Thursday, February 02, 2006

last to know

It seems strange and somehow unfair, though obvious due to the nature of the job, that as anesthesiologists we often learn bad news about a patient's prognosis before the patients themselves do. In endoscopy yesterday, I was giving anesthsia for a guy who was getting scoped diagnostically for months of back pain. He was a young guy, otherwise healthy, job and kids...but he had this pain, see. So I sedated him and he drifted off, and when the GI attending passed the scope down, there it was, staring us in the face, a lesion that was almost certainly gastric cancer. An endoscopic ultrasound was passed, and there was more, clear to even my untrained eye, mets to the liver. In one second from healthy guy to cancer patient. And neither he nor his wife knew yet.

The procedure finished up and the GI team left the room, excited and buzzing and talking about the specimens to be sent to pathology, did you see the blood supply feeding the mets, did you see that primary lesion, I mean, did you see that thing? Sometimes I feel like the primary team can care more about the procedure than about the patient. I know that's unfair, but it's hard not to feel that way when the second that scope is out or that last dressing is on, everyone leaves the room or goes to return their phone calls and completely ignores the fact that the patient is still in the room, on the table, for chrissake. For the record, just because your part is done doesn't make him not your patient anymore. But anyway, I turned off my drip and in a normal speaking voice said the patient's name, just once. "Jack?" He opened his eyes right away, looked up, and smiled groggily. And something about the look on his face somehow reminded me of how Cal looks when he wakes up in the morning, warm and sleepy and ready for the day to begin. And at that point my heart broke just a little.

"Jack, the procedure's all done, you did great." It was not my place to tell him what we saw on endoscopy, and he didn't ask. "How did you like your nap?"

"It was nice. You did a good job, I didn't feel a thing," he said, still sleepy but waking up gradually. "Thanks."

"No problem." And then, because I couldn't think of anything else to say, I said again, "You did fine." And I thought about the lesion in his stomach and the mets in his liver and his kids at home, and felt a little sick.

"I mean, I was totally out, I didn't hear or see or feel a thing" he said again. And I said I know, I know.

Currently reading: "A Million Little Pieces." You know, I don't give a shit about all that controversy, I think it was a good story and I couldn't put it down. Do you see now that readers are suing James Frey because they read the book and now they feel "cheated"? Oh PLEASE. I mean, I can see people being mad if they believed it was all God's Honest Truth, but it's not like it RUINS YOUR WHOLE LIFE just because it's not.


  1. Anonymous8:51 AM

    " heart broke just a little."

    Mine too.

  2. Anonymous4:24 AM

    Beautifully written, ver enlightening, and so so sad. I vote this post for the pre-book article.

    As a somewhat-but-barely-related aside, as a layman, one of the things that fascinates me about the field of medicine is its nonexistent margin of error. We're all human, we all mess up occasionally, and who hasn't botched a project at work or forgotten to take care of one of the myriad of details related to something else. It happens, and it's OK, usually ...but never when you're a doctor. This post, reminded me of that. How do you feel about this? How do you handle the pressure of knowing that you can never make an honest mistake? How do you feel about a respected physician who makes a small, unintentional error, with devastating consequences?