Work Text:
Dr. John Shen
Emergency Medicine
Night Shift Attending
Pittsburgh Trauma Medical Center
He is a damn good doctor. He can quickly read situations, start treating, formulate differential diagnoses like the back of his hand and find the most efficient way to test, rule out, and treat conditions.
He can crack a chest, hold a heart barely clinging onto each and every beat, and restart it without letting his Medium Dunkalatte get watered down by the insane amount of ice the baristas put in it every night at 6:25 p.m. when he goes through the drive thru.
He is so calm under pressure. MCI’s are his bread and butter. Pittfest was his first real chance to shine and Dr. Robby got to see his work in action doing triage. When it was all over Dr. Emery Walsh said that his triage and quick thinking led to a 23-year old not bleeding out in the waiting room when he correctly diagnosed fluid in the abdomen without needing an ultrasound. Dr. Jack Abbott, military veteran, told him “I knew I made the right choice bringing you to nightshift kid.”
So you would think he could navigate Doctordle successfully.
Yet every time he KNOWS what his diagnosis would be the game says
INCORRECT!
He is a damn good doctor. But the internet prefers Dr. Melissa King.
“Got it!” She shouts from across the nurse's station. Jumping out of her chair and scaring awake one of the patients in the hall.
She immediately shrinks into herself and yells out a “SORRY” before correcting herself and whispering “I am so sorry. I will be more careful.”
Ever since Ellis found this diagnostic version of Wordle she has insisted they need to do it every shift before rounds to “get the diagnostic juices flowing.” More than likely Dr. Trinity Santos is texting the resident group chat telling them how quickly she and Whittaker were able to solve the puzzle of symptoms.
Yet Dr. Melissa King, Mel as she preferred, never engaged in the dick measuring contest that was bragging about how quickly she was able to diagnose. She decided to make it a teaching opportunity to consult other physicians about hypothetical treatment plans given the small list of symptoms, test results, and medical history you can gain from 6 bullet points. She always spoils that she got it in 3 or less guesses as “the second clue typically gives away a different set of symptoms that equates to a diagnosis” or whatever she likes to claim about the game.
The correct diagnosis was Papillary Thyroid Carcinoma. However after vague cardiology symptoms and a complaint of foot swelling John had looked past cancer to go for broke with some more interesting diagnoses such as Congestive Heart Failure and Sepsis.
He should’ve known better it is never Sepsis. House MD truly lied about how interesting being a doctor can be. He may not be a Infectious Disease Nephrologist surgeon extraordinaire with a crack team who solves interesting cases but the night shift in the Pitt with his gang plus Mel King is more his ADHD speed anyways.
Mel King is always his speed. She goes her own methodical and rigorous yet caring and friendly speed, but she lets John tag along to supervise and consult.
He knows she is about to ask for a consult when she purses her lips to the left and scratches the top of her right ear with her left hand staring at her computer station. She will look up and quickly analyze who she would prefer to talk out her thoughts and reasoning behind treatment plans.
Dr. Melissa King
Emergency Medicine
Second Year Resident
Pittsburgh Trauma Medical Center
She has always wanted a Zebra. To be the one to find a rare medical condition and treat it effectively before referring out. She wanted to be able to not only find out what is wrong but solve the problem with minimal invasion into someone's life. Like finding a tree growing in a person’s lung. (Thanks Dr. Christina Yang)
She is very methodical when coming up with a differential diagnosis. Knows her limits on what is acceptable as medical creativity. That lies more in the treatment of traumas in Emergency Medicine. Thinking through problems that have a clear objective, keep someone alive, is easy, fun and relaxing.
She gets her zebra discoveries through her new daily ritual of Doctordle. They might not be the most rare but it is a strategy game that tries to deceive you of the true nature of the ailment by being coy with the clues. Cardiology symptoms rarely ever mean heart failure and more often represent an imbalance of fluids, metals or chemicals. Papillary Thyroid Carcinoma was the most common ailment that had related cardiology and fluid retention issues which was a successful two guess game.
She got very excited as she typically second guesses herself when she has gaps of information. She would be more thorough collecting history, symptoms, and chief complaints. But that is the nature of the game.
When diagnosing the same viral infections, strep, flu, and pregnancy she tends to lose focus. History shows that 4 random adults from different parts of the city, who have never interacted before, and sit in the waiting room for 4-5 hours (on average depending on acuity and current staffing) can share the same diagnosis all while presenting differently.
The differential diagnosis and acuity prioritization skills she has gained in the Emergency Room compared to the VA are undisputable but she still would prefer to consult her colleagues when there is an unusual presentation of her typical low acuity diagnosis.
Ellis is quick to go with the most simple solution. “Hoofbeats mean horses.” Simple, practical, rationale. Abbott is clinical down to the C but also as the Senior Attending he has the entire Pitt to think about when she mainly would just like to confirm that muscle rigidity, neck stiffness, and light sensitivity are pointing to meningitis and not Sepsis. Dr. Shen has always encouraged her to work through her crazy ideas and confirm this is a common case through testing and detailed notes.
She thought through her options and opted for Dr. Shen as she knew he wouldn’t see her as anything other than an overactive resident.
He was already looking at her with the face that read “Tell me what you got”
She dove into the details of the current case as quickly as she could without wasting his time and delivered her thoughts.
“It has to be meningitis. I am just trying to rule out Sepsis and a Subarachnoid Hemorrhage. I would also like to rule out rabies, that could explain the stiffness and light sensitivity but that is exceedingly rare as he also did not have any skin lesions to suggest animal interactions.”
He just stared at her. She was unable to read his face, unshockingly, but inferred that she was being ridiculous. She took in a deep breath and quickly shouted out a hair too loud
“That's okay, it would never be rabies. I will treat the meningitis as it presents and leave you to your latest trauma.”
Quickly turning away and taking a half step before she felt a hand on her shoulder and a voice saying
“I never would’ve considered rabies. Is that why you are so good at Doctordle?”
She paused and squeezed her fingernails into her palms only irritating the already damaged surface of her hands.
“I apologize. I don’t claim to be good at doctordle and do not want you to assume I am going wild with my differential diagnosis due to an online game.”
“Don’t. I want to hear more. If it was a small bat the bite wound could have healed without complication before the virus started to manifest in symptoms.”
She turned around and felt excited as much as she felt encouraged.
“He has been working in his attic recently to renovate in an effort to sell his house.”
“Bats love an attic. Do a full panel and report back to me, but also write up a meningitis protocol. Both are funky and need to be treated ASAP.”
It turned out to be meningitis however a quick acting Post-Exposure Prophylaxis calmed the nerves about a real case of rabies. Mel also got John, as he preferred to be called, a sheet with how she approaches Doctordle from a gaming strategy and diagnostic point of view.
He got her Boba as a treat. On their shared day off. As a date.