You are working as a receptionist at the only family practice in a small town in Idaho while you are studying to become a physician’s assistant. On a Saturday morning you are the only office worker there when a call comes in from a local church. The congregation is hosting a family that moved to the United States from Peru six weeks ago and is helping them find housing and work. In the meantime, the family is staying at a church-owned house and relying heavily on church members for help negotiating this new country and for translation while their English is still sketchy.
The woman on the phone identifies herself as Leslie, a church member. She seems distraught. She says that the mother of the young family became ill yesterday and seems extremely ill now. Her symptoms started out as stomach cramps and quickly progressed to a very watery diarrhea. You hear moaning in the background and Leslie tells you that the patient is pointing to her calves and crying. You ask Leslie how many stools the sick woman has had in the last 12 hours. She replies that it is almost constant and that the woman can no longer leave her bed at all.
When asked, Leslie says there is no blood in the excreta. It is very clear with lots of little white flecks in it. You put her on hold and run down the hall to the examining room where the physician is doing a well-baby check.
When the doctor opens the door you whisper that you think there’s a case of on the phone.
The doctor’s eyes widen and she asks you how you came to that conclusion. What is your reply?
Why was the doctor initially dubious about your diagnosis and why does the patients recent immigrant status convince her that your diagnosis was correct?
The doctor asks you to tell Leslie to call 911. The sick woman should be transported to an emergency room right away and the doctor will call ahead and meet her there. What is the first intervention likely to be performed when the patient arrives?
The next day you ask the doctor about the patient’s status. She says that currently the patient is receiving a course of the antibiotic ciprofloxacin, though it won’t help her. Why won’t it help her and why was it prescribed if it won’t?
The incubation period for this disease is one to four days. Can you think of any way that the young mother could have been infected so recently even though she has been in this country for six weeks?
