March 12, 2010

• All I can do.

  In another milestone in my medical career, I got to tell someone today that they have cancer. Someone who was very unaware of this fact.

  This particular gentleman came in with abdominal pain. A pretty nonspecific symptom. following my clinical experience and the general practice guidelines we did a history and imaged him…and his liver was riddled with tumors. Big ones. like the size of grapefruits, and the liver itself is not a particularly large organ.

  I thought I went about it okay. I hope I went about it okay. I asked him what he knew about what he had found out, and then basically told him straight out that he had a number of tumors in his liver. I didnt use one of those classic lead in phrases like “I have some bad news, or i’m sorry to tell you this.” Maybe I should have, but I would hate to hear that. every time someone asks me if i have a few minutes to talk, I always want to say no, because I know what i hear next I am not going to like.

  I stayed in the room with him for a while. I held his hand. I didnt say anything after that, because what would I say? It’s not like he would hear any of it. He asked me how long he had.

  How the hell am i supposed to answer that. My training did not include eyeballing people’s expiration dates. I told him the appropriate doctorly things…we have consulted the appropriate specialists, we will do everything we can, dont give up hope. All the things we are supposed to say but faced with the reality, who really believe me? Then he dialed his wife and brother and he asked me to tell them as he couldnt. How do you say no to that?

  So I had to have the same conversation I just had with him, but over the phone and with people who never met me. I was just the disembodied doctor over the phone.

  “I’m sorry but your husband has cancer.”
  “I’m sorry but your brother has cancer.”

  It’s been a pretty rough month with patients like these, not to mention some things going on in my personal life-see previous entries. For all the joking and lightheartedness I post here, I sometimes wonder if I am in the right field, if I should have gone into cooking or acting or something else instead. And when I am only a year into residency, that can be a pretty scary thought to have at this stage in the game.

  All I can do is have faith that the next day brings something to remind me why I love this.

  All I can do is wonder.

  All I can do is hope.

  • 12:38 am
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