Monday, February 1, 2010

"I don't think you have cancer..."

So, this past month has been pretty light. I had vacation for 2 weeks, then I had clinic only 1 day a week for the rest of January. Those last 2 weeks were supposed to be for research. I took "research" to mean sleeping in, working on an art project, and reading the occasional medical article. I'm pretty sure that's what it means. [Some people may be dismayed by this idea that their doctor is off somewhere wasting time rather than reading every new article that comes out. I prefer to think of it as making myself well-rounded.]

I covered this last weekend at the hospital. Thirteen patients to see each day, so not bad. One I saw on Sunday is a middle aged man with an intestinal disorder that requires he takes steroids. This makes him a little immunocompromised and at risk for weird infections. He came in with abdominal pain, which isn't unusual for him given his condition. What was unusual is that the abdominal CT scan picked up a weird finding in his lower lungs. A scan dedicated to the lungs confirmed a weird nodular pattern with a focal problem in one of the upper lobes. Now he's got to get a procedure done to figure out what the heck is going on in his lungs. Could be an infection (hence the reason I saw him) or cancer or some other inflammatory process.

He looked sad, so I asked if he was doing ok. After chatting for awhile, he said, "Do you think it's cancer?" To be honest, I have no idea. I suppose I could've said that: 'Well, sir, I'm not sure that's why we need the biopsy.' But, he knows that. So, instead I said (with as much confidence as I could muster), "Well, maybe I'm biased since I do infections for a career, but this pattern is more suspicious for an infectious process, I think." I'd like to say he breathed a sigh of relief, and I renewed his hope in the world. What really happened is he looked at me skeptically and didn't say a word. So, I said, "We should know for sure by the middle of the week, when we have all the results back. Either way, we're going to do our best to get you through this." Again, he didn't look all that convinced; I said good bye and put my note in the chart.

Sometimes you just can't make someone feel better. Sometimes they are too scared, too nervous, too cynical to think they might catch a break. He's been sick his whole life with an incurable intestinal disease. Why should things start looking up now? I encouraged him to have a positive outlook, and we'd see how things went.

Maybe some people are just hardwired to be "glass-half-empty" and nothing you can do is going to convince them that it's also half-full.

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