Monday, April 10, 2017

 

This morning, I shadowed an internal medicine physician in an outpatient clinic, and the day began as expected. High blood pressure here, swollen foot there, follow-up visits everywhere…nothing extraordinary or out-of-the-blue. Until a 74-year-old man presented with a chief complaint of shortness of breath and fatigue, accompanied by a laundry list of past medical conditions: congestive heart failure, diabetes, and depression to name a few. He wanted to feel like himself again, to breathe again. But there was one big piece of information that the patient refused to disclose, or totally neglected, as the physician discussed his comorbidities and medications with him.

Dr. X asked, “any history of cancer?” which in my mind was a totally routine question to ask, and the patient casually replied, “no.” What happened next shocked me out of my little white coat.

Overlooking the physician’s shoulder, I notice him pull up records from a cancer institute and double-check to see that the right patient was linked to this history of colon cancer. “Any past surgeries?” he asks.

“Oh, yeah they did something to stomach a couple months ago.”

“Mhm…do you have colon cancer?” A direct blow to the elephant in the room.

“It was some procedure to take out a piece of my colon.”

Wait, huh? The patient didn’t even answer the question. The energy in the room was…a bit uneasy, to say the least. I was confused. Maybe the physician was not. He’s surely had more experience in patient encounters than I have.

The discussion turned to the fact that the patient was diagnosed with stage 3b colon cancer just a few months before, for which he also went an entire round of chemotherapy (again, not something the patient admitted; rather, all this information was retrieved from the report).

When the physician finally told him directly that he has cancer, the patient seemed unbothered, uninterested…disconnected even. He refused to see another doctor for that condition, and even told those at the cancer institute that he would not be back for follow-up treatment. His current focus was his shortness of breath.

This encounter brought up many thoughts in my mind, from whether or not the patient understood the severity of his disease, how his fatigue could be a consequence of the malignancy, yet predominantly I considered the extent to which his depression was affecting his desire to receive care. The patient lives alone, and handles his healthcare all on his own.

I realized in that moment that I was experiencing such a small glimpse into this man’s life. The 20 minutes we spent talking, listening, and inspecting would come and go for him. Yet the truth that he was going home to an empty house lingered. The cancer, the depression, all these things were constant and ongoing in his life, not just a couple minutes of the day, as it was for us.

So, maybe he knew about the cancer all along and wanted to have a moment of blissful forgetfulness. Maybe he’d forced it to the back of his mind so much that it didn’t occur to him to mention it. Maybe he just didn’t want to get into it. But whatever the reason for this awkward encounter, I silently wished recovery for this patient. Recovery in his current ailments, recovery from the depression, recovery from the cancer in his body, and whatever other parts of his life I could not, and would not, ever see.

Do I think I’ll remember this patient for the rest of my life? Perhaps I will, now that I’ve written about it and can revisit this forevermore. But one thing I’m sure not to forget is how he made me feel.

 

Peace & love (& journaling & elephants & awkward encounters),

“The I.T. Factor”

Future Badass MD.

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