You know how in the last post I was ranting about how the worst part of being a third year medical student was the getting yelled at for no reason part?
I take it back. I take it all back.
The worst part of being a third year med student is realizing that you can't do anything for your sweet middle-aged patient who doesn't know her pancreatic cancer has spread.
She was accompanied by her husband of forty years. They were high school sweethearts, but it was obvious by the way he looked at her that the plan was to be old-aged sweethearts too.
She came in to the hospital because of a bacterial infection that was so terrible, she had no idea who or where she was. She couldn't tell us who the president was or what the date was. She only answered one question correctly, and that was her husband's name.
As part of the workup, we found that her cancer had grown so much that it was now constricting her duodonum - which was why she was only eating clear soups and smoothies for the past two weeks. The site of her bacterial infection turned out to be a liver abscess. But there were three other masses on her liver that turned out to be cancerous. And she was accumulating abdominal fluid because of omental metastases.
My attending isn't an oncologist. But looking at the scans and pathology reports, she sighed and remarked that our patient probably only had three months or so. The chemo didn't seem to be having any kind of effect at stopping the cancer.
But there must be something that we can do, right?
Unfortunately, no. All we can do is treat her bacteremia, and get her out of the hospital so she can spend as much of her life out there, instead of in here.
Two days later, my patient was smiling and joking around with her husband, her infection now under control. She was ready to go home.
It was time, according to my attending.
I nodded, grabbed my white coat, and followed her to the patient's room, where we sat down and tried to explain all the new lab findings to our patient. Since my attending was doing all the talking, I took the opportunity to just watch the patient and her husband's reactions.
They didn't cry or even become distraught. She simply nodded and said that she understood what we were telling her. Her husband told us that he'd make an appointment with the oncologist right away. They were a team, and they were going to attack this cancer together.
She was discharged later that afternoon, with our best wishes.
Yesterday night, on my way home, I passed by the the local Starbucks and saw my patient's husband sitting next to the window. He looked at me, as though wondering if I remembered who he was, so I smiled and waved. He waved back, and I walked in to say hi.
His wife had come back to the hospital for her outpatient procedure to open up her duodenum so that she could go back to eating solid foods. She'd have to come back in a couple of days to switch out her biliary stents. Yes, she was hanging in there.
And in the midst of this very matter-of-fact conversation about his wife, he suddenly broke down. They were planning on going on a cruise in December, he told me, asking if I thought that she'd still be strong enough to go. And their daughter just found out that she was pregnant again. Would his wife be able to help her through labor? Would she still be with us?
I didn't know what to say, as I silently sat there and handed him pieces of tissue from my white coat.
At that moment, his cell phone rang. The procedure was finished, and his wife would be waking up from sedation within the next 30 minutes, if he wanted to go sit in her room so that he'd be there when she woke up. He did, and so after I wished him good luck and sent all my love to his wife, he got up to go back to the hospital.
As a third year med student, I spend a lot of time with my patients. I'm often the first person they see in the morning, and I make sure to say goodbye before I head home at night. I get to know my patients rather well, and I often find myself holding their hands. Sometimes it's when they're getting blood drawn and they need someone's hand to squeeze through the pain. Othertimes, it's as they're getting wheeled down for some procedure, and they want a familiar face with them, especially since the family can't go. My job is to hold hands and reassure my patients that things will be okay. That of course they were going to recover from their pneumonia! That yes, while the pain is bad, they were definitely not going to die in the hospital - at least, not on my watch.
Yesterday, I couldn't answer the husband's questions the way he wanted me to. I couldn't reassure him that they were gonna kick this cancer, and she'd be with him until they were old and gray.
I could have told him reassuring lies, but I didn't - because that wouldn't have been honest. I only wish that I would have told him the one truth I did know, just from spending three days with them - that they were lucky to have each other.
Cancer sucks. Especially when you all you want to do is punch it in its face, and you can't.
