I'm so sorry. I forgot.
You were such an enigma of symptoms that I got caught up in working you up, and then when it took me so long to get all of the different consult teams involved, it almost became a comedy of errors when I came to see you in the morning. "Sorry, Radiology thinks we need to get this one test, Surgeon X thinks that it's too small to biopsy, Team Y doesn't think it's anything serious." I was so excited when I got the right people to see you, the right consult, the right tests. Things came together. I got the tissue and sent it off to pathology and was excited when finally, after weeks of uncertainty, I had the diagnosis.
Melanoma. Finally, I could call in that last consult to hematology/oncology and start you on the right treatments. Until I realized. Metastatic melanoma. Stage IV. There were no treatments that could cure you. You, young and healthy, you are going to die and I can't do anything to change that.
I'm sorry. I'm sorry that I couldn't tell you that you are going to die. I'm sorry that I couldn't tell you that there isn't a cure. I know that I failed you as your doctor by being less than honest, by leaving that task to the cancer doctors. I couldn't do it, because I had already sat in the team room and cried and there was no way that I could maintain composure if I had been the one to say the words. I'm sorry, because suddenly this was personal and all I can think of is the two little kids you'll leave behind and the fact that with your limited days, you had to spend too many of them in the hospital, waiting for us to do the detective work and I had been so flippant and rushed in my morning assessment that I forgot that we are human and frail. And maybe that's the hardest part of all.
Thursday, November 08, 2007
Sunday, August 12, 2007
Hero worship
There are few physician-writers who I admire more than Atul Gawande. I seriously considered driving through a blizzard to have the opportunity to shake his hand and obtain his signature. And I would have done it if I had gotten out at a decent hour... and they hadn't closed the freeway.
To all of those in the medical profession, I strongly recommend that you pick up a copy of his book Complications: A Surgeon's Notes on an Imperfect Science and then following it up with reading Better: A Surgeon's Notes on Performance. Dr. Gawande has the amazing ability of presenting a balanced argument to many sides of a complex issue, and yet still guiding you to the conclusion that he wanted.
To those of you not in the medical profession, well, I recommend that you pick them up as well. I had my friends read Complications for our monthly book club and they loved it. If you want to get a good introduction to some of his writings, he has a selection that appeared in The New Yorker linked to on his website. I highly recommend "The Way We Age Now" and I recommend printing it out and giving it to the elderly people in your life.
Recently, Dr. Gawande has been the guest opinion commentator at The New York Times. His views on the problems of our health care system are well worth a read and careful contemplation. Unfortunately, you can only access them if you have a subscription to the Times. Luckily for you, I scrounged around the internet and found links to the articles.
The Power of Negative Thinking
Can This Patient Be Saved
Curing the System (which along with his review of Sicko is one of the best commentaries on the complexity involved in health care reform.
Bad Medicine Sneaking In
Doctors, Drugs and the Poor
Let's Talk About Sex
Rethinking Old Age
A Katrine Health Care System
The Obama Health Plan
Happy reading!
To all of those in the medical profession, I strongly recommend that you pick up a copy of his book Complications: A Surgeon's Notes on an Imperfect Science and then following it up with reading Better: A Surgeon's Notes on Performance. Dr. Gawande has the amazing ability of presenting a balanced argument to many sides of a complex issue, and yet still guiding you to the conclusion that he wanted.
To those of you not in the medical profession, well, I recommend that you pick them up as well. I had my friends read Complications for our monthly book club and they loved it. If you want to get a good introduction to some of his writings, he has a selection that appeared in The New Yorker linked to on his website. I highly recommend "The Way We Age Now" and I recommend printing it out and giving it to the elderly people in your life.
Recently, Dr. Gawande has been the guest opinion commentator at The New York Times. His views on the problems of our health care system are well worth a read and careful contemplation. Unfortunately, you can only access them if you have a subscription to the Times. Luckily for you, I scrounged around the internet and found links to the articles.
The Power of Negative Thinking
Can This Patient Be Saved
Curing the System (which along with his review of Sicko is one of the best commentaries on the complexity involved in health care reform.
Bad Medicine Sneaking In
Doctors, Drugs and the Poor
Let's Talk About Sex
Rethinking Old Age
A Katrine Health Care System
The Obama Health Plan
Happy reading!
