She was one of those 'natural' people, who always wanted to do things naturally, and even the odd x-ray terrified her. Too much radiation. She once wore a cast on her arm for 6 weeks after falling off a horse, for what could have been just a sprain, just to avoid the two x-rays it would have taken to rule out a fracture.
So, obviously, getting a mammogram was out of the question.
Her doctor tried over and over again to explain to her that a mammogram gives you a very minimal amount of radiation, the same amount as living in a city for 7 months (0.7 milliseverts) - the average U.S. citizen is exposed to 3 mSv per year of 'background' radiation.
The mammogram would have picked up her breast lump long before she felt it, long before it was diagnosed as cancer, and long before she would have to get her breast surgically removed.
A few years later, she started losing weight suddenly, then one day coughed up a startling amount of blood. She had never smoked, so lung cancer never even crossed her mind. Fortunately the radiation dose of 1 chest x-ray (0.1 mSv) no longer scared her, given her past experience, so she got the x-ray her doctor recommended to check it out. Unfortunately, however, breast cancer can spread to the lungs, which is what her doctor found on the x-ray. She died a few weeks after I met her in hospital, surrounded by her family, and countless beautiful flowers and cards showing how much she would be missed.
The week before she died, she said to her doctor over and over, over the sound of her oxygen and between short, gasping breaths, "I should have listened to you. I should have gotten that mammogram."
I had a conversation with another patient last month who is younger than my dad, an incredibly friendly and cheerful man, who is dying because he was too afraid to have a doctor stick a finger up his bum. Had he done that, his prostate cancer would have been discovered a long time ago, long before the it had the chance to spread to his spine, ribs, and legs, forcing him to live his last few months unable to get out of bed and suffering from excruciating pain every time he tried to take a breath. While you are celebrating Christmas with your family this year, his family will be celebrating their first Christmas without him.
It takes a lot to wrap my head around the fact that I am meeting and treating patients who will be dead very soon.
It's harder to accept the fact that a good number of these patients, who drink litres of alcohol a day, smoke like a chimney, don't get off their couches, and especially those who don't bother getting screened for cancer, could have had much longer lives.
Yeah, the screening tests we have aren't perfect, and some of them are uncomfortable and seem a bit undignified. But they do save lives, and so if you are in that age group, there is no excuse to not get them done.
This is not the place to get medical advice, so talk to your doctor about getting a prostate exam, a pap smear, or a mammogram. Sooner rather than later, please.
Sunday, October 12, 2008
She was one of those 'natural' people, and the odd x-ray terrified her.
Monday, July 21, 2008
Sometimes it seems as though the world's greatest people are dealt the worst hands in life
Happy birthday Dad!!!
The flight paramedic I worked with this week started his job the year I was born. He has seen patients of all sorts, at all stages in life, with all sorts of background stories. Yet, the story of the patient we flew into the big city, and what she did right before we loaded her onto the helicopter, he told me later really moved him.... something that means a lot considering how hardened he is and how much he has seen.
Actually, considering the several shifts I've had with the flight paramedics over the years, I have been surprised at how sensitive they are to their patient's needs while serving in a job that could have the tendency to see them slip into the mindset of a courier transporting inanimate packages. Even in the little things. "You're gonna feel a poke here" is something the lab tech should have said (many times) when she was digging to find a vein; instead, it was the paramedics who were keeping an eye out for the patient in that time. Treatment of a patient like a pincushion is something you never want to see... it is even harder to watch when the patient receiving the bludgeoning had been admitted for treatment of a suicide attempt.
But back to this inspiring patient.
It was a sweltering day in the city, and I had been regretting trying to dress nicely to impress the paramedics beacuse in my pants and long-sleeved shirt I was doing more sweating than shadowing. I wished we could stay in the air-conditioned ambulance station at the airport but instead when the pagers went off. I was hoping for an exciting scene response trauma call, but no, we had to head to the helicopter to answer yet another boring transfer call.
Rachel, a 33-year-old mother of two, was being brought in to the big city to see a specialist for a growth in her throat. It hadn't been biopsied, but it was pretty obvious to everyone that it was the cancer coming back.
You see, ten years ago, after a dental procedure, she started having trouble swallowing some foods. She ignored it for a few days because she assumed it was inflammation left over from her root canal, but it didn't go away, and finally looking in the mirror with a flashlight revealed a growth that made her weak at the knees. Her worst fears were confirmed when she was given the diagnosis of cancer.
