“And the weight loss?” I was jotting down notes, developing a timeline with arrows and question marks.
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“Hard to say. I go up and down with the weather. Up in the winter, down in the summer. What did your scale say?”
“238.” I said.
“Winter, I get up to 250, sometimes 260. Probably dropped more weight this summer than usual. Appetite’s down. Bowels looser than usual, but I go through that sometimes, too. Got a nervous stomach.”
“Anything else?” I asked.
“Muscle aches. Strength is down. One night I took my temperature, and it was just over 100º. The whole deal is getting me down.”
As he spoke, I methodically palpated his neck for lymph node enlargement. There were a few tiny nodes, but none were particularly worrisome. In assessing whether lymph nodes are abnormal, I estimate whether they are larger than the fingernail on my ring finger, have a rubbery consistency or are attached to the adjacent soft tissue. Each of these findings suggests a possible malignancy. Leon’s lymph nodes were a little generous in size, but not pathologic.
I asked him to open his mouth. The faint smell of Listerine was present. The tonsils were unremarkable. Most of his teeth were missing, and the rest were rotten and loose. Then, on to the heart. I placed the stethoscope firmly on his upper chest to dampen the background scratching noise chest hair makes. A harsh, crescendo murmur was present at the edge of the upper sternum, and I asked Leon to stop breathing for a moment so that I could time the murmur during the cardiac cycle. I motioned the resident over and had her listen.
“Aortic valve,” Leon declared confidently. “Calcified, with two cusps instead of three, what the cardiologist called a bicuspid valve.” I’d forgotten about the Times crossword puzzle. The man was a sponge for medical jargon. “Told me not to worry about it, so I don’t. Suggested I repeat the 2-D echocardiogram in a year.”
“Any new sexual partners?” the resident asked.
For a moment there was silence. Then, “My pecker has gone on strike. Not much left there.”
“I’m sorry,” said the resident.
“Me too,” Leon shrugged.
“Any shortness of breath? New cough?” I asked, moving on to the lungs.
“Nah, nothing but me and my chronic smoker’s cough. I clear out the junk first thing in the morning, and then I’m good to go for the rest of the day.”