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00:00This program dramatizes true medical enigmas reported by the doctors themselves.
00:06The names and characteristics of the people have been altered.
00:10When we enter a hospital, we find that the doctors have all the answers.
00:15They don't have them.
00:20Kauat is three months behind in development.
00:23It looks like he's in pain.
00:25The baby wasn't gaining weight.
00:27Three months means something is wrong.
00:3339.5. It went up by one degree in the last half hour.
00:35He looked like he was in a death bed.
00:37The temperature is still high.
00:39Don't be offended, but I'm almost moving hospital.
00:47Mom, he's sick.
00:50Everyone was very worried. Maybe he wouldn't survive.
00:53You never told us that.
00:55You never told me that Kauat was sick.
00:57Grandma!
00:58When the temperature goes over 41 degrees, there's a risk of cooking your own organs.
01:02True medical enigmas.
01:05Come here. There's something wrong. Come here, please.
01:08I don't know what's wrong with him.
01:10He's getting worse.
01:19Do you have a scene?
01:20I'm David Reed and I work with Alan.
01:22Alan is my twin brother. He's four minutes older than me.
01:25I think the patients are the most confused.
01:27Many of them don't know who is who.
01:29In fact, most of them can't tell.
01:31That's the hardest part.
01:33Alan Reed studied at the University of Medicine in Georgia...
01:35and lived at the University of Medicine in South Carolina.
01:38I did theater in college. I got good grades there.
01:41It's serious.
01:43This case is about immunology.
01:45Alan and I are going to talk about it.
01:47It's about a very rare disease.
01:49It's going to be a big scene.
01:50My name is Roger Tung. I'm a cardiologist.
01:52I'm a doctor. I'm not an actor.
01:55Luckily, everyone around me is a real actor.
02:00Today's case, which we're going to reenact,
02:04is one of the most memorable cases of my entire career.
02:08It was the first case I was assigned when I was a student.
02:12The first file they gave me when I entered a hospital.
02:16Attention, let's see if it's ready.
02:18I think it's mine, right?
02:20Take two.
02:22Action.
02:28Okay, I got it.
02:31Looks like I started well.
02:35Good morning.
02:37Why did they put you on the same shift as me?
02:40It's going to be hard to tell who's who today.
02:43Everyone has a system to keep their lives in order.
02:47Things in order give us a sense of calm and control.
02:51Both personal and professional.
02:54Unfortunately, systems can fail.
02:57People can be betrayed by their bodies.
03:00The way we react to the unexpected and the unplanned
03:03is what defines our character.
03:05Very well, everyone, listen.
03:07Stop that now.
03:10I had to hear complaints all morning.
03:12Here's the deal.
03:13You should already know that the hospital
03:15is going through a system upgrade this week.
03:18The servers are going to drop sporadically.
03:20There's going to be a drop in energy.
03:22You're doctors.
03:23I hope you see this as doctors.
03:25I don't want to hear any more complaints.
03:27It's going to be an inconvenience, but that's life.
03:30Stop complaining.
03:31Go back to your patients.
03:32Thank you very much.
03:34Dr. Whitten, take care of the baby now.
03:36In my place?
03:37No, with you.
03:39Keep an eye on her.
03:40She does anything to not take care of babies.
03:42Got it.
03:43Good luck.
03:44Whenever there's a system failure or a problem,
03:46it's much more difficult to work,
03:48which makes life more complicated.
03:50Forget the baby.
03:51I don't want to deal with 19-year-old parents.
03:54Cal White is three months behind in development.
03:58The pediatrician said he only gained 900 grams
04:01in 12 weeks of life.
04:03He won't stop crying.
04:05His signs are pressure 7 by 3, pulse 135,
04:09temperature 38.3, weight 5 kilos, height 60 centimeters.
04:13Before, the pediatrician said,
04:14wait a minute, babies grow all of a sudden.
04:16And some grow faster than others.
04:18And then he said he should be a lot bigger now.
04:21Cal was over a kilo underweight,
04:24and that may not seem like much,
04:26but every three months means there's something wrong.
04:28I'll examine him.
04:29All right.
04:36As supervisor,
04:38my role is to monitor the entire medical team
04:40made up of residents,
04:42first year residents,
04:44and medical students.
04:47Any more visitors, Dr. Stark?
04:48There's a patient we need to see.
