The human side of medicine

I spent the morning in medical oncology. I was handed a chart and told to go talk to the patient and find out how things were. We glanced at the most recent biopsy report. It read "invasive ductal carcinoma, nuclear grade 2 of 3." If that scares you, it's supposed to. I was seeing my patient post-surgery for removal of the lump and dissection of her axillary lymph nodes (the ones in her arm-pit).

I enter the room. Her and her husband are visibly worried but they agree to be seen by me before the staff physician. She seems to be doing well. The two of them are very pleasant people, and they even crack a few jokes. She looks perfectly healthy aside from the staples that are still present in her almost-fully healed wound. They ask me if I have the results from her surgery. A part of my heart sinks. She already knows that she has invasive cancer but the surgery and axillary dissection are the only way to stage her disease. I tell her that I have some results but that I don't know if we have the most recent results from her surgery. I leave to get the staff physician.

It turns out that the results from the surgery aren't available yet. So she has to wait another two weeks; she's already waited two. The staff doctor explains that's all we can do for now because he can't begin treatment without the results.

Later that morning, I see a patient who was being very difficult with the other student, the resident and then with the staff and me. He's not satisfied with all the waiting that he's been put through; I wasn't there for the whole story. This is a patient who's caused another doctor to refuse to see him anymore. He's very angry and I understand that having a diagnosis of invasive colon cancer isn't the greatest experience in one's life but I've met plenty of very sick and dying people who manage to remain pleasant through till the end. What I'm basically saying is that I don't think it's the way this man has been treated or his illness that is making him miserable.

During the interview, the doctor explains that since he's failed the last two rounds of chemotherapy that there's no point in combining them and there's no point in doing anything until we see results from his CT scan (which hasn't even taken place yet). He tells the doctor that he's contacted doctors in an American hospital who say that what he's proposing, to combine the regiments, is legitimate. This patient is basically trying to dictate his own care. I fully believe that patients have a say in their care, but when a doctor tells you something is pointless and thinks it could only do harm, I feel that one should probably heed the doctor's advice. That is, of course, my humble opinion.

I saw another patient, a woman with colon cancer as well. She was, by far, one of the most pleasant people I've met in a while. My classmate had a good choice of words to describe her, my favorite of which was "Charming." This woman has disseminated herpes zoster, which basically means she had shingles all over her body. Despite this, she was still pleasant and polite with us. What a breath of fresh air after the last patient.

Today, I saw my staff be compassionate with the pleasant patients and turn his back on the unpleasant one. I'll say this: I don't know the whole story with the miserable patient. A part of me still feels a little dirty having seen what transpired in that examination room and how that man was treated. Will I ever know if it was justified? Probably not. Can I learn from it anyway? You bet