Good news! You have lymphoma!

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.