Episode 2: Where Did You Pick This Up, Mrs. Patel?

Description

A beloved grandmother’s sudden onset of chronic confusion and weakness seems to be the result of aging until pathologist Celia Grange, MD, uncovers the truth hiding where no one suspected.

Cast:

Narrator/Sage Whitlock: Elizabeth V. McLeod, MD, MS, FCAP
Anita Patel: Sridevi Devaraj, PhD, DABCC
Meera Kapur: Jaime Singh, MD, FCAP
Dr. David Row: Earle S. Collum, MD, FCAP
Dr. Celia Grange: Xiaoyin "Sara" Jiang, MD, FCAP
Voiceover Intro/Outro: Robert Frick, MD, FCAP
Technical advisors: Jason V. Scapa, MD, FCAP, and Bobbi S. Pritt, MD, MSc, FCAP, with contributions from Elizabeth V. McLeod, MD, MS, FCAP; Thomas J. Cooper Jr., MD, FCAP; Xiaoyin "Sara" Jiang, MD, FCAP; and Feifan Fred Chen, MD, FCAP

This episode of Case Encounters is inspired by a real-life pathology case from the archives of The College of American Pathologists.

To learn more about the work a pathologist does on your lab test, visit yourpathologist.org.

Case Encounters is a production of The College of American Pathologists, with creative direction from StudioNorth.

Executive Producer: Robert Johnson

Creative direction by StudioNorth

Produced and directed by Natalie Gregory

Editing, sound design, and original music by Jake Sorgen

Written by Paige Freeborn for StudioNorth

Special thanks to Justin Charlton-Perrin and Clemmie Lozano

Additional production support from Nefsi Williams, Isabelle Ritz, and Anabella Torres

Hosted on Ausha. See ausha.co/privacy-policy for more information.

