Partnering with Patients

During my first year of medical residency training in 1977, a middle-aged man presented to our emergency department with symptoms and signs of an enigmatic, multisystem illness. All the physicians initially involved in evaluating him were completely stumped by his presentation. Then, a senior resident arrived and asked the patient one question: “What do you think you have?" Everyone nearly fell over when the patient confidently replied, “I think I have coccidiomycosis.” And the evaluation proved him right! None of the residents working in my hospital located in Baltimore, Maryland, had ever seen a patient with this fungal infection, and none expected to encounter it: coccidiomycosis affects chiefly people who live in Arizona and southern California where the spore is found in the desert sand. What the initial evaluators had not appreciated is that, although the patient lived in Baltimore, he worked as an interstate truck driver and had recently driven through southern California desert soon after earthquakes had struck and had generated clouds of dust filled with fungal elements that seeded the patient’s respiratory tract and ultimately caused his enigmatic (to us) systemic illness. At truck stops on the route back to Baltimore, the patient read bulletins about multiple other truckers who had developed “Valley Fever” (coccidiomycosis) after driving through California’s San Joachim Valley, just as he had done.