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Volume 18, Number 10—October 2012

Another Dimension

A Natural History of Infective Endocarditis, Preceded by Decompensated Chronic Liver Disease and Severe Community-Acquired Pneumonia
Indictment in Four Parts and with Right of Reply

Nancy L. MerridewComments to Author 
Author affiliation: The Alfred Hospital, Carlton, Victoria, Australia

Suggested citation for this article


His stalwart skin, sallow armor,
harbored memories and marks
of a difficult life.

His grave affliction, already perilous,
he endured alone—
ostracized by family and society.

His swollen belly, crazed by Medusa,
pouted taut as artificial breaths
stretched rankled lungs.

His seasoned vessels, illicit euphoria’s labyrinth,
adorned with plastic portals
infused antidote.

His cloying blood, claret lately poisoned,
delivered assassin to lair—
Duke in silent carriage alighted at the chamber.

** ** ** ** **

TWO.Malice Aforethought

His haughty foe, ignoble despite the Criteria,
stole a vantage of supreme command
at the Greatest Vessel door.

His insistent heartbeat, two sounds once discreet,
in rhythmic phrases murmured
remarks of furtive progress.

His ardent doctor, genius clinician,
lifted stethoscope to precordium—
message received.

His pliant pulses, company accommodated—
Watson struck and shuddered,
Corrigan thumped and ebbed.

His teeming veins, mercurial blood extracted,
yielded Duke’s identity
for precise retaliation.

His shriveled Liver, nominally ironic,
sacrificed to intoxicated sanctuary—
Child-Pugh C proscribed surgical reprieve.

His adept assailant, though exposed for battle,
abetted by fickle liver
retained advantage for the coup.

** ** ** ** **

THREE.Progressive Assault

His heart, excavated by festering mercenaries,
inexorably leached
their venomous arsenal.

His body, conscripted slave to advancing legion,
appointed satellite outposts—
Streptococcal Empire rising.

His scent, previously acrid,
drifted metallic—
life corroding.

His brain, shadowed by grim delirium;
encephalopathic, embolic, prophetic—
entombed within cranial vault.

His eyelids, fluttering shrouds,
veiled infinite irises, icteric globes and
retinas maligned by immunity.

His urine, once flaxen,
oozed vermillion—
tributary of beckoning Rubicon.

His skin, chameleon canvas—
flushed lesions and jaundice
defaced faded tattoos.

His fingers, pulps mottled carmine,
uniquely etched tips
reached to probe oblivion.

His nail-beds, fleshy Rosetta,
signaled the secret
in flecked hieroglyphs.

His palms, unaccustomed to prayer,
denied redemption—
pocked, they too bore stigmata.

** ** ** ** **

FOUR.Homicidal Ascendancy

His surgical saviors, glinting mirage,
could offer no cure
except hastened demise.

His thwarted physicians, ashen surrender—
our elixirs no match
for the adversary.

His recalcitrant Duke, relentless,
accomplished unsavory
feats of cardiac passage.

His core engine, chambers thus connected,
ramped to fuel abscessed conduit—
blood roared relentlessly.

His slumped neck, kinetically possessed—
terminally mutilated muscle’s
futile beats rocketed and ricocheted.

His uncanny figure, cadaveric,
inevitably bloated;
Starling forces prevailed.

His sodden lungs, emancipated from machines,
hissed and spluttered
beneath swelling king tide.

His dying breaths, labored then whispered,
dim light obscured final chest fall—
curtains drawn, despite the summer sun.

His only visitor, a community case worker,
absent that day.
Alone when he succumbed to the darkness.

** ** ** ** **

Audi Alteram Partem

Virulent villain—do you admire your conquest?

Dr. Merridew is a trainee in internal medicine at The Alfred Hospital, Melbourne, Australia. Her research interests include infectious diseases, public health, and medical education.

Suggested citation for this article: Merridew NL. A natural history of infective endocarditis, preceded by decompensated chronic liver disease and severe community-acquired pneumonia. Indictment in four parts and with right of reply. Emerg Infect Dis [Internet]. 2012 Oct [date cited].

DOI: 10.3201/eid1810.AD1810

Table of Contents – Volume 18, Number 10—October 2012


Please use the form below to submit correspondence to the authors or contact them at the following address:

Nancy L. Merridew, The Alfred Hospital, PO Box 1292, Carlton, Victoria 3053, Australia

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