Wednesday, April 04, 2007
National Poetry Month
The month of April has been set aside as National Poetry Month. I'm not one for celebrating the "themes of the month," I don't have the time nor the memory to dedicate an entire month in the rememberance of a particular people or event.
A couple of weeks ago, however, I subscribed to the mailing list for "The Writer's Almanac", a daily radio show (and now podcast), spoken by Garrison Keillor, whose voice contains the magic to sooth away stress and hurts of daily life. Each day, he recites a poem and talks about important events that have happened that day in literature history. In browsing the archive, I stumbled across this poem, that I thought was fitting for this blog.
Cases
Man in his late seventies comes in with his wife,
weak, lost twenty-five pounds, can't eat, hard to talk,
seeing double off and on past eighteen months,
been to a family doctor and two specialists.
They don't know, I've got some ideas. It's
beyond my scope, here in the rural north country.
I get him tucked away in the medical center
by the following morning. He's out in five days
with a diagnosis, I was right for once. He's
eighty percent better on treatment, says
he's two hundred percent. Gives me the credit
for once. The gray hair helps. Man comes in
to emergency with loss of vision in one eye.
works full-time, in his sixties. It goes away
and he wants to go home. Internist and eye doctor
find nothing. I find something and say, No.
Family says I'm overreacting but they all agree,
reluctantly. Urgent angiogram-surgery on the
neck arteries is booked for the following morning.
That night his opposite side becomes paralyzed.
Emergency surgery cleans out a nearly
blocked vessel. They don't appreciate the
postoperative pain. They don't appreciate my
style or anything about me. He walks out
saved from an almost certain permanent
disability. Woman comes in with a headache,
high blood pressure, in her fifties. I do a spinal,
few red cells, radiologist gets me on the phone.
He says the CAT scan's negative, I'm not
so sure and send her down country for an
angiogram. Radiologist was right and I was
wrong — no aneurysm in her brain. Young
mother of two comes in with seizures hard to
control all her life, and paralyzed on the right side
from birth. I consider a CAT scan a waste of money:
the gray hair stands for experience, remember?
She gets slowly worse over the years. Her family
doctor does a CAT scan, finds a malformation
of the brain. We just ain't so smart, my old
teacher used to say when I was an intern. A man
comes in, in his sixties, can't work, losing weight,
muscles are twitching, hard to swallow, hard
to talk. Do some tests, tell his wife and him
he's got Lou Gehrig's Disease, it will affect
his breathing, he's going to die, it will be
tough, we'll try some things. We do, he gets
worse, can't walk, can't feed himself.
I visit the house: a small cape with a screened
Porch behind a variety store in a small town in
New Hampshire. He gets worse, I
visit some more, talk some to him,
to his wife and son, the man dies.
~~Parker Towle, from Body Language. © The Library of America
(To read more poetry or to subscribe to podcast or email list for The Writer's Almanac, please visit http://writersalmanac.publicradio.org/)
A couple of weeks ago, however, I subscribed to the mailing list for "The Writer's Almanac", a daily radio show (and now podcast), spoken by Garrison Keillor, whose voice contains the magic to sooth away stress and hurts of daily life. Each day, he recites a poem and talks about important events that have happened that day in literature history. In browsing the archive, I stumbled across this poem, that I thought was fitting for this blog.
Cases
Man in his late seventies comes in with his wife,
weak, lost twenty-five pounds, can't eat, hard to talk,
seeing double off and on past eighteen months,
been to a family doctor and two specialists.
They don't know, I've got some ideas. It's
beyond my scope, here in the rural north country.
I get him tucked away in the medical center
by the following morning. He's out in five days
with a diagnosis, I was right for once. He's
eighty percent better on treatment, says
he's two hundred percent. Gives me the credit
for once. The gray hair helps. Man comes in
to emergency with loss of vision in one eye.
works full-time, in his sixties. It goes away
and he wants to go home. Internist and eye doctor
find nothing. I find something and say, No.
Family says I'm overreacting but they all agree,
reluctantly. Urgent angiogram-surgery on the
neck arteries is booked for the following morning.
That night his opposite side becomes paralyzed.
