along with increased dyspnea and a productive cough. However, his oxygenation was not compromised, and his lung exam did not reveal any area of consolidation. His chest xray was unremarkable. He did have a warm area in his lower leg, which he attributed to vein stripping from a previous CABG.
The team kept looking for the elusive pneumonia - and could not find it.
On the second hospital day, the blood cultures grew group B streptococcus. We now assume that this was a most unusual presentation of cellulitis.
In this case the history taking was superb, and the history pointed strongly to a classic diagnosis of pneumococcal pneumonia. However, the confirmatory data did not support the diagnosis, and thus eventually they had to look elsewhere.
Guido would understand their angst.
