Tuesday, December 21, 2004

This “May” Be Consistent With My Therapy

A sad memory. He dies.

As I write this I cry. Honestly.

It has been a very rough week. First day on service and on call at the same time, had 2 patients on the floor crashing while trying to admit eight more, figure out the patients I am suddenly managing and teaching two relatively new interns how to do anything. Left very late at night and presented my patients to the Chief of Medicine in the morning. Who made me look like shit in front of everyone. The week went downhill from there. After this afternoon, I am broken.

On my first night I admitted a poor (very poor) fifty something y/o man. He had no medical history, because he never goes to doctors, because he can’t afford it and has no insurance. He had some "smudge" on his x-ray way up on the top left side of his lungs. To quote the radiology resident’s preliminary report this smudge “may be consistent with cancer”. “May be consistent with cancer” as a Ferrari “may be consistent with an expensive car”.

It was cancer, it was horrible cancer, it was inoperable horrible cancer, and it’s the angel of death on an x-ray.

In today’s medical world radiologists, and just about everyone else, covers their butt by using words like “may be consistent with” or “cannot exclude”. This x-ray should have been dictated the way it was dictated back in the 50’s: “C.A.N.C.E.R.!!!!CANCERCANCERCANCERCANCER!!!!!”

I think in a way that it would be more humane and honest!

Before I left I had to tell his wife that we need a biopsy to check if this could be cancer. I was lying because I know it is. We have to confirm it anyway. She cried. She has no one else in this world. She has no money, they don’t have a real place to live, she barely gets by with him and now she will have to get by without him. I nearly broke down in tears right in front of her and had to leave the room as fast as possible. I locked myself in the on call room and cried. I’m still crying.

My message to the tobacco industry and the great CEO’s of the past (and present) who found ways to play with people’s brains and make them believe they were somehow better for smoking: Thank you very much for your wonderful gift. So many people dead, dying. So many residents crying, so many wives watching their world crash around them. Thank you so very much. I hope one day you’ll have something that would be “consistent with a conscience”. Maybe we should tattoo it on your forehead, but only the way they used to do it: