“Can I run a case by you”, my younger colleague asked.
“Certainly”, was my obvious answer.
She proceeded to tell me about a patient who had been to the emergency room recently with abdominal pain, jaundice, profound fatigue and itching. Her liver enzymes were elevated but her imaging did not show anything abnormal, from the appearance of her liver to her gallbladder, bile ducts, pancreas and everything else.
My colleague saw the patient in follow up and all the hepatitis and mononucleosis tests from the emergency room had come back negative.
She asked “What do you think this could be?”
“Well they checked for all the usual things“, I said and started googling on my laptop. “I have an idea.“
I soon found what I wanted, and said “I’m printing an article. This is something I learned about not all that long ago, but it made a big impression on me.“
The printer rattled behind me and my phone rang. It was a specialist at Cityside needing to talk to me. I said to my colleague “read this and see what you think”.
After I finished my call I went down to her office. Her nurse exclaimed as I walked through the door “you’re a genius”.
Sally was reading the article I had printed about G.I. manifestations of tickborne diseases. “It fits”, she said as she ticked (Sorry, but love puns…) off all her patient’s symptoms from the table in the article.
I told her about the lesson I learned from Dr. Kim about anaplasmosis and very soon afterward was able to share with a young colleague. It still isn’t that well known a disease, but its incidence in Maine is increasing dramatically.
So Sally softend her nurse’s compliment and said “experience counts“. I don’t deserve to be called a genius, but I do like being recognized as experienced. After all, it’s been 42 years since I graduated from medical school.
A Country Doctor Writes: 
So glad you never stop learning; and teaching. Being chair of CME at my hospital for 35 years was the most fun part of my career.
One writer suggestion: for the word “imaging” use what modality was used, even if multiple.
The RUQ is a complex bundle of anatomy, physiology, and pathology!