Case 1: Maria's Travels
Synopsis: An epidemic caused by a fungus has begun in the U.S with potentially devasting effects on the corn crop. Derrick Hernandez and Maria Santini are graduate students studying the epidemic and crop improvement. An important resource in their studies is wild corn, teosinte, which may be resistant to the fungus. Teosinte grows in a few isolated locations in Central America. Maria, a geneticist, and Derrick, an ecologist, are headed south for their first field season. Maria went first to Mexico city to do some archival research on Zea at the Tiemplo Major. Derrick went first to Guatemala to another teosinte site. He'll join Maria and other researchers at the main teosinte site in the mountains of western Mexico, near the town of Durango.
Maria's Travels - Part 1:
While enroute to Durango from Mexico City, Maria was delayed several days by storms. Worse, she contracted diarrhea, which she began treating right away. After a day's rest in Durango, she made the steep and difficult hike to the research site where she soon collapsed. Her symptoms were abdominal and leg cramping, disorientation, and rapid shallow breathing. Alerted by radio, Dr. Frederico Stegnaro in Durango advised giving her small amounts of saline during the night. The next day she made her way down the mountain on a pack mule and with Derrick's help (he was feeling poorly himself) to see the doctor.
At the clinic, Dr. Stegnaro took Maria's blood samples and did a variety of procedures to test out several possibilities. Thin and thick blood slides showed no evidence of malaria,but her blood chemistry was more revealing. Her hematocrit was abnormally high, blood pH lower than normal and K+ very low. He also noted what might be one or two unusual red blood cells. He started rehydration therapy and sent her by ambulance jeep to Mazatlan Hospital.
Maria's Travels - Part 2:
Maria's husband of five years, Marcus Woods, met her in Mazatlan where he had flown upon hearing the news of her collapse. At the hospital, additional tests were run to try to determine the cause of Maria's symptoms. Rehydration therapy was continued. Dr. Margarita Villas-Incle, who specialized in general internal medicine and Dr. Carlos Luna, a hematologist, visited Maria and Marcus to interpret the blood tests and other results.
Dr. Villas explained, "We are not sure what exactly caused your collapse two days ago. Dr. Stegnaro was able to find evidence of electrolyte imbalance and severe volume depletion. We think the most likely explanation is the combination of fatigue, diarrhea, and unusual exertion. The dehydration is probably the most important factor. Your baby will not be harmed by this episode."
Almost together, Maria and Marcus exclaimed "Baby?"
"You did not know? We ran a pregnancy test on you as part of the blood work. We do it on all female patients of child bearing age," Dr. Villas said. "You are pregnant."
"I have been trying to get pregnant for four years," Maria said happily.
"This is wonderful news," Marcus agreed.
Dr. Villas said, "Congratulations. Now, though you must be careful to make sure all goes well. You must not return to physically demanding work for at least two weeks, but you can travel home in a day or two."
Maria's Travels Part 3:
Dr. Luna said, "I wanted to talk with you about some of the other findings. The doctor in Durango reported one or two odd erythrocytes. I did not find these. But I did do a special electrophoresis test on a sample of your blood. Senora Santini, are you aware that you have sickle cell trait?"
Maria, stunned, said, "What? What? I have sickle cell disease?"
"No, Senora Santini, you have sickle cell trait, not the disease. You will live normally with no restrictions."
"How could I have this? I'm Italian!"
"Most people think that only individuals with African ancestry can have sickle cell," the doctor replied, " but that is not true."
Maria turned to Marcus and quietly asked "Marcus, doesn't your cousin Leland have sickle cell?"
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