The one-liner we received about a new admission:
"70 something year old guy with history of coronary artery disease who presents with difficulty walking, decreased sensation on the right side of his face and weakness of his right arm."
Sounds like a stroke. After seeing him and performing a physical exam, it looks like he had a stroke. Weakness, sensory changes, even some difficulty with speaking. Neurology is consulted as part of our stroke protocol. A barrage of diagnostic testing is ordered. He and his family are obviously scared. I was calm as can be, until I saw the Head CT for myself...
This gentleman has served in the U. S. Army. He's worked hard all of his life in the paper industry. Has a wonderful wife, raised some great kids from what I can gather. One of his daughter's is a Nurse. Talk about having a wonderful ally who knows how to navigate health care! He has also had quite a sordid medical history. Subdural hemorrhages, a couple skull surgeries to clear them up. Heart problems, blood cancer, arthritis, chronic kidney disease, well, essentially every organ system has been touched by disease. Yet, he is a gentle, friendly, and well-grounded man. He reminds me of my grandfather because of these traits.
A 3cm mass was identified on the Head CT in the region of the brain responsible for the right side of his body. In the Left parietal lobe. Which explains most of his Right sided arm and speech difficulties. Next, the chest film showed a large mass in his right lung. Holy Hades, what else for this unfortunate soul? Breaking the news to him and his family. My Attending did a decent job of breaking it to him. I honestly cannot say I could have done any better or worse. Our patient handled it well. His family as well. I think they were more relieved to have an answer, regardless of the severity/nature of the news.
I think if I were in his shoes I would have tuned out after I heard "brain tumor". After it sunk in, he broke composure and began to cry. A lull in the conversation ensued. A welcome one. We wrapped up with our immediate plans. Hand shakes, 'Thank You's' and such were thrown about. We just dropped an exploding birthday gift in his lap. He made no mention of his birthday nor allude to how terrible this news was, or how unlucky he was to receive this news on his special day.
Further imaging studies showed metastases in his liver and his abdomen. To get an answer as to what type of cancer we are dealing with a biopsy was ordered. His cancer doctor was called. Plans were put into motion. Further plans of care hinge upon the pathology report. We need to know what type of cancer we are dealing with. Where it came from (most likely the lungs), how malignant, and what stage.
This morning I chose to sit down and spend as much time as I could with this gentleman. I let him do most of the talking. I learned a lot about him not only through his stories but also his body language. He punctuated his calm demeanor with fidgeting, mainly when it came to anything related to his current situation. I assured him I would check on him before and after his procedure. He was appreciative. I went about my business, he was left to ruminate on his situation.
I went to check on him in the recovery area after his biopsy. He was tired of waiting around, and also quite hungry as we had kept him NPO (nothing to eat) since midnight. I ordered him a lunch, asked the nurses to find out when he was released to return to our floor, and updated him before I had to go to the ED for an admission. Never did he show any signs of frustration or voice any displeasure. As I traversed the halls towards the ED I could not help but think about him, his family, and how these past 24-hours have flipped their world upside down.
Harsh reality. As I was sitting at my laptop following up on some lab studies I was asked to place a discharge order for this gentleman. At first I was confused, I thought he had just returned from special procedures and would be in house for another day or so. My Attending said "he'll be better off at home with his family instead of staying here surrounded by strangers, we are not treating him for anything, we know the source of his symptoms, the next step hinges on the biopsy results and what he and his Oncologist choose to do with that information." I could not have put it any better myself. So, I pulled up his medical record on my laptop and started placing the orders. Next, I had to write a prescription for a pain medication. This is when the situation entered a whole different realm.
Anytime I write a prescription for narcotics, I have to obtain a special prescription from the nurses who in turn have to sign one out from the Omni-Cell (essentially an ATM-like device for inpatient medications and such). When I write prescriptions, I include the patient's date of birth. As I read the screen and began to write the date, it finally clicked, his birthday was yesterday. The same day we delivered Earth shattering news to him and his family. Their lives are forever changed. I felt horrible I did not realize this until now. Also, I felt horrible for him, his family, and what lies ahead for them. This caused me to reflect upon my grandfather and how prefers not to celebrate his own birthday because it reminds him of his father's death. Hopefully this association of negative, life-altering news with a special day in his life never comes to fruition. I guess it will depend on how the next few months play out for him.
Once I complete my tasks to get him discharged I went to see him in his room. My goal was to wish him a belated birthday in addition to sharing with him the news he was free to go. I prefaced my birthday wishes with "in light of what has taken place the past couple of days it just came to my attention yesterday was your birthday. I know it has been an extremely upsetting and challenging time since this unfortunate news has been shared. I want to wish you a Happy Belated Birthday. I wish you and your family best. It was a pleasure to meet you and to listen to your stories."
We extended our hands towards each other to shake. He embraced my right hand with a firm grasp with both of his hands. He looked me straight in the eye and said "Thank You. Thank You for everything you have done for me. You all took great care of me." As he said this I could see the emotions welling up in his eyes. I almost started to get misty-eyed myself. I said goodbye to him, his wife, and his daughter. Wishing them all the best. They all thanked me. I merely replied "It was my pleasure." I then left their lives as quietly and swiftly as I entered. I took a moment to pause and reflect upon what had just happened. His life is in the balance. Their family dynamic and their lives are forever changed yet, I will go about my life as though nothing ever happened. Or will I? It is expected of me as a physician, to keep calm and carry on. I will never forget this gentlemen and his story nor how he handled such terrible news in such noble way.
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