“The patient is a 27 year old man who was admitted to Dealy Hospital 10 days ago with a chief complaint of mid-epigastric pain.  He was observed on the surgical service for 3 days.  During that time his temperature spiked to 1020.  A week ago he developed board like abdominal rigidity and was taken to the operating room where he was found to have a perforated appendix.  The appendix was removed, numerous drains were left in place, and he was started on gentamicin – 7mg/kg.  The next day his creatinine, which had been 1.0, was 2.1.  His IV fluids were increased to 6 liters a day, but his creatinine rose to 3.2.  Following an IVP he became oliguric.  His fluids were increased to 8 liters a day, perhaps more the I & Os are not complete.  We were consulted last night because his creatinine was 12.0.  The physical exam is remarkable for a BP of 212/140, a pulse of 120, bilateral rales, and anasarca.  Noteworthy labs in addition to the creatinine, are a BUN of 210, a CO2 of 14 (his anion gap is 26), and an albumin of 1.3.  He needs dialysis and fluid restriction, which is why I transferred him here”

Grollman was very impressed by the robust succinctness of Black’s presentation.  Trucker’s mien did not suggest that he was impressed.   He looked like Vesuvius in 79 AD.

“Transfer him to Howard Johnson’s,” said Trucker so indistinctly that Grollman involuntarily said “What?”

“I said transfer him to the fucking Howard Johnson,” screamed the incensed nephrologist with such energy that the large blue vein running perpendicularly down his violet forehead seemed certain to rupture.  Grollman was genuinely startled.  He had never heard an internist say “fuck” in a public part of a hospital.  Maybe nephrologists weren’t really internists, he thought – not for the last time.  No one else seemed to pay any mind to the outburst including the nurses, clerks, and attendants who were within earshot, which was everyone one the floor.  Grollman didn’t get the context of sending someone to Howard Johnson’s until he remembered that the firm had motels in this part of the country in addition to the ice cream parlors he was used to.

“$12 a night including TV and breakfast,” said Trucker his engorged vein receding a bit.  “No antibiotics, no X-ray dye, no fucking fluid overload.”