Through the waiting room monitor we saw a man pushing a woman in a wheelchair up to the registration window. We recognized the woman as someone who frequently comes to the emergency department for treatment of her chronic back pain. She also chooses to sit in a wheelchair and be carted around rather than expending the calories necessary to mobilize her protuberant derriere. Don’t be fooled. She gets out of the chair and onto the bed just fine.
This time, though, it was the husband who registered to be evaluated. He has had pain in his upper back for a couple of months and he finally decided to get it checked out. He hasn’t seen a physician in a “coon’s age” and smokes like a chimney. Yes he has had a cough. No he hasn’t had any injury to his back. Other symptoms? Well now that you mention it, he did started getting migraine headaches a few months ago but they seemed to get better with Motrin, so he didn’t pay too much attention to them.
His right lung sounded like crap, so we got an x-ray.
The x-ray looked like crap, so we got a chest CT. I added a head CT just on a hunch due to his headaches.
The CT scan of his chest showed a large tumor in the middle of his right lung.
His head CT showed multiple brain metastases.
Metastatic lung cancer has a generally poor prognosis. This will most likely be his last Christmas.
One of the toughest parts of being a doctor is telling someone that they have a serious illness. It’s like you can see the life force just drain out of people sometimes. Not a look that is easy to describe or that you’d ever want to see. Imagine walking into a hospital thinking you’re healthy – maybe you have a back strain – and having a doctor walk into the room and tell you have cancer. Like being hit with a brick.
I didn’t have the heart to tell him that he had metastatic disease. How do you walk up to someone you’ve never met before and hand them a death sentence?
Both the patient and his wife didn’t believe me at first. “Whaaat?!?!” they both chimed when I said that the chest x-ray looked like it could be cancer. I showed them a printout of the x-ray. The patient sat there with a blank look on his face. I can’t even begin to imagine what was running through his mind. Fear? Family? Kids? Death?
I tried to offer a glimmer of hope. “If it is cancer, there are a lot of ways to treat it. For right now, we just have to confirm whether it is or it isn’t and then work on getting you better.”
His wife furled her brow and crossed her arms. Then she let loose on him.
“I’ve been telling you to get this checked for months! Did you listen to me? NO! Now you’re going to check out and no one is going to be there to take care of ME!”
Maybe that was just her way of dealing with bad news. Still a wrong answer. I really felt like grabbing the wheelchair and dumping her onto the ground. Maybe a few good stomps on her back to show her how she just made her husband feel.
Tears started to well up in her husband’s eyes. That made me even more angry. I patted him on the shoulder, told him not to worry – we would take good care of him. Then I walked out of the room before I did or said something I would later regret.
After the patient was discharged, I watched the patient push his wife out through the lobby and out the front door – just as slowly as they walked in. The edges of crumpled discharge papers wiggled back and forth in his back pocket with each step he took.
Then I watched the tech crumple up the linens and toss them into the laundry bin. I’m betting a good portion of the patient’s life force went into the laundry bin along with those sheets.
His wife did as much to his spirit with those words as any gang banger could have done with a baseball bat.
I’m betting he won’t even make it to Thanksgiving.