Transcription

Speaker #0
This is Case Encounters, a journey into the true medical mysteries solved by pathologists, like the case of Anita Patel and her very unwelcome guest.
Speaker #1
This is Mrs. Patel, an active 76-year-old woman with an adoring family, a home and garden she loves, and a simple life. Mornings with chai and marigolds, afternoons with books and her daughter's visits. Routine, ordinary, almost quaint. Little did she know, something sinister was setting up camp.
Speaker #2
I just forget things sometimes, Dr. Rao. My left arm and hand have been feeling clumsy. I'm tired all the time and these headaches. I know I'm getting older, but something's just not right. My daughter here will tell you I'm just not myself.
Speaker #3
That's right, Dr. Rao. My mom just seems to lose her way in conversations. She can't cook, won't eat. Something's just wrong. I'm worried her cancer might be back, or that her heart or COPD is worsening.
Speaker #4
Right. Okay. Well, there could be a number of causes for your feeling this way. Let's run some labs, and with your medical history, I'd like to do a brain scan and see what's happening, just to be safe.
Speaker #1
Mrs. Patel and her daughter left the family doctor's office with a requisition for an MRI and a prescription for hope. All she wanted was to go home and tend to her garden, to take her mind off things. Most times, we see or sense the things that threaten us. A stranger in a dark alley. A storm cloud looming. Food that smells a little off. But sometimes, things that pose the greatest threats are undetectable to us. hidden in unsuspecting places.
Speaker #4
Good morning, Anita. Been a couple weeks. How are you feeling?
Speaker #2
Pretty much the same, really. I'm not even finding peace in my garden these days.
Speaker #3
I was just over there yesterday, and there are weeds, and the bird feeder's empty. This isn't like you, Mom.
Speaker #2
I know, dear. I'm just too tired.
Speaker #4
I'm sorry to hear that. I can see how difficult this has been for you. I really wish I had better news. The MRI shows a mass in the right side of your brain. Here, let's have a look at this together. It's about the size of a golf ball, roughly 5 centimeters. The center is necrotic. which means the cells in the center of the mast are dead, and the edges are swollen. It could be a recurrence of cancer, but...
Speaker #3
Not again
Speaker #1
I thought I'd beaten this. I was feeling so good for so long. The language of medicine can sound precise, but precision isn't always certainty. To the scanner, it looked like cancer. To Mrs. Patel, it felt like betrayal. To Rao... It was still a question mark. So he had the mask removed and sent to pathology. This is where our story really begins. And where pathologist Dr. Celia Grange enters. Her world is quieter than the rest of the hospital. In her lab, there's no frantic activity, no tears, but an equal sense of urgency that comes from seeing someone's life under a... thin piece of glass, stained and silent, showing her a side of the story her colleagues can't see.
Speaker #5
Hmm, necrosis. Everything's dead. Acute inflammation, but no malignant cells. This doesn't look like cancer. What?
Speaker #1
What was meant to be a confirmation of the suspected diagnosis, cancer, instead unraveled into a tiny garden of chaos. A battlefield of immune cells, tissues in ruin, fragments that didn't belong. Not a malignancy, a mystery. The kind that deepens the longer you stare at it.
Speaker #5
Hmm, not what I expected. Let's stain these little guys and see what lights up.
Speaker #1
Stains are like flashlights in the dark. Each one shines a different colored light, coaxing hidden clues into view.
Speaker #5
Cytokeratin? Hmm. No metastatic tumor cells? The gram stain is filamentous, branching.
Speaker #1
For most of us, this stained tissue sample would look like a pink and purple splattered painting in a modern art gallery. For Dr. Grange, those specks of color provide critical detail, clues revealing something she didn't expect.
Speaker #5
Silverstain really highlights those filaments. Acidfast is weak, but it's real, is it?
Speaker #1
Cancer had been the suspect, and it's what Grange expected to find. But what she saw wasn't a runaway tumor. It was a microscopic intruder. lurking in the tiny folds of Mrs. Patel's brain.
Speaker #5
Wow, nocardia. A soil organism in her brain? Rare, but there it is. No record of a lung infection in her chart. Where did you pick this up, Mrs. Patel?
Speaker #4
Rao here.
Speaker #5
Hey there, David. It's Celia. How's your day going?
Speaker #4
Not bad. I'm just trying to figure out this new phone system. I think this call was supposed to forward to my cell, but clearly it's not working, as usual.
Speaker #5
Oh, yeah. I can't make that thing work to save my life. But listen, I've been reviewing Mrs. Patel's chart. Has she been traveling anywhere lately? Maybe camping or something?
Speaker #4
Camping? She's 76. I mean, I guess she could have... been, but I doubt it. Why? What did you find?
Speaker #1
Nocardia, a bacterium found in dirt, compost, and stagnant water. The kind of thing you brush off your shoes without a thought. And here it was, masquerading as a tumor inside Anita Patel's brain, confusing her, stealing her appetite, giving her headaches. and generally interfering with her ability to enjoy one of the things that brought her the most joy, her garden.
Speaker #4
Hi, Anita. Hi, Miro. Thanks for waiting. I know these results can feel like they take forever. How are you feeling today?
Speaker #3
She's just not getting better. Walking around the house all day, putting post-it notes with our names on everything, so we know who gets what when she's gone. I keep telling her she'll live us all.
Speaker #2
You never know, Mira, honey. Who'll feed the birds? Are you going to make sure the marigolds are watered enough? I have so many books piled up to read.
Speaker #4
Well, the good news is you'll have plenty of time for the books, and you'll be back to your garden in no time. The results from the biopsy tell us the mass is not cancer.
Speaker #3
Thank goodness.
Speaker #4
It is a pretty serious infection, though. It's caused by a bacterium called nocardia.
Speaker #3
An infection? In her brain? How on earth did that even happen?
Speaker #4
It's rare, really. but the earth is actually the likely culprit. These tiny creatures live in soil, decaying plants, standing water. We can breathe it in, sometimes without knowing. Or it can get in the bloodstream from a cut or abrasion. Any chance of exposure like this, Mrs. Patel? It makes me wonder about your garden. Unless you've been camping lately by any chance?
Speaker #3
Camping? I can't even imagine it.
Speaker #2
Oh, stop. Mira, we used to take you kids camping all the time. My garden? I spent hours out there. I had a small pond put in a while back. It never occurred to me.
Speaker #3
I knew that pond would be more trouble than it's worth. So, it isn't cancer?
Speaker #4
No. Difficult, yes, but not cancer. The treatment will be long. You'll be on antibiotics for a few months. But this is treatable, and we'll monitor you closely. Oh,
Speaker #2
thank God. I'm having that pond removed this week.
Speaker #1
Mrs. Patel was lucky. She got diagnosed before the nocardia caused any real damage. The mass was extracted, and so was the pond. The garden had always been her sanctuary, a place of beauty, love. But love, even of simple things, can open the door to strangers. Sometimes they arrive with gifts. Sometimes.
Speaker #0
You've been listening to Case Encounters. This story is inspired by a true medical mystery solved through collaboration, curiosity, and a pathologist. Names and locations are fictitious. Until next time, stay curious. The voices you just heard are those real pathologists, people who work long days and even longer weeks to solve medical mysteries big and small. To learn more about the work pathologists do for patients, visit yourpathologist.org. For a full list of the pathologists featured in this episode, those who advised the creation of this story, please visit the show notes. Case Encounters is a production of the College of American Pathologists. Creative support from Studio North. Produced and directed by Natalie Gregory. Sound design, editing, and original music by Jake Sorgen. Written by Paige Freeborn for Studio North.