04:50Now?
04:51Yes, now.
04:52We need to have empathy for them,
04:54because I've been through this.
04:56And a lot of doctors,
04:57after they get to a certain level,
04:59forget they're residents.
05:03Jamie Kempdel, 26 years old,
05:05admitted today with weak fevers.
05:08Lindsey Wheaton, 25 years old.
05:10I'm with him.
05:13I'm his fiancée.
05:16He was totally debilitated.
05:18He was athletic, but he was pale,
05:21and it looked like he'd run a lot of marathons.
05:25And his fever, how was it?
05:2639.5, it went up a degree in the last half hour.
05:29The same high fever every day,
05:31always the same time in the afternoon.
05:32Every day for three weeks,
05:34he's lost five pounds since they started.
05:36It's a nightmare.
05:37We want to plan our wedding,
05:39and he can barely get out of bed.
05:41Can we have a bigger room?
05:42A double room?
05:43I don't know.
05:44The hospital's packed.
05:50The most difficult cases for me
05:52are those involving patients my age.
05:55There's an elephant up there.
05:57I think it's the elephant.
05:59There's an elephant up there?
06:01I think for obvious reasons.
06:03Because I could be in a bar with them,
06:05having a drink.
06:07The saddest cases I've been involved in
06:10are those involving patients with terminal illnesses.
06:15In this case, we were hoping
06:17that he wouldn't have a fatal condition.
06:23Jamie, can you tell me how you're feeling?
06:27Jamie, answer the doctor.
06:30I'm exhausted, man.
06:32He's had a lot of tests,
06:34and no one knows what the problem is.
06:36Let's find out what it is.
06:38When a patient reaches a debilitated state,
06:41he already has a baggage of frustration and suffering.
06:45And that translates into tremendous emotional stress,
06:48and often with unrealistic expectations.
06:51What tests have you had?
06:54Between his doctors and us,
06:56we've had a lot of tests.
06:58We've discarded bacteria, flu.
07:00Blood tests so far have been negative.
07:02Pulse radiography was normal.
07:04Lumbar expulsion to meningitis, negative.
07:06If he had bacterial meningitis,
07:08well, without treatment,
07:10he'd only live another two or three days.
07:12Tomography?
07:14We did, without any infection.
07:16But we also tested arthritis, rheumatoid, and lupus.
07:19Both negative.
07:21All of them negative.
07:23We knew it could be some kind of very rare diagnosis.
07:27And there must have been some complicated factor
07:30in the fever he had.
07:32The bride said that until that happened,
07:34he was in his best physical form.
07:41He's got a count of leukocytes at 30,000
07:43and high sedimentation.
07:45And no other symptoms?
07:47No.
07:49We sent him to two points in space
07:51to try to find a reference.
07:53Like, cough fever is one thing,
07:55abdominal pain fever is another.
07:57He had fever without any other symptoms.
08:00And that was very intriguing.
08:02Do you have any idea what it is?
08:04I think it's something like FOI.
08:07What does it mean?
08:09Well, it means undetermined origin fever.
08:12It's a fever that lasts a long time without a diagnosis.
08:15Undetermined origin fever?
08:19That's great.
08:22FOI is one of the most difficult conditions for a doctor.
08:27The problem is that it can be anything.
08:39It's all right, Carl. It's all right.
08:42How long has he had the fever?
08:44Weeks.
08:46Have you seen his diet?
08:53He's been rejecting the formula.
08:55When he drinks, he vomits right away.
08:57Is there anything else? Solid food?
08:59No.
09:00And does he have a fever and a shortness of breath?
09:02No.
09:03My mother said babies always get sick.
09:05Carl was never healthy.
09:07I think only in the first week of his life.
09:09Was there a problem with pregnancy or childbirth?
09:11No, it was all right.
09:17And his family history?
09:19Any serious illness on either side?
09:21No.
09:22No, not that I know of.
09:24We analyzed his family history, and there was nothing extraordinary.
09:27We didn't know of any specific diseases that affected the family.
09:30All of his close relatives were healthy.
09:33It looks like he's in pain.
09:36Maria, I want a full hemogram and a feces test, too.
09:39Let's do some tests and then we'll talk, all right?
09:42All right.
09:43Let's go.
09:44The baby wasn't gaining any weight,
09:46and he looked even sicker since he got to the hospital.
