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.
About Me
- Julia
- I've kept a personal blog for several years now, but wanted someplace where I could discussion more substantial issues and where I could wax poetically on my medical experiences without boring others.
5 comments:
Hi,
Found your blog through a comment you left, I think at 10/10.
It seems like it's been melanoma week in my life. Any chance you could elaborate on some of the symptoms? And was this a classic (freckles/light eyes candidate/20s-40s) candidate? Just curious -- hoping it'll help me when I start clerkships in the summer.
Follow-up:
I sound really, dreadfully impersonal in the above. I didn't mean it that way. I've known two people with metastatic melanoma who weren't diagnosed in time, and thought maybe learning the symptoms clinically might put me in a position to help someday.
K.
My patient presented with severe headaches and vision loss due to an intracranial bleed. Further images revealed several lesions there, which made melanoma on the differential, but there were several other cancers that were likely. At one point we were all convinced this was lung cancer of some kind. It was not an easy diagnosis--we only got the answer after the biopsy and the surgeon knew that instant because it was so black and necrotic.
My patient only fit the "20-40s" category... we never found a primary. This is why medicine will never become a"cookbook" formulation, because you will get patients that don't fit into neat little categories.
So.....were you going to inform me of your blogging? I just got your comment about the calendar picture voting. How have you been any way? Why didn't you call me when you were down here for Christmas....unless you didn't come down here. Your mom and dad both told me you were coming down to see Laura. So, I was waiting to get an email or something. But no.... Just teasing. Hope all is well. Nice to see you're alive and doing well Ms. Doctor. :) weird.
Hey...hope that you will get this message. I would love to try and catch up. Please call me. I work monday-friday next week, and have the weekend off. The 2nd is my last day at work, then have a little over a week to try and get us packed up. so call me.
480-705-0043 home
435-327-2316 cell
dez
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