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Sleep Apnea, Snoring, Narcolepsy,
Insomnia and Other Sleep Disorders.

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CASE VIGNETTE - 4.


Andrews felt shaky and simultaneously defensive. "What do you mean by that, Jack? You're trying to say I drugged this guy up or something?"

Tyler shook his head. "No, Bill. Look, I'm sorry. I shouldn't have said it that way. It was what Mrs. Waxman was saying."

"What?"

"That's partly why I came over to talk with you personally, Bill. I don't know what she intends to do, but she made a real scene in the ER. Seems like a decent woman, but she lost it. She was screaming, asking how on earth you could have done this to them. Something about how you already had jeopardized his job with whatever it was you had prescribed for him, and now, with that death, they stood to lose everything that they have."

"For God's sake, Jack--I didn't do anything! What on earth was she talking about?"

"That whatever it was that you gave him had been making him sleepy to the point that she couldn't get him up any more to get to work on time--that he had already gotten three warnings from his employer--and that he didn't seem to know what he was doing even when he was up on his feet. And she said that you had been the only doctor that her husband had even half-trusted."

Andrews flipped open Waxman's chart to his last office visit. "See, Jack. That's all I was giving him. Only new drug was the antidepressant."

"OK..." said Tyler. "Wouldn't be likely to be causing his asystoles. I'll call and tell them to go ahead with the pacemaker, if I can use your phone."

"Sure--but see, Jack? You wouldn't think that that drug in that dosage would make him all that sleepy, either. Would you? Most of my other patients seem to do fine on it."

"Yeah, you wouldn't think so in most people. I'm certainly not the one that you might have to convince on that point, though. I hope that the final results of the tox screen wind up providing an explanation."


They did not.
The only drugs in Waxman's system were reasonable levels
of those prescribed by Andrews and their metabolites.

Select from the following menu to continue...

What was wrong with Waxman? What clues could have led Andrews
to a correct and timely diagnosis?

What complications have been associated with this widespread condition?

How can harried physicians in a busy practice setting avoid
this frequently encountered pitfall?


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