Part of our medical school curriculum is to see as many patients as possible so we gain as much exposure and experience as we can before we graduate. Today i saw a patient with a relatively common problem. He was due for discharge that afternoon. Initially, i thought it was a pretty straightforward condition, but further along my questioning, i was starting to feel a little ill at ease.
The first alarm bell went off when i wondered why the physicians in charge of his care were not willing to use more invasive interventions on this guy when it was pretty obvious he more than fulfilled all the criteria. The second alarm bell went off when i asked him why a more conservative management was chosen for him and he replied it was because of incidental findings of an irregular heartbeat and pleural effusion (fluid in the side of his lungs). The third and final gong was when i decided to ask the million dollar question and found out he had lost 30kg in the past six months.
All these frightened me because the care of this patient was no longer as straightforward as i thought it would be. Worse of all, this patient was oblivious of all the ominous signs that my medical training taught me to recognize.
I started asking about his occupation before he retired when one of the senior doctors came racing in.
“TELL ME, HAVE YOU EVER BEEN EXPOSED TO ASBESTOS?” he boomed. Without waiting for the patient to reply, he turned to me and said, “Always ask about his occupation. It is good you are asking.”
“Yes…in the chimneys…” the patient whispered, as the truth slowly made its mark on his face.
I felt the dread creep over me.
Without saying another word to the patient, the physician asked me, “Do you want to see the chest x ray? Come, i will show you.” With that he left. I nodded to the patient and hurried off after him.
We did not see the imaging immediately because the physician got sidetracked by several calls. By the time we did have a look, a good ten minutes had passed and i remembered thinking to myself that i should be getting back to the patient because this unnecessary detour will probably add to his confusion and fears. I did not follow my instincts however. Instead, i fulfilled my medical obligation and learnt as the physician painstakingly took time off his busy schedule to point out the pathognomonic features of mesothelioma. I was grateful for his effort.
By the time i returned to the patient, i know whatever it was, was going to be bad. The patient did not know that, but i knew. The patient looked up as i entered the room, and i swear to God, he aged years since i left him twenty minutes ago. And dear Lord, his eyes were red. In our insensitivities, we just made an octogenarian cry. I felt sick.
“Are you all right?” i asked quietly.
“Do you want some time by yourself?”
“No, i have got it, then i have got it,” he said.
I nodded. And because i did not know what else to do, i continued with my examination of the clearly benign and now, certainly less important condition he came into hospital with. I did not want to stop the examination because it would just make the patient understand the magnitude of his terminal illness; yet i cannot mention a word more about his malignancy because we have yet to run the proper diagnostic investigations and it was not my position to discuss this with him.
When i left, he asked me who that doctor who raced into his room was. I could not even tell him that because i did not know myself. He nodded mutely and asked if he could still go home. Again, i could provide no answers. I told him i will find the doctors for him. They were nowhere to be found.
I left him sitting on his bed, his eyes troubled, his posture deeply bowed; a stark contrast from the man i saw who was busy doing crosswords when i first spoke to him, a mere sixty minutes ago.
I hate this.