Tuesday, November 21, 2000:
Working on:
Turkey Day and this weekend.
Amy's watching: 28 Days (DVD).
Happy she's back: Ikoru.
Then why so BLUE (balls)?
Amy's red friend is over.
MR. THINNER
(or Better Than The Atkin's Diet ... and about as healthy too)MR. THINNER: "I haven’t coughed up any blood since I came in."
Another forty year old. Pancreatic cancer.
The last pancreatic cancer guy I had was a lawyer. He was completely yellow (jaundiced) and in constant pain. I still remember his young daughter screaming at me in the hallway until her eyes teared up. Her complaints had been completely irrelevant. It was the sound of a girl wanting to fight with Death, but finding me instead.
A morphine snowstorm stopped his moaning (for good) and hence, the daughter stopped screaming also. Silent tears are much louder. I can still hear them.
This guy wasn't quite there.
Yet.
ME: "So, you were diagnosed with pancreatic cancer one month ago?"
MR. THINNER: "Three weeks, actually. I started losing a lot of weight all of a sudden. Sixty-two pounds in the past month."
ME (scribbling notes): "Wow. So a month ago, things seemed completely normal?"
MR. THINNER: "Yeah. I was 180 pounds."
ME: "How’s your appetite been?"
MR. THINNER: "Great. I eat like a horse, everything I can see … and I still lose weight ….
That’s pretty scary, doc."
Being a medicine person I also talk to him about his childhood-onset diabetes and his smoking history. It all seems irrelevant now of course. But it’s a lighter topic than cancer at least.
MR. THINNER: "I haven’t had a cigarette in two days, and I don’t even miss it. I’m quitting for good."
A little late now, I think.
ME: "Good for you. How often do you check your blood sugars?"
MR. THINNER: "Several times a day. I keep it under control. My mom always said as long as you keep taking your medicine like you’re supposed to, you’ll be okay. If you don’t, then you’re dead."
ME: "Mom knows best. She sounds pretty smart."
MR. THINNER: "Yeah. She was. She was a wonderful woman."
His mom died of pancreatic cancer too.
ME: "How much do you drink a day?"
The drink-a-day question is a trick. It implies to a heavy drinker that having a few drinks every day is okay, or at least that I won't be surprised if he does drink every day. This helps us to assess his potential medical condition. Non-drinkers usually correct us pretty quickly.
MR. THINNER: "Oh no. I never drink. My dad was an alcoholic. He’d drink and then he'd beat up my mom. No, I never drink."
MR. THINNER: "I like how all of you have treated me since I’ve been here. I know I’m going to live now."
ME: "Yeah. Thanks. That’s great to hear."
I left feeling like I should have said, "I know you’ll live too," but I just couldn’t make up a lie like that out of the hopelessness I was feeling. The oncologists are much better at that kind of alchemy.
Plus he was a nice guy, and a positive Nice Guy Sign means,
"You’re toast."
(I don't make the rules. I just observe them.)
MRS. KARAAK
ORTHO GUY: "Well, I saw your Mrs. Karaak today. There’s good news and there’s bad news."
ME: "Yeah?"
ORTHO: "The good news is that she had a shoulder dislocation, and I pulled it back in line for her."
ME: "Cool. Thanks."
My own shoulder felt better just hearing about it.
Orthopods are surgical jiu jijitsu artists.
ORTHO: "The bad news is that she also has a fracture, and I heard a crack when I pulled her arm ... ah, I think I made it worse. We’re taking her to the O.R. tomorrow if she’s cleared by you."
ME: "I’ll take a look at the chart today again. Uh … thanks."
Well, that’s one way to drum up some business.
The surgeons always like to get some sort of blessing. They call it medical "clearance." Medicine people (internists) aren't allowed to say "clearance." We say "optimized medically" or "minimized risks." This is a reminder that something terribly wrong can always happen, and all of our magical medical blessings can't stop it. Ours is a fickle god.
Surgeons are aggressive optimists. Have blade; will save.
Internists are vigilant pessimists. The Devil is in the details.
Bad luck (genetic or otherwise) is why we exist.
Despite the fracture, she actually felt better after the ortho surgeon yanked on her arm. So it was a good thing.
MRS. KARAAK: "I can actually use my hand now."
ME: "Great. Those ortho guys are pretty good, huh?"
MRS. KARAAK: "Will I be okay for surgery tomorrow?"
ME: "Yeah. No heart problems and we've been able to control your pressures and your seizures since you came in. You’re doing great."
HER DAUGHTER: "She’s nervous about procedures."
ME: "Oh, you won’t even know they did it. You’ll fall asleep, and wake up and say – When are we starting? And they’ll be all done. Surgeons are sly like that."
Yeah, sometimes I don't even know when my patient had surgery. Ahem.
MRS. KARAAK: "Haha. Thanks. I feel much better now."
HER DAUGHTER: "Thanks so much."
ME: "You’ll do great. I’ll see you later then."
I can do "optimism" when appropriate. I just hoped it wouldn't turn me into a liar.
MRS. KARAAK: "Not so fast. Come here."
With her one unbroken arm, old Mrs. Karaak gave me a surprise hug then, and I hugged her back … careful not to make her broken shoulder even worse. (I’m a doctor, not a surgeon! … hahaha, cheap shot.)
Of course, I turned a little red then. Which is a good sign to stop.
Fade to blush.
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