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, October 06, 2008
If this post ends abruptly...
Note - I'm writing this in the hospital as I'm on call, so if it ends abruptly it means I got paged and have to run and was up all night and didn't get the chance to finish it.
While most of my call shifts have been pretty interesting, tonight seems to be very slow. So far, I've just been sitting around in the library, doing noth
Tuesday, May 20, 2008
Unleash the medical students.
I just found out that, should I pass my finals and make it to third year, within just a few months I'll be able to prescribe things and order some lab tests.
Here I thought you had to be a doctor to do those things. But no, they'll be letting me and my classmates, fresh out of the pre-clinical years of med school, play doctor. With real patients.
The best part is they're giving us plenty of time between us learning how to do these things... and us actually being on the wards.
That's right. Rather than putting us in the hosptial as soon as we have written our finals, which is when we have proven that we know which lab tests to order and which drugs to prescribe....ok, well, we've really more just demonstrated that we can memorize thousands of PowerPoint sides containing millions of trivial details (example: "in UK, 1 unit is defined as 8 grams absolute alcohol = .5 pint ordinary beer")...they've chosen to give us an entire summer to forget the relevant parts of medicine before they set us on the wards.
I'll even be allowed to order some investigations without permission: X-rays, electrocardiograms, most blood tests and cultures.
Don't get too concerned, though. I won't be handing out scripts for narcotics, heart medications, or medical marijuana anytime soon (note to friends: notice that last one, and please stop asking). Here's what I will be allowed to prescribe without permission:
Okay, you're probably a lot less worried now. And I'm not sure they even call it "prescribing" - it's no secret that anyone can buy all those things at a 7-11.
Still, I'll be able to write those things in the patient's chart...me, who doesn't really know anything about medicine yet...and the nurses will actually go ahead and give it to the patient.
Those poor, poor nurses.
I'm not sure who I should feel more sorry for... the nurses? or the patients?
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.
Sunday, September 30, 2007
Getting used to palliative patients might take some time.
For our clinical skills classes, we spend most of our time on actors / standardized patients, who come into our clinical skills training rooms at the hospital and we learn how to do basic exams on them.
However, the odd time we'll go onto an actual hospital ward and get the opportunity to examine symptomatic patients.
Last semester we were at the hospital practicing our cardiac exams on a couple of hospitalized patients. My group was assigned a patient who was really friendly, and such a great sport - she didn't complain once about the four medical students percussing and auscultating her chest, tapping for a lung here, listening for a murmur there, asking her to sit up and lie down, even though it was obvious that due to her bad back the ordeal wasn't entirely pain-free for her.
Over the twenty or so minutes we spent at her bedside, she told us more and more about her condition, but she also talked her life - her job, her family, and the things she enjoyed doing before she ended up in the hospital. She wasn't too old, and she was pretty coherent. She seemed like a really nice lady, and I really enjoyed the chance to get to know her.
After our exam, we went to the nurse's station with our physician tutor, who called up the patient's lab tests and CT scans on the computer. We talked a bit more about the patient - she had a few other conditions that weren't related to our cardiac exam which we briefly talked over - and then were ready to move on to the next one, when the doctor said something that hit me like a truck.
"So that's Mrs. Walters. With all of that going on in her body, she doesn't have much longer to live."
I was shocked. I had just spent twenty minutes with this patient. She seemed to be functioning cognitively pretty well, and I figured she was in the hospital getting fixed! Never in a million years would I have thought she was about to die.
The seriousness of her situation started to set in, and from a medical perspective I realized that yeah, if I had been given this patient as a narrative case, I probably would have figured out that the prognosis was dismal. But because I met the patient as a person first, and didn't know all the details of her condition while I was talking to her, I hadn't really thought about what her prognosis was. Even while our tutor was going through the patient's chart, listing her conditions, the impending outcome of the sum of her conditions never hit me until the doctor put it into those words.
I suppose that now that I think of it, I might as well get ready for my clerkship year next year, when I will be meeting dozens of patients on a regular basis - some of them who don't have much longer to live. I've never really been in that situation before, and I think it's going to take some getting used to.
