The rat

By Sadiqua Sadaf, MBBS, Deccan College of Medical Sciences, Hyderabad, India & Amy Yu, MD, MS, Johns Hopkins Medicine 

Watching “House” in India as a medical aspirant is a near universal experience, second only to discovering the term “zebra” during one of its many riveting episodes.  

I was recently an observer at Johns Hopkins. One morning while running through the handoff with the interns, I thought I’d come across the proverbial black and white stripes—a patient who’d initially presented with diarrhea and vomiting that progressed to AKI with significant hematuria in the setting of septic shock. They had a low platelet count and significant anemia, and the list of differentials was long because of the mostly inconclusive workup. Hematology, nephrology, and urology consultants were called in to rule out the probable causes and shared their diverging explanations.

I could hear the hooves. What could have caused such a fulminant picture in someone with no apparent risk factors? “Well, their leptospirosis test just came back positive,” said an intern. 

I was surprised to learn Baltimore, Maryland, did indeed have a rat problem and a diagnosis of leptospirosis wasn’t just possible, but entirely probable.  And just like that the once promising zebra had turned into a rat.   

Here are two takeaways from this experience:

1. Clinical codeswitching  

Much is made of the value that foreign trained medical graduates bring to the diagnostic table, and this key skill stands as their most valuable contribution, one that helps them alter the diagnostic thought process to fit a different landscape.  

2. Multicultural rounds 

Having voices from different backgrounds promotes an exchange of ideas and fosters flexible thinking for everyone. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.