Description

A beloved grandmother’s sudden onset of chronic confusion and weakness seems to be the result of aging until pathologist Celia Grange, MD, uncovers the truth hiding where no one suspected.

Cast:

Narrator/Sage Whitlock: Elizabeth V. McLeod, MD, MS, FCAP
Anita Patel: Sridevi Devaraj, PhD, DABCC
Meera Kapur: Jaime Singh, MD, FCAP
Dr. David Row: Earle S. Collum, MD, FCAP
Dr. Celia Grange: Xiaoyin "Sara" Jiang, MD, FCAP
Voiceover Intro/Outro: Robert Frick, MD, FCAP
Technical advisors: Jason V. Scapa, MD, FCAP, and Bobbi S. Pritt, MD, MSc, FCAP, with contributions from Elizabeth V. McLeod, MD, MS, FCAP; Thomas J. Cooper Jr., MD, FCAP; Xiaoyin "Sara" Jiang, MD, FCAP; and Feifan Fred Chen, MD, FCAP

This episode of Case Encounters is inspired by a real-life pathology case from the archives of The College of American Pathologists.

To learn more about the work a pathologist does on your lab test, visit yourpathologist.org.

Case Encounters is a production of The College of American Pathologists, with creative direction from StudioNorth.

Executive Producer: Robert Johnson

Creative direction by StudioNorth

Produced and directed by Natalie Gregory

Editing, sound design, and original music by Jake Sorgen

Written by Paige Freeborn for StudioNorth

Special thanks to Justin Charlton-Perrin and Clemmie Lozano

Additional production support from Nefsi Williams, Isabelle Ritz, and Anabella Torres

Hosted on Ausha. See ausha.co/privacy-policy for more information.

