I just have to add a rant over something that happened today. A patient came
in to our ER with a complaint of malaise, weakness, "green sputum", no
fever. He apparently is a recovering alky, no drug use, many many trips to
the ER for vague symptoms. Previous labs were pretty much normal, hiv neg,
lyme neg, rpr non reactive. No hx of travel.

The doc sent up a full battery of stuff (as he usually does) including
cardiac, troponin I, EtOH, dau screen and a request for Q fever and Brucella
antibodies. He claims that he consulted with Infectious Disease. He did have
a WBC of 11.3 with 70% grans. It appears that something is going on!

He never did order a blood culture or a sputum culture! I told the
pathologist that this guy is out of control and he's now not looking for
zebras, but now he's going after Eohippus!  I suggested that we hold this
specimen until we hear directly from an ID doc, but it got sent out to
Quest.

The patient was given a PPD and sent home! I really hope our path goes after
this guy. He's already tracking his ordering of troponins, BNPs and blood
cultures without medical indication of doing so.  I just needed to rant!