It was quiet, and gave me time to review files, figure out my day and have a quiet cup of coffee before the day turned frenzied.
A knock on my office door and in came a colleague's nurse, clutching a sheet of paper. She said she was getting a patient ready for the first appointment of the day and had done a pulmonary test, a flow-volume loop for Jeff to read. "I've done it several times, and it always looks like this!" she exclaimed.
Now, normally a FVL looks like this, at least in general terms:
I looked at the report she was holding. It looked like this:
I resisted the impulse to turn the sheet upside down. After a moment I looked up. "Judy" I said, "You've hit the jackpot. Jeff is going to present this at the next ATS conference, I'm betting. You've just diagnosed the one in a million patient." I paused for effect. "This patient's lungs are upside down inside their chest!" Her eyes were wide. "Take this back to Jeff and tell him what you've discovered. He'll probably give you a raise." I handed the report back. She hurried off.
Now, the test is done with a fleisch pneumotach. It looks something like this:
See the two tubes connecting to the port on the bottom? She had no doubt reversed them when she assembled it for the test.
I was just starting rounds when my pager went off (remember pagers?). It was one of those that messages could be sent via text. From Judy, it had only one word, an anatomical reference far south of my pulmonary specialty.