The tumour grew incredibly fast, and she soon lost feeling in her face, control of her facial muscles, and had to soon start eating through a tube. That seemed like a minor inconvenience when she had to have a tube put into her throat because the tumour was blocking her airway. Surgery was attempted, followed by chemotherapy and radiation, which took the pressue off her trachea and allowed her to breathe again, but left her bedridden.
Then, miraculously, her strength began to come back, and so did the feeling and control in her face. She soon was talking, sitting up, then standing. Nobody seriously expected the day to come when she would leave the hospital, but she did... walking entirely on her own.
Unfortunately, the road to recovery soon came to an end. Three years after that, shortly after the birth of her second son, the cancer relapsed, this time much worse. It had spread to the bones in Rachel's vertebrae, paralyzing her from the waist down. Again, she had to undergo surgery, chemotherapy, and radiation. And, amazingly, against all odds, she again had a complete recovery, more miraculous than the first - all of the feeling and mobility in her legs returned. She could walk again!
It would have been nice if it could end there, but the story goes on, and not in the direction anybody would want for her. Earlier this week Rachel was having dinner with her family when she got some food stuck in her throat and started choking. She was unconscious for some time before anyone could revive her, and the preliminary tests suggest that not only was the cancer returning, but she had lost some cognitive function while her brain was deprived of oxygen.
Right before we picked her up to take her to the big city for some more tests, a few more results came in. It seemed as though the tumour was growing around some crucial arteries and veins, and that surgery would not be able to reach it. Treatment this time around, if any, would likely be palliative.
Despite all of this, she was one of the most genuinely nice people any of us had ever met. She thanked all of the paramedics profusely, and didn't complain about anything. "Thank you for serving me," she said to the paramedic I was shadowing as we took her into the hospital. He replied, "No, you have been the one serving me."
When it comes to life, it seems that sometimes it's the world's greatest people that end up getting dealt the worst hand. I don't know how I would cope if I had to go through everything she had in the past ten years. She truly put a face to courage and grace, and since then I have found myself remembering her every time I think I have it rough with traffic or something else minor in comparison.
Like I said, though, the paramedic told me he was also really moved by something she did right before we loaded her onto the helicopter. As we pulled her out of the ambulance, and were readying the aircraft's stretcher support, she did something that made me regret cursing the sun the whole day. She was strapped in to her stretcher, but her arms were free, and she spread them out and looked into the sky. "It is such a beautiful day," she said. "I love the sun!" And, knowing full well that she would likely be on a cancer ward for the next several weeks or months, and that this could be the last time she would be at home, she added aloud with the most beautiful smile on her face, "And who knows when I'll see it again."
Tuesday, February 05, 2008
"The chemotherapy hasn't helped yet, but I can beat this."
In yet another assignment to hone my interviewing skills, I found myself on a hospital ward this week asking a charming patient about her medical conditions. Though it wasn't what had brought her to the hospital this time around, I soon found out this fairly young lady was battling pancreatic cancer, and could no longer work due to the severity of her condition.
"I come in twice a week for my chemotherapy. It hasn't really helped yet, but I don't think I've been on it long enough for it to start curing the tumor," she said, fidgeting with the Natural Cures for Cancer book on her lap. "I'm pretty optimistic that I can beat this."
I was inspired by the patient's courage. Given her dismal condition, it was nice to see there was a ray of hope promised by the treatment.
Before I presented the patient's story to my preceptor, I obtained some collateral information from the chart as I had been asked. From what I read there, however, any ray of my hope in my mind quickly dimmed.
I'd had a feeling during the interview that something wasn't quite right. While I'm not a doctor yet, let alone an oncologist, I do know that pancreatic cancer is pretty serious. But, I had taken her on her word that there was an encouraging outlook. Perhaps her type of pancreatic cancer responds well to chemo, I thought.
What I found in her chart confirmed my initial suspicions:
"Patient has Stage IV advanced pancreatic adenocarcinoma, receiving palliative chemotherapy."
Though palliative chemotherapy can help with the pain and other symptoms of cancer, it's not provided with the intention of "curing the tumor."
Maybe nobody ever fully explained to her the role of palliative chemotherapy. Worse yet - heaven forbid - maybe she hadn't even been told that her therapy was palliative.
But the situation probably wasn't either of those. Because right after that, the physician had written,
"Patient is in denial with regards to her condition, despite numerous discussions regarding prognosis."
When I discussed the case with the doctor, he explained it to me another way. "Barring a miracle, the flowers in her room will last longer than she will."
I still wonder if I should've gone back to her room to say goodbye.