Emergency surgery cleans out a nearly
blocked vessel. They don't appreciate the
postoperative pain. They don't appreciate my
style or anything about me. He walks out
saved from an almost certain permanent
disability. Woman comes in with a headache,
high blood pressure, in her fifties. I do a spinal,
few red cells, radiologist gets me on the phone.
He says the CAT scan's negative, I'm not
so sure and send her down country for an
angiogram. Radiologist was right and I was
wrong — no aneurysm in her brain. Young
mother of two comes in with seizures hard to
control all her life, and paralyzed on the right side
from birth. I consider a CAT scan a waste of money:
the gray hair stands for experience, remember?
She gets slowly worse over the years. Her family
doctor does a CAT scan, finds a malformation
of the brain. We just ain't so smart, my old
teacher used to say when I was an intern. A man
comes in, in his sixties, can't work, losing weight,
muscles are twitching, hard to swallow, hard
to talk. Do some tests, tell his wife and him
he's got Lou Gehrig's Disease, it will affect
his breathing, he's going to die, it will be
tough, we'll try some things. We do, he gets
worse, can't walk, can't feed himself.
I visit the house: a small cape with a screened
Porch behind a variety store in a small town in
New Hampshire. He gets worse, I
visit some more, talk some to him,
to his wife and son, the man dies.
~~Parker Towle, from Body Language. © The Library of America
(To read more poetry or to subscribe to podcast or email list for The Writer's Almanac, please visit http://writersalmanac.publicradio.org/)
Tuesday, March 20, 2007
Searching for butterflies
NHS Blog Doctor: Who breaks a butterfly upon a wheel? (Trackback link)
This past week, I clicked on the website of one of my favorite medical bloggers, Barbados Butterfly (http://barbadosbutterfly.blogspot.com), and to my dismay came to a page stating that the blog was only opened to invited readers, and I, completely unknown in the medical blogsphere was certainly not one of the elite. I was saddened. I read Barb's blog on almost a daily basis. As a newly graduated medical student, I virtually memorized her "Tips for Interns" because while I was not in a surgical field, these were vital tips for anyone fresh and green embarking into the medical world.
One of my faults is that I'm as curious as a monkey. I couldn't just let it rest that she had decided to close off her blog, I had to find out what happened to her. In a past life I must have either worked as a tabloid reporter or a sleuth (those skills do come in handy in medicine!). A quick google search revealed the above post. I guess that was my answer.
In interest of learning more, I clicked on the links that also discussed her disappearance and wished her farewell ... and quickly noticed something. Take a look at the various goodbye posts:
The Girl with the Stethoscope
Dust In the Wind
Dr. Dork
MSSP Nexus
Hmm.... there is one happy little anonymous around here! And the final link, that caused the secret to be revealed:
Tea at Ten
The same smiling anonymous who just happened to know all of the verses to "Call a Code." Coincidence? I think not.
I think I won't be deleting her from my list of bookmarks just yet, because I have a feeling that Barbados Butterfly will be unfurling a new set of wings.
:)
This past week, I clicked on the website of one of my favorite medical bloggers, Barbados Butterfly (http://barbadosbutterfly.blogspot.com), and to my dismay came to a page stating that the blog was only opened to invited readers, and I, completely unknown in the medical blogsphere was certainly not one of the elite. I was saddened. I read Barb's blog on almost a daily basis. As a newly graduated medical student, I virtually memorized her "Tips for Interns" because while I was not in a surgical field, these were vital tips for anyone fresh and green embarking into the medical world.
One of my faults is that I'm as curious as a monkey. I couldn't just let it rest that she had decided to close off her blog, I had to find out what happened to her. In a past life I must have either worked as a tabloid reporter or a sleuth (those skills do come in handy in medicine!). A quick google search revealed the above post. I guess that was my answer.
In interest of learning more, I clicked on the links that also discussed her disappearance and wished her farewell ... and quickly noticed something. Take a look at the various goodbye posts:
The Girl with the Stethoscope
Dust In the Wind
Dr. Dork
MSSP Nexus
Hmm.... there is one happy little anonymous around here! And the final link, that caused the secret to be revealed:
Tea at Ten
The same smiling anonymous who just happened to know all of the verses to "Call a Code." Coincidence? I think not.
I think I won't be deleting her from my list of bookmarks just yet, because I have a feeling that Barbados Butterfly will be unfurling a new set of wings.
:)
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