The C word.

I spent the past two weeks doing an elective rotation in the Hematology and Oncology clinics. I never thought that cancer clinic would be anything near "fun", but it was actually a very enjoyable experience for me. I learned so much about the physician-patient relationship.

Mr. X had skin cancer on his face. Before I went in his room to talk to him, I flipped through his chart and looked at his CT scans on the computer. I knew when I saw his scans, that this was going to be a tough interview. A good portion of his face was missing. It had been destroyed by the cancer. I composed myself before I walked in. I didn't really know what to expect, but I wasn't expecting this man to be the jolliest patient of the day. I know that if I was missing half of my face, I wouldn't be the most pleasant person to talk to. So I walked in, introduced myself, and looked him in the eye. I could tell he was smiling. Not because his lips were curled upward (because he didn't really have the ability to do that), but because of the way he looked at me with his one good eye-I could see the twinkle. I asked him the routine questions and made small talk. When I got back to my chair to write the progress note, the doctor informed me that Mr. X's treatment wasn't working. I proceeded to go back in the room and watch the doctor inform this man that there were no more options for him. Mr. X didn't seem rattled at all. It was like he knew what the doctor was going to say before he said it. He left the clinic after he signed all the paper work for hospice care. I didn't see him, but I'm pretty sure he still had that twinkle in his eye.

Cool was a young guy, still in college. When he was younger, he had two different types of cancers at different times that had been treated and taken care of. That day, I happened to pick up his chart. As I read up on him, I quickly realized that he was going to have to be told that he now had a third type of cancer. It was a rare type, and not a lot of research has been done on its treatment so know one really knows what works. I asked the attending if he wanted to do this, but he told me to go ahead and do it since I had seen him do it several times before. I went in and sat down and talked to him. I told him about his cancer, what we needed to do to see what stage he was in, and what we needed to do before we could do treatment. I don't really remember all the words I said... but I remember the look on his face. Cool's face was a mixture of fear and disbelief. I asked him if he had any questions and he shook his head now. When I got up to leave the room, he was looking at the floor and he said to me, "I've got some bad luck, don't I?" I just smiled and told him we were going to take care of him the best we knew how. Never looking up, he just nodded his head.

Reflecting back on those two weeks talking to people who battle for their lives every day... I realized that I don't know what to say to those people. I need to get in the Word more to learn comforting things to say to these patients and their families when they are hurting and hanging on to precious moments. The following verses are a few that I've found that may be encouraging to someone battling cancer or someone close to a cancer patient... and also for the doctors that treat them day after day. We must delight ourselves in the Lord... To do that we must have a unquenchable thirst for his Word. Only then may we serve him to the best of our abilities.


James 1:12
"Blessed is a man who perseveres under trial; for once he has been approved, he will receive the crown of life, which the Lord has promised to those who love Him."

Revelation 21:4
"...and He shall wipe away every tear from their eyes; and there shall no longer be any death; there shall no longer be any mourning, or crying, or pain; the first things have passed away."

John 14:27
"Peace I leave with you; My peace I give to you; not as the world gives, do I give to you. Let not your heart be troubled, nor let it be fearful."

Isaiah 41:10
"Do not fear, for I am with you; Do not anxiously look about you, for I am your God. I will strengthen you, surely I will help you, Surely I will uphold you with My righteous right hand."

Psalm 34:18
"The LORD is near to the brokenhearted, And saves those who are crushed in spirit."


Galatians 6:9
"And let us not lose heart in doing good, for in due time we shall reap if we do not grow weary."



Pics:

Me and my good buddy from med school, Rob Cannon, at his wedding. I got to be the stand in bride!


Kristy and Clare's first trip to the delta... We posed with the Teddy Bear at the Great Delta Bear Affair.

Same white coat... New pair of shoes.

I have finished my first three weeks of psychiatry. I worked with the Detox team. I saw lots of broken and addicted people. Some wanted help, some didn't, and so many relapsed. The same people coming back over and over for the same thing. It was just not my cup of tea. I felt so frustrated. I couldn't empathize with these patients. I don't know what they feel like. Empathy is such an important thing for a physician-patient relationship. I felt sorry for these people, but I couldn't feel with them. There was a barrier there that I never figured out how to break down.

I wanted to update where I was at this point, but Psych is not the subject of this post. All the things that have happened away from the hospital is the reason for this blog entry.

I have "stepped" into a new role without realizing what was happening. In my family, I am a daughter, a fiance, a sister, a granddaughter, a future daughter-in-law, a niece, a cousin. The latest thing I have become is medical advisor. My grandmother has had 2 strokes in 2 weeks... I am a concerned granddaughter, just like any granddaughter would be, except I know more. Instead of just being worried, I'm thinking about a differential diagnosis, etiology, pathology, and running risk/benefit scenarios in my head. I am also the one they are asking the questions, "now what?" and "what should we do?" or "will it get better?". There is also another side to this... When it comes to my family's health, I don't know if knowledge is a blessing or curse. I don't know if I will like knowing as much as I do when it comes to my family's health. Sometimes knowing the reality and the survival odds can leave little room for hope. Hope is what keeps us going in those situations. It is what we cling to so much. It keeps us from throwing in the towel. It presses us to keep putting one foot in front of another. What will win the next time I am faced with this? Will my face shine hope or will it show skepticism?

