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Estela, 26, lay curled up on a stretcher, her forehead beaded with sweat. Nausea, vomiting and stomach cramps had laid her low for two days, she said. She was on methadone, and if she’d missed a dose, withdrawal could be causing the vomiting and stomach cramps. But heaving for two days straight would be unusual.
“So you did take this morning’s dose?” I asked.
“Seventy-five milligrams at eight this morning,” my patient replied. “I missed yesterday.”
The facts weren’t fitting my tidy theory. I turned to Paul, my medical student. “Small bowel obstruction?” he offered. “Hepatitis? Pancreatitis?”
