Well, I have some good news and some bad news... The bad news: you cancer, but the good news is that its lymphoma!
I recall standing next to my attending at the gyne oncology clinic as an elective medical student in complete disbelief at the words that had just come out of her mouth. The poor patient dissolved into tears. She had been pacing back and forth with too much back pain to sit in the chair next to her husband, a result of massive lymph nodes pressing on her psoas muscles.
A hideously awkward discussion ensued where the attending (sickeningly upbeat and logically) explained that lymphoma had a drastically better prognosis than ovarian cancer, so it was a better cancer to have really. The whole time the poor patient's husband tried to refrain himself from punching said attending in the face. Or maybe that's just the fly-on-the-wall little medical student's interpretation of what happened. My attending then did a smooth punt and turf to medical oncology despite the sobbing patients request for answers.
I remember feelings of helplessness washing over me, overcome with empathy for this hurting woman and anger towards a frankly ridiculous attending. It was in the midst of a frigidly cold elective in Ontario during which I was supposed to be impressing people but felt achingly lonely and completely incompetent for the entirety of the rotation.
Last night I had a vivid flashback on call at the Death Star. The emergency physician called me to see a woman with "new onset metastatic ovarian cancer" who had recent growth of parotid (jaw), neck and axillary lymph nodes (and of course, a mass in her pelvis). It felt like a case of: "patient has vagina, please see in consult." She was young, and as I spoke with her and her husband the fear was palpable. A single tear slipped down her cheek as she answered my questions. The truth was, the chance of her having ovarian cancer was slim to none as further investigations confirmed, gyne oncology was not the service that could help her. Unfortunately Dr. DoucheBag McEgo was the internal medicine Sr resident and it took three heated discussion, four hours and a (useless) consult with hematology for him to admit the patient. My blood was boiling with Dr. McEgo's passion and determination to turf this lovely patient to anyone but his team.
Hours passed, internal med finally saw her but as I walked by to see another patient, her husband grabbed my arm, looking for answers. What's going on? Does she have cancer? Is she going to die?
Leaving the post-partum lady with a fever and the palliative patient with metastatic uterine cancer who now had a lung full of fluid, I sat on her stretcher and laid it all out for them. Yes, right now it looks like lymphoma, but there's treatment for this. The husband curled up in fetal position crying. My heart broke a little...maybe a lot, but it felt like I was actually doing something useful. Not turfing, not fighting to get rid of patients, but being present in the pain, messy as it is. I'm not scared of tears anymore and I'm no longer just a witness to it all.
Saturday, October 30, 2010
Friday, October 1, 2010
Full Circle
February 14th, 2008 Vancouver was enveloped in its standard winter cloak of gray clouds and cold rain. Although, even that I was only aware of cycling in the drizzle to work in the dark mornings for 6:30am rounds, leaving as light left the sky in the evenings. Exhausted and drained from another day at the Death Star. There was a haze in my eyes and my head ached, I was on call that night and groaned inwardly when the oncology fellow paged me to go to Emergency to see a patient.
She was a woman in her early 50s, who after a long post-operative recovery from ovarian cancer debulking surgery had now developed an abscess. She was febrile and in significant pain, accompanied by her husband. She was also a physician, as was her husband a fact I knew from her lengthy admission to the service.
The most amazing thing happened that night. Though her own pain and fear, she focused on me as a person. How is residency going? What type of practice are you considering? What are you struggling with? What do you love about the specialty? I stood next to her stretcher in the emergency department, examining her, explaining the CT scan she would get and the antibiotics she would be on, all the while completely floored. Here was my patient, a physician no less, taking the time to recognize my humanity, something no one else had taken the time to do that whole year. I remember the night vividly.
September, 2010 Why don't you see the next patient? She's a doc so make sure she's okay seeing residents first. And there she is as I walk in the room. A warm smile on her face, her arms tanned from the sun, positively glowing despite a recent recurrence and chemotherapy. Hey! I know you, February 14th. Were her first words to me. You saw me on the night I was readmitted to hospital!
I couldn't help but recount to her how she had recognized the person-hood of a junior resident in the middle of the night in the emergency department and in doing so had renewed my faith in a healing vocation. We can't cure her cancer, but nothing about her suggests a dying woman, she is living and vibrant, full of hope and laughter. And so I come full circle.
She was a woman in her early 50s, who after a long post-operative recovery from ovarian cancer debulking surgery had now developed an abscess. She was febrile and in significant pain, accompanied by her husband. She was also a physician, as was her husband a fact I knew from her lengthy admission to the service.
The most amazing thing happened that night. Though her own pain and fear, she focused on me as a person. How is residency going? What type of practice are you considering? What are you struggling with? What do you love about the specialty? I stood next to her stretcher in the emergency department, examining her, explaining the CT scan she would get and the antibiotics she would be on, all the while completely floored. Here was my patient, a physician no less, taking the time to recognize my humanity, something no one else had taken the time to do that whole year. I remember the night vividly.
September, 2010 Why don't you see the next patient? She's a doc so make sure she's okay seeing residents first. And there she is as I walk in the room. A warm smile on her face, her arms tanned from the sun, positively glowing despite a recent recurrence and chemotherapy. Hey! I know you, February 14th. Were her first words to me. You saw me on the night I was readmitted to hospital!
I couldn't help but recount to her how she had recognized the person-hood of a junior resident in the middle of the night in the emergency department and in doing so had renewed my faith in a healing vocation. We can't cure her cancer, but nothing about her suggests a dying woman, she is living and vibrant, full of hope and laughter. And so I come full circle.
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