This past weekend, all these questions I was pondering and the reality of all that was happening hit me hard. I felt a new weight on my shoulders. The people I've looked to for answers are now looking to me. Will I lead them astray? I found peace in the fact that Matthew 10:20 says "For it is not you who speak, but it is the Spirit of your Father who speaks in you." If I am where I should be in my walk with Christ, God will direct me to give the advice to my family that they need. The burden is not mine to carry. It is not on my back, but in his hands. If I trust in Him, he will take care of me and the health of my family.

I know my family reads this... I love you all. I am so glad that I can help out our family in this way. I am gladly embracing this role I've been given. God led me here. He has blessed me with the skills to become a doctor. None of it would have been possible without you. You've been beside me all the way. To my future family... I love you all too. You've been great cheerleaders as well. I'm so very blessed to be joining a family as solid as yours.



See you at the Great Delta Bear Affair on Oct. 23!!

A few pics for thought:

Strapping on the gloves

The time period between when you find out you or someone you love has a lesion that is highly suspicious for malignancy and getting the biopsy results back is super stressful. When you get the call that confirms your worst fear and dashes your highest hopes... It’s hard to hear. You heart races, your body goes numb, your thoughts trail off. It is really happening. What you hoped your family would never experience is meeting you head on. After the initial shock, your mind switches gears. You begin to strap on the gloves and get ready for a fight. My mom was diagnosed with thyroid cancer last fall. I can vividly remember standing next to her as she got her biopsy done. I can remember exactly where I was and what time it was and where I was going when my dad called me back to give me the pathology results. As a medical student, I had access to tons of academic papers and resources. I had done my homework. When I read the path report, I immediately knew the prognosis, the 5 yr survival rate, the 10 yr survival rate, and the treatment and its side effects. Mom’s cancer had a straightforward treatment with little to no side effects and a low metastasis rate. Her 5 year survival was 99% and her 10 year survival was 95%. But those numbers finally hit me across the face. 95% doesn’t mean that someone was just 5% dead and 95% alive. It meant that out of 100 people, 95 were 100% alive and 5 people were 100% dead. Statistics don’t mean a thing when it’s your mom. The statistics don’t care who that 5% is.

God worked in and on me a lot last fall. I learned to trust in Him for outcomes. I learned that He creates the statistics. I learned that He does indeed hold us in the palm of His hand. I learned how powerful prayer is. I learned how He provides peace in a storm. I learned how He turns fears into triumph. I learned from my experience, and I didn’t forget.

Mrs. Babydoll (I’m going call her that because I can’t use her name that is what she called me) was a sweet old black lady with a voice that was deepened by 55 years of smoking. She was THE BEST patient I’ve had this month. She was so nice and cooperative, except for when we were telling her she had to quit smoking. Mrs. Babydoll had a grandson that was tall, strong, and built to play football. He was tough on the outside, but you could see the pain in his eyes of seeing his grandma lay in that bed and not being able to do anything about it. It’s a man’s intrinsic nature to want to fix things and protect their family. He could do neither in this situation. He was helpless, and he was very uncomfortable with it. He begged me to make her stop smoking. I did my best. I told her what it was doing to her lungs. I told her the cigarettes were the reason she was going to be wearing an oxygen nasal cannula from now on. I told her that if she lit a cigarette while she was on that oxygen that she would blow herself up. She laughed, said “Well, we wouldn’t want that to happen would we baby doll?”

We fixed the problems Mrs. Babydoll had when she came to the hospital, but there were some additional weird findings on her physical exam that just weren’t adding up. The diagnosis and treatment did not explain these symptoms or their spontaneous resolution. Cancer does weird things and given her smoking history, we decided to do a CT scan of her chest, abdomen, and pelvis just to make sure there wasn’t something we were missing.

The next morning, I went to the hospital and did my morning routine. I checked all the imaging, tests, and labs on my patients. I saw the report had been finalized by the radiologist and my heart sank as I read it. I knew, given her history and the size of the mass, that the odds were stacked against her. We went in to visit her and tell her that she was going to go home that day but she had to get a biopsy before she left because we had found a mass. Her expression went flat. I could tell she knew. She knew it was probably cancer. She knew it was probably from the cigarettes. She knew that her days might be numbered. I bet you that her heart was racing, her body was numb, and her thoughts were trailing off. The smiling, jolly lady I had gotten to know was sitting fearfully facing an uncertain future. As we walked out of the room, I smiled and gave her hand a squeeze and told her it was a privalege taking care of her. She winked at me and told me to be good and thanks for everything.

That was about a week ago. Her biopsy results came back today. The prognosis is not good for her, but I bet you she already strapped on her gloves.

I can’t help but ask… Does Mrs. Babydoll have Jesus to carry her and her family through this?
That question raises other questions…. Why do I have to wonder about that? Why don’t I already know? Did I miss an opportunity?


Highway 61 blues...
I miss home.