09:49That made us realize that there was a very serious problem going on,
09:52but we had no idea what it could be.
10:01Jamie Campbell had the so-called undetermined origin fever.
10:06It sounds like a very useless term for those who aren't from the area,
10:09but when doctors use this term,
10:12it's because it really has a lot of mystery.
10:16And it's intriguing, because it requires a very comprehensive evaluation.
10:20We need a detailed history.
10:22I want to know where he lives, what he does every minute of the day.
10:25I want to know what he eats.
10:27And the most important thing when analyzing the patient's history
10:32is to find out where he traveled, where he was,
10:35what he does, what he eats, who he was with.
10:38And we need to dig deeper into all of that.
10:42He's active.
10:44He's a no-board instructor. He lives in the open air.
10:47He's in great shape. Did you see his biceps?
10:50He's got a tank belly.
10:51What does that have to do with his diagnosis?
10:53And there's more.
10:55He complained of pain in his knees and in his thighs.
11:02It must be because he practices sports. What else?
11:04He likes adventure.
11:06His fiancée said they went camping in the Amazon.
11:13And before that, they went backpacking in some exotic corner of South America.
11:17Which means he was exposed to all kinds of exotic diseases there.
11:20That's right.
11:24Sammy, let's do a blood test for malaria.
11:27There are different types of infections that occur in different regions of the world,
11:31on different continents.
11:33He may have been affected by contaminated water or food.
11:37Typhoid fever, hepatitis A, leptospirosis, what else?
11:40Now we're getting serious.
11:43Check all his sores.
11:45And in the meantime, do a feces test.
11:47I know he doesn't have diarrhea.
11:49But we have to take him to the hospital.
11:57Three-month-old Cal arrived at the hospital late in his development.
12:00He has a disability to gain weight.
12:03Sue?
12:05Oh, Mom! He's all right!
12:09His blood glucose was normal, so he didn't have diabetes.
12:12We didn't find any parasites.
12:15They can cause diarrhea, but it's an unusual cause of these symptoms,
12:19especially in a baby.
12:21Do you have the baby's results?
12:23Yes.
12:28Glucose in normal blood.
12:30Feces test negative for parasites.
12:32I'll give you a hint.
12:34Look at the count of leukocytes.
12:38Yeah, the eosinophils are very high.
12:4038%?
12:42It's no big deal.
12:44The eosinophils were designed to kill parasites.
12:46It's their only function.
12:48A normal baby would have 6% eosinophils.
12:52Cal's level was 38%.
12:54That was the highest I've ever seen.
12:57And a clear indication of a very serious disease.
13:00Doctor, this is my mother.
13:02I'm Dr. Reed. This is Dr. Harper.
13:04Hi.
13:05Eileen.
13:06What's wrong with Cal?
13:08We detected a high level of a type of white blood cell
13:10common in children with allergies.
13:18We think he must be allergic to his formula.
13:20Do you always use this?
13:21Always.
13:22We see allergies to milk all the time.
13:24It's very common.
13:26Do you breastfeed?
13:29No, I never breastfed.
13:31We ask about family history, recurrent diseases.
13:34Do you have allergies in the family?
13:39Maria, we're going to do a rast test.
13:41In this test, we collect blood to measure specific antibodies to milk.
13:44Another injection?
13:46It's just a little bit, I promise.
13:50Very good, Cal.
13:55We tested Jame Campbell for malaria, yellow fever, and typhoid fever.
14:00That's enough.
14:01He must have started to feel a little bit of a cough
14:04from all the samples we had to collect.
14:06We really need blood tests to find out what you have.
14:09We could open a blood bank with what they took from him.
14:12It's very important to do the hemogram when the fever is intermittent
14:15because it increases the chance of discovering the bacteria.
14:19Because it's when it comes out of the toga.
14:21But I took malaria medicine when we traveled.
14:24Well, there are resistant variations out there.
14:26I think Jame's fiancée was more frustrated because she had a lot of energy
14:30and he was very weakened by the fever.
14:32And she was planning the wedding.
14:34I have 400 invitations to send this week.
14:37And I wanted life to go back to normal.
14:39Is there ever a sign here, huh?
14:41I think she's without a sign.
14:50We did the milk allergy test in Kauai and it was negative.
14:54So we knew that something else was causing intestinal problems.
