It really is a jungle out there.
All of us have had cases we never forget. Mine was a 12 year old female who I was asked to see in consultation for noisy nasal breathing.
It seems the patient was unable to talk about her problems, so her caretaker, dressed in a loud green coat with bright white buttons, told me that for the past several months she had noticed the patient had left sided noisy nasal breathing, irritability, and a change in appetite. The patient, Sally, had no previous history of surgery or similar complaints and was taking no medications.
The patient's past medical history was otherwise unremarkable. She was not sociable, usually playing by herself. She had an extensive family history and review of symptoms was otherwise non-contributory.
Physical exam showed a hirsute, overweight, female with abnormally long fingers and toes. She had significant craniofacial dysmorphosis. On ENT exam, I could hear noises coming from her left nostril. The remainder of the exam was normal.
My initial clinical impression was some kind of symdromic abnormality or an intranasal cause of her problem.
Because the patient was uncooperative, we scheduled her for fiberoptic nasopharyngolaryngoscopy under general anesthesia. Endoscopic exam was normal except for a shiny white object in her left nasal cavity that I extracted without difficulty. The object was a button that looked remarkably similar to one on the coat of her caretaker.
Follow up with Sally's primary care physician indicated complete resolution of Sally's nasal obstruction, but the foreign body removal did nothing to resolve her hirsutism or abormal facies. But, then again, I wouldn't have expected it to. You see, Sally is a Pongo pygmaeus abelii, a Sumatran Orangutan at the Denver Zoo, where I am a consulting otolaryngologist in the primate division.
The convention wisdom has always been that 98% of the DNA between chimps and humans are the same. It turns out that is not true. It's only 95% similar and there are many other differences. For example, apes have 24 pairs of chromosomes, not the 23 pairs in humans.
Despite that, I am amazed at how similar the endoscopic anatomy of our forebearers is compared to humans.
Orangs are an endangered species with only 9200 left in the wild, so it is unlikely that I'll be reporting a case series.
I've provided a lot of uncompensated care in my career, as I'm sure almost all you have, and I've never regretted helping those who couldn't pay the freight. This was no exception. The patient seemed extremely grateful and , every now and then when I make a housecall to see her at the Zoo, I can't help think Sally remembers me and occaisionally gives me a smile. Every now and then she'll offer me a banana in exchange for her care.
My nontraditional medical career, consulting to the Zoo, has been a kick. And here you thought your last clinic day was a zoo.