FOLLOW DR. KO: The Unfortunate Case of the “Drug Mule”

Screen Shot 2013-12-31 at 6.08.10 PMOn a crisp Saturday morning, Internal Medicine Residents from all over the state of New York trickled into the University of Rochester’s School of Medicine, sporting ties and dresses in lieu of their usual white coats and scrubs. In their hands they clutched a precious cargo, a cylinder that protected a poster to be used for a presentation about their research or about an unusual clinical case.

I was among the ninety-seven young (when does one cease to be called young, I wonder?) residents who had been selected to present their work at the annual New York American College of Physicians’ abstract competition. I had to rush to the airport right after work on a Friday afternoon, and then with barely six hours of sleep, (no, six hours is not enough) drag myself up and out into the cold air of Rochester, firmly gripping my poster, all the while wondering why I was giving myself all this extra work on my only free weekend of the month.

But then, as soon as I got a glimpse of other young physician’s work and ideas, my somnolence evaporated. How stimulating and motivating it was so see the talent out there! I especially remember one resident who was doing a double residency in Internal Medicine and Pediatrics. One residency is a daunting enough task, but two! And then I watched in amazement as he juggled his research poster with one hand, and his toddler with the other. It never ceases to amaze me how people can raise children and be in residency at the same time. His poster illustrated two years of laboratory work during which he exposed mice to different degrees of radiation and then extracted their stem cells to measure the relationship between the radiation exposure and the death of the cells. Fancy stuff. When I asked him how he had time for residency, family and research, he simply replied: “I don’t, really.”

My presentation was not nearly as fancy, but did make for what I figured would be a captivating story. It was about a “drug mule” I had encountered during my rotation in the Intensive Care Unit (ICU). She was a young woman barely out of her teens who was brought into our Emergency Department after suffering a seizure on the street. She subsequently went into cardiac arrest and was brought back to life after more than twenty minutes of CPR. Before her heart stopped, she was able to tell us that she had tried cocaine for the first time.

While in the ICU, our patient was kept on mechanical ventilator support for over a week because she could not breathe on her own. A number of people claiming to be her relatives showed up daily to visit, and her alleged mother raised concerns about my patient’s enlarged abdomen. We did an abdominal X-ray and saw nothing unusual. Eight days later, a nurse found pellets of a white substance in her diaper! That’s when we opted for a CT scan and found numerous other drug pellets that had not been picked up on the X-ray. It turned out that she had been paid to smuggle a load of cocaine into the U.S., probably never realizing the risk she was taking.

I found only one study comparing the sensitivity and specificity of different imaging modalities for detection of concealed drugs in the human body. A CT scan, although costly and laborious, is definitely the way to go when someone is suspected of concealing drugs in their body. This is especially so when there is imminent danger to the individual’s life, as was the case with our patient. Given that one or more of the drug pellets had already burst, a steady stream of cocaine was leaking into her system causing havoc.

When I first set out to become a doctor, research was not at all on my mind. I wanted to be a clinician, to be with patients. Forget about lab rats and data collection, forget about grant applications and writing papers. That “stuff” wasn’t for me, so I thought. But that changed during my third year of medical school, when I first got my feet wet in research on Transient Ischemic Attacks. Despite the small role I played in the project, I felt an indescribable satisfaction from giving back to the scientific community. I was, in my own very small way, contributing to the advancement of Medicine!

The judges seemed taken by my presentation about the cocaine overdose. I felt I had told a story, showed images, presented some data, and had effectively conveyed the message I wanted my audience to take home. However, I had to rush back to the airport before the announcement of the winner of the poster competition was made. I had entered this contest for fun, really just “for the heck of it”. But then a very welcome surprise came through my phone as I was to board my plane: I had won! Out of the fifty-seven contestants in my category, I came in first. Certainly worth the plane rides and the early mornings! All those years working at the McGill Office for Science and Society had seasoned me properly!

Who would have thought back then that I would be representing the state of New York at the National American College of Physicians conference? Not me.

Melody Ko

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