14:57And what kind of intestinal problem would it be?
14:59There's a condition that can occur in children called malrotation.
15:02This happens when the intestines don't bend or rotate properly.
15:05Is that serious?
15:06Intestines with malrotation can have serious problems
15:09if they don't connect properly to the intestinal wall.
15:12It would be an explanation for vomiting and your inability to gain weight.
15:16I'm going to x-ray the abdomen and make a barium enema to get a better idea.
15:21When someone we love gets sick, our natural instinct is to be very afraid.
15:26Wait, wait.
15:27And when doctors don't provide answers, people lose confidence in their work.
15:33When the diagnosis is not clear, the emphasis is all on the history.
15:39And when composing this history, it is very important to interview
15:44not just the patient, but members of the family and close people.
15:47Sometimes we get a lot of information that wasn't initially provided.
15:51I don't think you'll be able to connect from here.
15:56So, how long have you been engaged?
15:59Three months.
16:03And how did he ask for your hand?
16:05It was at his father's ranch in New Mexico.
16:09He woke me up in the middle of the night, all emotional.
16:13He had helped two calves to be born in the stable.
16:17Then he said he wanted to have a family.
16:25It was beautiful.
16:28For the first time, I felt there was information that was very, very important for me to know.
16:34Is there something wrong?
16:36No.
16:38In fact, it can be something very right.
16:42Any clue can be a hope.
16:46And we pursue this clue and explore every aspect of it,
16:51because it can solve our case.
16:54It was raised on the farm.
16:56A person who helps calves to be born comes into contact with what?
17:01Dreams.
17:02After birth, placental material, milk?
17:05Yes, yes.
17:06And if the animal is infected with bacteria?
17:09That's where you want to get.
17:11Well, it's very rare, but in calf births and everything else ...
17:16Say it, Sammy.
17:18It could be brucellosis.
17:22Wandering fever, so the intervals.
17:24Transmissible by contact with non-pasteurized dairy products, placenta and postpartum liquids.
17:30Yeah, it could be that.
17:31Well, there are about 200 cases in the United States per year.
17:34But I think New Mexico has some infected herds.
17:37Here it says that the initial symptoms are headache, high fever, fatigue, weight loss, loss of appetite and ...
17:43belly of tank.
17:45We did not want to wait because we thought it was a perfect indication with that historic and the fevers.
17:51It had to be this disease, it was brucellosis.
17:53It takes 3 to 5 days for antibodies of brucellosis to appear.
17:56I do not want to wait so long.
17:58Let's start administering streptomycin right now.
18:01Everyone was euphoric.
18:03It could only be that.
18:04It was not just a rare diagnosis that none of us had seen, but it was treatable.
18:09And do you think it will work?
18:11Well, let's say I'm cautiously optimistic.
18:14Antibiotics need time to act.
18:16But we hope that by tomorrow, the fever will disappear.
18:19Oh, I hope so.
18:21Finally they began to believe that we could treat it and cure it.
18:26We were just looking for an answer.
18:29And if the answer had treatment, we did not care what it was.
18:37We made a barium enema in Kauai and radiographed his abdomen.
18:41The treatment seems normal.
18:43Oh, the server fell again.
18:46In addition to the simple radiographs, the barium ones provide us with much better images of the intestinal tract.
18:51I do not see any problem here.
18:53Why did you think it was a bad rotation?
18:55I saw a similar case last week, and this one looks the same.
18:59You can not draw hasty conclusions, okay?
19:07Yes, I know the servers fell.
19:09Yes, I know there was a power outage.
19:11But I have no reports from Campbell's for two hours.
19:13This is not acceptable.
19:15I want to be...
19:16Excuse me.
19:20Why did no one invite me?
19:22So Jamie Campbell was treated for brucellosis.
19:25It is a bovine disease that he may have contracted in his father's ranch.
19:30I'm sorry, doctor. He's 39 and a half.
19:33The fever did not go away.
19:34And that was very frustrating.
19:36Because we bet everything on the brucellosis hypothesis.
19:39And apparently that was not the diagnosis.
19:42I'm sorry. He's still 5 pounds.
19:45We fed the baby cowhide intravenously, hoping it would gain some weight.
19:49But he did not gain anything.
19:51It was very frustrating, because we felt that we had not made any progress.
19:59She's only 19. How can she have such a baby? So young.
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