
Office of Education
Yale University
School of Medicine
367 Cedar Street
300 ESH
New Haven, CT
06519 USA



|
|

Cases | Cardiothoracic | Kugel

Case author: Frederick D. Haeseler, M.D.
Elsie Kugel: Introduction
At their 50th anniversary party, Elsie and Max Kugel's two sons and daughters in law, and 5 grandchildren presented them with tickets for an all expense paid 10 day Caribbean cruise on the Flamingo, a state of the art luxury liner, out of Fort Lauderdale, Florida. It was their first cruise ever and they had the time of their lives.
Every day began with a buffet breakfast. Elsies favorite was whitefish and cream cheese on a toasted bagel. After breakfast they would read the Miami Herald, dropped at sunrise by helicopter, then fall asleep in their lounge chairs. At about 11 am they would swim in the heated pool, shower, and head back to the dining room. In the afternoon there was more sun bathing and a brisk walk three times around the ship's perimeter. Then it was back to the dining room for dinner, followed by an hour of comedy with a pair of George Burns look alikes who, once land was out of sight, would always lead off with the same joke, Will the owner of the blue Volvo parked in violation please report to the bandstand! After that, it was dancing til midnight to the music of the Flamingo All Stars.
About midway trough the cruise they docked at Saint Vincent, West Indies, and Elsie and Max spent the morning shopping in the bustling streets of Kingston. They had a lobster lunch in the Hibiscus Cafe and then headed back to the Flamingo to escape the subtropical afternoon heat. When they got back to their cabin, Elsie said, My feet are killing me. She took off her sandals and put her feet up on the bed. Max could see at once the deep marks from her sandal straps and the puffiness extending up her shins. Keep your feet up Elsie. Looks like you are retaining fluid. After that they avoided excursions and Elsie learned to raise the leg support on her deck lounger.
On the last night of the cruise, Elsie was awakened by indigestion and took a couple of Maalox tablets. She was uncomfortable with a vague ache in her upper abdomen and sat up for a while reading a magazine, then went back to sleep, vowing to start a diet that very morning. The next morning she felt a little off, as she explained it to Max, who immediately looked worried.
In the airport Elsie had to sit down every 30 feet because of a strange sensation of not getting enough air. Panting, and looking down at her swollen feet she said to Max, It's the Miami heat; I'll be better as soon as we get back to Salt Meadow.
When their youngest son Rodney picked them at the airport he could see Elsie was having a hard time breathing. Even though she insisted that it was just a case of jet lag he called Dr. Grey on the cell phone. Mona, Dr. Grey's nurse answered, and told Rodney to drive straight to the office as soon as they got back to Salt Meadow.

Next: Patient interview




|