Medical cases present with lots of puzzles of various sizes and here is one that I felt I should share.

One evening a young 25 yr old obese boy was brought gasping to my ICU , he was blue , his Oxygen saturation was just 40  and I immediately intubated him and put him on the ventilator. We were perplexed not knowing the cause as to why such a young fellow was brought in a state of respiratory collapse. He was senseless and totally non responsive.

We got his investigations done to ascertain the cause, there was obviously none and relatives could not really enlighten us on any past record. One lesson I had learnt in my medical college days was when you are unsure as to what you are dealing with , strip the patient completely and look for certain not so visible signs. And lo it was eureka – just below the chin there a  thin cut mark suggesting strangulation which was not obviously seen as it was within the fatty folds of his skin . We immediately got the local police into action . They promptly responded by scruffing up his realatives and then it was exposed that there were some local disputes in his village where this boy was acting tough on some people.

He was strangulated , so there was an obvious attempt of murder . The case was investigated and his murderers were identified and were punished but we unfortunately lost the patient.