My review of systems

FL is a young man presenting with a flu-like illness.

Is that it? It is unbelievable how much is condensed in half a line. Well, now that I can write, I will break it down. It started close to midnight. At 2:21 a.m., to be precise. But I wouldn’t realize until 3:30 a.m. My heart was pounding, gushing blood to my eardrums and forehead with each stroke. If lying down on a side, I would hear the “shhh” with each beat, like ocean waves against a cliff. I was sweaty and hot. Fever and heart: I had Kawasaki’s, I dreamed in an Inception-esque way, unconsciously recalling the three Kawasaki disease patients of the week. But the pounding was unbearable. Then — finally — I woke up with one agonic word in my mouth: ibuprofen.

My wife, alerted with all of the comforter maneuvering, materialized the glass of water with the magic orange pills. That was just the beginning.

The arctic cold came about 2 hours later. Curled in bed, I could feel the paradoxical cold hand touching the hot thigh. Goose bumps. Suddenly, the sheets and comforter were not enough. Then is when the shivering started. For those of you who don’t remember it, shivering stinks. Extremities glue to the body to save heat. Stretching a leg to the virgin mattress area can be lethal. It finally ended, mostly due to exhaustion. Ibuprofen.

The next morning was even grimmer. Ants were crawling within the flesh of each extremity. The regular axonic signal was unable to trigger the motion of the now hundred-pound legs. Fever, ear buzzing, sweat, pins and needles announced the new day. Ibuprofen. At least it is not Kawasaki disease, I thought.

The chills became coarse. By noon, I was heading back to bed, which started feeling more like a coffin. After a while, it is no longer comfortable, but other options are worse. So stay quiet, drink more water. Hold on. … Water should go out too! Let’s carefully evaluate the risk and benefits of that trip to the restroom. It may be too cold and discourteous to the legs. The shivers may affect my precision. But it’s about time. … Supine again, it’s 9 p.m., and pizza with complementing wings seems most nutritive for the body and for the soul. At that time, suddenly, both nasal passages gave up. Just like that. Headaches got worse. Ibuprofen. Decongestant. More water.

Fifteen hours later, I’m writing this. Energy is back, but I’m still operating at 50%. Left turbinate is up and running. I came to a symbiotic agreement with the sore throat. Now we’re talking about below 101-degree temperatures. Life, although not good, is OK.

I feel like I somehow connected to each patient I saw recently. (Counter transference, my wife — a psychologist — would accurately interject.) In fact, people in the hospital joke that my service has the highest average temperature (for the fevers … got it?).

Now it is time to go to bed. Water, ibuprofen and decongestants surround the Kleenex box. The boiling in the legs has ceased, but this body doesn’t feel as mine.

Would that explain how I felt?

P.S.

That was a complete review of systems (ROS). In the E/M world, remember that you need at least two systems for an extended note, and at least 10 for a complete note. You can write a three-page consult, but leave the ROS out and your claim won’t cover a cheeseburger. All outpatient notes require the ROS. Alternatively, your nurse or the patient can record them, if you review and edit them as necessary. To avoid the painful list of negatives, just indicate the pertinent positives and follow with “a 10-point review of systems was otherwise negative.” Save trees, or bytes.