Transcription

Speaker #0
This is Case Encounters, a journey into the true medical mysteries solved by pathologists, like the case of Anita Patel and her very unwelcome guest.
Speaker #1
This is Mrs. Patel, an active 76-year-old woman with an adoring family, a home and garden she loves, and a simple life. Mornings with chai and marigolds, afternoons with books and her daughter's visits. Routine, ordinary, almost quaint. Little did she know, something sinister was setting up camp.
Speaker #2
I just forget things sometimes, Dr. Rao. My left arm and hand have been feeling clumsy. I'm tired all the time and these headaches. I know I'm getting older, but something's just not right. My daughter here will tell you I'm just not myself.
Speaker #3
That's right, Dr. Rao. My mom just seems to lose her way in conversations. She can't cook, won't eat. Something's just wrong. I'm worried her cancer might be back, or that her heart or COPD is worsening.
Speaker #4
Right. Okay. Well, there could be a number of causes for your feeling this way. Let's run some labs, and with your medical history, I'd like to do a brain scan and see what's happening, just to be safe.
Speaker #1
Mrs. Patel and her daughter left the family doctor's office with a requisition for an MRI and a prescription for hope. All she wanted was to go home and tend to her garden, to take her mind off things. Most times, we see or sense the things that threaten us. A stranger in a dark alley. A storm cloud looming. Food that smells a little off. But sometimes, things that pose the greatest threats are undetectable to us. hidden in unsuspecting places.
Speaker #4
Good morning, Anita. Been a couple weeks. How are you feeling?
Speaker #2
Pretty much the same, really. I'm not even finding peace in my garden these days.
Speaker #3
I was just over there yesterday, and there are weeds, and the bird feeder's empty. This isn't like you, Mom.
Speaker #2
I know, dear. I'm just too tired.
Speaker #4
I'm sorry to hear that. I can see how difficult this has been for you. I really wish I had better news. The MRI shows a mass in the right side of your brain. Here, let's have a look at this together. It's about the size of a golf ball, roughly 5 centimeters. The center is necrotic. which means the cells in the center of the mast are dead, and the edges are swollen. It could be a recurrence of cancer, but...
Speaker #3
Not again
Speaker #1
I thought I'd beaten this. I was feeling so good for so long. The language of medicine can sound precise, but precision isn't always certainty. To the scanner, it looked like cancer. To Mrs. Patel, it felt like betrayal. To Rao... It was still a question mark. So he had the mask removed and sent to pathology. This is where our story really begins. And where pathologist Dr. Celia Grange enters. Her world is quieter than the rest of the hospital. In her lab, there's no frantic activity, no tears, but an equal sense of urgency that comes from seeing someone's life under a... thin piece of glass, stained and silent, showing her a side of the story her colleagues can't see.
Speaker #5
Hmm, necrosis. Everything's dead. Acute inflammation, but no malignant cells. This doesn't look like cancer. What?
Speaker #1
What was meant to be a confirmation of the suspected diagnosis, cancer, instead unraveled into a tiny garden of chaos. A battlefield of immune cells, tissues in ruin, fragments that didn't belong. Not a malignancy, a mystery. The kind that deepens the longer you stare at it.
Speaker #5
Hmm, not what I expected. Let's stain these little guys and see what lights up.
Speaker #1
Stains are like flashlights in the dark. Each one shines a different colored light, coaxing hidden clues into view.
Speaker #5
Cytokeratin? Hmm. No metastatic tumor cells? The gram stain is filamentous, branching.
Speaker #1
For most of us, this stained tissue sample would look like a pink and purple splattered painting in a modern art gallery. For Dr. Grange, those specks of color provide critical detail, clues revealing something she didn't expect.
Speaker #5
Silverstain really highlights those filaments. Acidfast is weak, but it's real, is it?
Speaker #1
Cancer had been the suspect, and it's what Grange expected to find. But what she saw wasn't a runaway tumor. It was a microscopic intruder. lurking in the tiny folds of Mrs. Patel's brain.
Speaker #5
Wow, nocardia. A soil organism in her brain? Rare, but there it is. No record of a lung infection in her chart. Where did you pick this up, Mrs. Patel?
Speaker #4
Rao here.
Speaker #5
Hey there, David. It's Celia. How's your day going?
Speaker #4
Not bad. I'm just trying to figure out this new phone system. I think this call was supposed to forward to my cell, but clearly it's not working, as usual.
Speaker #5
Oh, yeah. I can't make that thing work to save my life. But listen, I've been reviewing Mrs. Patel's chart. Has she been traveling anywhere lately? Maybe camping or something?
Speaker #4
Camping? She's 76. I mean, I guess she could have... been, but I doubt it. Why? What did you find?
Speaker #1
Nocardia, a bacterium found in dirt, compost, and stagnant water. The kind of thing you brush off your shoes without a thought. And here it was, masquerading as a tumor inside Anita Patel's brain, confusing her, stealing her appetite, giving her headaches. and generally interfering with her ability to enjoy one of the things that brought her the most joy, her garden.
Speaker #4
Hi, Anita. Hi, Miro. Thanks for waiting. I know these results can feel like they take forever. How are you feeling today?
Speaker #3
She's just not getting better. Walking around the house all day, putting post-it notes with our names on everything, so we know who gets what when she's gone. I keep telling her she'll live us all.
Speaker #2
You never know, Mira, honey. Who'll feed the birds? Are you going to make sure the marigolds are watered enough? I have so many books piled up to read.
Speaker #4
Well, the good news is you'll have plenty of time for the books, and you'll be back to your garden in no time. The results from the biopsy tell us the mass is not cancer.
Speaker #3
Thank goodness.
Speaker #4
It is a pretty serious infection, though. It's caused by a bacterium called nocardia.
Speaker #3
An infection? In her brain? How on earth did that even happen?
Speaker #4
It's rare, really. but the earth is actually the likely culprit. These tiny creatures live in soil, decaying plants, standing water. We can breathe it in, sometimes without knowing. Or it can get in the bloodstream from a cut or abrasion. Any chance of exposure like this, Mrs. Patel? It makes me wonder about your garden. Unless you've been camping lately by any chance?
Speaker #3
Camping? I can't even imagine it.
Speaker #2
Oh, stop. Mira, we used to take you kids camping all the time. My garden? I spent hours out there. I had a small pond put in a while back. It never occurred to me.
Speaker #3
I knew that pond would be more trouble than it's worth. So, it isn't cancer?
Speaker #4
No. Difficult, yes, but not cancer. The treatment will be long. You'll be on antibiotics for a few months. But this is treatable, and we'll monitor you closely. Oh,
Speaker #2
thank God. I'm having that pond removed this week.
Speaker #1
Mrs. Patel was lucky. She got diagnosed before the nocardia caused any real damage. The mass was extracted, and so was the pond. The garden had always been her sanctuary, a place of beauty, love. But love, even of simple things, can open the door to strangers. Sometimes they arrive with gifts. Sometimes.
Speaker #0
You've been listening to Case Encounters. This story is inspired by a true medical mystery solved through collaboration, curiosity, and a pathologist. Names and locations are fictitious. Until next time, stay curious. The voices you just heard are those real pathologists, people who work long days and even longer weeks to solve medical mysteries big and small. To learn more about the work pathologists do for patients, visit yourpathologist.org. For a full list of the pathologists featured in this episode, those who advised the creation of this story, please visit the show notes. Case Encounters is a production of the College of American Pathologists. Creative support from Studio North. Produced and directed by Natalie Gregory. Sound design, editing, and original music by Jake Sorgen. Written by Paige Freeborn for Studio North.

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