Who really failed?

Nurse: So, does she really have late stage cancer?
Me: Probably, its not looking very good.
N: When where you guys going to let her know about what you think?
M: Oh, you mean she doesn't know?
N: She doesn't have any idea.
M: Right, I'll get on that.

An anxious discomfort gnawed at my gut. I paged my senior resident who told me just to go ahead and let her know we thought it might be cancer but still had to run more tests (classic cop out doctor line . . . more tests.) In med school you practice 'breaking bad news', but its with actors as patients and your classmates are on the other side of the 2-way mirror ready to give you feedback.

A soft-spoken artist in her late 50s had come to the emergency department vomiting, abdomen distended, complaining of gradual weight loss over the last year, drenching night sweats, and weakness. She had a bowel obstruction. When I felt her stomach later it had a huge tender irregularly shaped mass that went from her pelvis to above her belly button. She hadn't been feeling well for a long time she said, but enemas and vitamins from her naturopath had been helpful on and off. On further questioning she had actually had menstrual bleeding for the last six years. We were always taught that bleeding after menopause means uterine cancer until proven otherwise. Imaging showed nasty necrotic masses. On exam foul smelling pus and blood oozed freely from her cervix. She had known she hadn't been well, but earlier in life had been seriously scarred by her interactions with the medical system and had avoided it at all costs. I felt this woman deserved so much more than what a two week-old doctor could give.

So I went to talk with her now that she had been up on the ward for a day. After pleasantries about her orchids and art, nausea and pain, I tried to explain some things.
Me (outside voice): We're worried this might be cancer in your uterus.
Her: Oh, so what's next?
Me (inside voice): If it was me I'd just take off into the wilderness and spend my last months surrounded by beauty . . . or maybe sky-diving, hmmmmm . . .
Outside voice: We'd like to do some more tests to see what our options are.
Her: Do you think its bad?
Inside voice: Bad? No, not bad, try horrific. Or maybe more of a tragic injustice of unimaginable consequence!
Outside voice: We don't know, but it does sound like you've been sick for a while.

She asked a few more questions, which I could only answer in the same evasive manner. We were transferring her to the cancer center and they would admit her there. But then she was quiet . . . pensive, overwhelmed, swimming in this new reality. What was going through her head? Anger? Regret? Sadness? Or a complete unawareness of what was happening?

I suppose it was tempting to join my colleagues in the anger band-wagon, to say that alternative medicine practitioners do more damage than good, that they even kill people and should be held responsible. But instead I was overwhelmed with sadness. Sadness that we had failed this woman. Bleeding for six years. In unexplained pain for over a year, and yet she would not come see a doctor until she was in agony, unable to even eat. What damage had Western medicine done to her in the past that she was so hesitant to seek help?

Maybe if we had listened, maybe if she had been heard years ago. Then I would be meeting her at an art show not sitting on her bed with the curtain drawn around it in a muggy shared hospital room. I'm going to wipe the image of the weak pale woman laying powerlessly in a foreign bed from my mind and replace it with a vibrant artist molding a creation out of clay on a potter's wheel in a rustic home in interior BC.