Part III – The Physician June 5th Three weeks had passed. Th e
swelling was still present and it had become an even more difficult
for Margo to move her finger. In addition, the amount of fluid
oozing from the wound had increased, suggesting that the medication
hadn’t worked. It was now time to visit a local physician.
Following the advice of a neighbor, Margo set up an office
appointment with Dr. Chan, an internist. After the usual battery of
questions, Dr. Chan sent in the nurse to collect a specimen from
Margo’s finger. Dr. Chan mentioned to Margo that the specimen would
be sent off to the regional hospital laboratory for analysis and
that he would provide her with another prescription for Keflex,
which she should continue to take until test results came back.
June 15th Th e test results arrived in Dr. Chan’s office on June
15th and were as follows: • No yeast or fungal elements were noted
• Gram-stain reaction: no organisms seen • Culture of anaerobes and
aerobes @48 hours yielded no growth • Enrichment culture results:
moderate growth on day 5 of an acid-fast bacterium (AFB). o Growth
identified as Mycobacterium fortuitum by the Florida State
Laboratory. Armed with a microbial identification, Dr. Chan
prescribed Doxycycline and Bactrim to be taken for four months. Dr.
Chan also mentioned that the isolated organism was known to be
found in tap water. Consequently, Margo planned to ask her condo
community why an organism that could cause so much pain would be
living in the water that was coming out of her faucets. And
although she was annoyed to learn of the source of the organism, at
least she could take some comfort in the fact that she finally had
an accurate diagnosis and that by taking her medicine she could
fully recover from her injury and start to enjoy her new home.

Provide one specific and realistic solution

Explain why this solution was chosen

Support this solution with solid evidence

Concepts from class (text readings)

Outside research

Personal experience (anecdotes)