NEW ORLEANS, LA – Dr. Joseph Dell of Orthopedic Surgery was hoping it would be a calm day; no surgeries were scheduled and his clinic schedule today was surprisingly light. After two months of relentless calls for orthopedic trauma, it was mostly clinic now, a much needed break, and it seemed the opportune time to get reorganized, catch up on dictations, and reconnect with research mentors. But before the day could even get started, Dell’s computer screen froze.
“The ESPN home page was stuck and I couldn’t do anything,” said a frustrated Dell.
Wiggling the mouse had no effect. The keyboard was unresponsive; Control-Alt-Delete was to no avail. Dell turned off the computer and attempted to restart it. However, after an unusually long reboot, Dell’s fears worsened as he noted the infamous blue screen of death (BSOD).
“Uh oh, I hope it’s not a virus,” Dell muttered with growing concern. “Oh man, I hope I don’t lose all my stuff. Shoot! But I have software to protect against this. Not now, damn it, not now! Stupid computer, I hate this damn thing!”
Dell took a deep breath. Think, he thought to himself. Think! Dell soon realized he had one option left. He knew what to do. Of course! He called the only people he knew how to call for help. I can always trust them!
“Hey, this is Dr. Packard of Hospital Medicine.”
“Hey, this is Ortho,” responded Dell. “I need your help with antiviral management.”
“Oh, if that’s all, it might be best to call Infectious Diseases,” Dr. Packard suggested politely.
“Hey, this is Dr. Sony of Infectious Diseases.”
“Hey, this is Ortho,” replied Dell. “I need your help with antiviral management.”
Sony listened to Dell’s case with interest, asking questions and taking copious notes. “What kind of PC?” Sony asked.
“No idea,” replied Dell.
“What’s the computer’s HIV status?” asked Sony.
“It hasn’t been tested,” Dell reluctantly admitted.
“This is a unique case,” Sony replied. “Normally we evaluate humans, you know, people who have infectious diseases, not computers. But this is an interesting case nonetheless since it certainly sounds infectious… You know what? What the heck, we’ll see the computer. Thanks for the interesting consult!”
Sony and team evaluated the 6-year-old Asus computer’s regimen. The Asus was only on Norton Antivirus monotherapy and the regimen had last been updated in 2012. Infectious Diseases worried about antiviral resistance since Norton Antivirus should typically be boosted with another antiviral agent. Of note, the Asus was allergic to penicillins.
With the Asus computer growing more unresponsive, altered, and febrile, bacterial and fungal etiologies had to be considered. Plus with the BSOD suggesting hypoxemia, Infectious Diseases could not rule out a problem with the computer’s fans.
“We recommend several studies,” commented Sony in his official consult. “Please send sputum cultures to rule out tuberculosis and PCP, blood cultures, urine cultures, urine Histoplasma antigen, and get a CT of the CPU without contrast. Please consent for HIV and place PPD. Place the computer under airborne precautions. Consider lumbar puncture. See antibiotic recommendations below.”
Infectious Diseases adjusted the regimen, adding Kasperski Antivirus as a booster. They also broadened antibiotic coverage by adding empiric Norton Antibacteria and Kasperski Antifungus. Pharmacokinetics dose-adjusted all antibiotics, accounting for Intel processor spread. They plan to de-escalate therapy as more culture data become available.
In the meantime, Dell is holding his breath, hoping his computer doesn’t crash again and can miraculously pull through.
“If the Asus doesn’t make it, we’ll have to call Palliative Care,” Sony said shaking his head. “I know it’ll be hard for Dell to hear but we’ll have to have The Talk. You know the one. The one about getting a Mac. I know, I know. I dread The Talk too.”