I still remember taking a quick peek at the unread CT scan before I saw you in the ER room. Is that a mass?.I spoke to myself looking at the haziness in the hilar region.… The story you gave me was even more concerning - a visit to pulmonologist a couple of months back for chronic cough and hemoptysis, your smoking history..After the exam, I glanced over the computer to look at the CT report by radiology , and there it was confirming the worst suspicions. Hilar mass/collapse UL/adrenal lesion , most likely CA lung with metastasis.
Sir, it looks like you have a lung mass, I broached the discussion.
"Well, what does that mean? "You asked me, earnestly
I cannot say for sure, but it very concerning for lung cancer, I said slowly.
I could sense your trepidation.
"I came in for the cough and I thought I could go back home after getting a shot or something," you said, in disbelief.
Sir, I am sorry. Things are a bit complicated now with the mass – so we have to get some tests done to figure out what this mass is. I’ll need to get the lung doctor involved, we’ll most likely need a bronchoscopy – you know – when they sedate you and pass a small tube with camera down your wind pipe, to try to get a sample from this mass..
Will it hurt? You were apprehensive.
Not really..You will be sedated during the process.
So the mass? Things were staring to sink in.
I’m sorry…The mass, as I said, we need to know what exactly it is so that we could give you the right treatment.
The transport person had come to move you by that time. And I didn’t have the heart to go over the adrenal lesion and the likely metastatic CA part at that time.
In an hours time, I was back in your room.
You looked so worried. You reminded me of a little boy, lost in the woods – you had such an inncocent face, and it almost looked as if you were on the brink of tears..
What should I tell folks at work ? I guess I should take a day off from work tomorrow.
Sir, I think it would be longer than that..you know, the diagnosis has not been made yet, and depending on what it turns out to be, we will have to coordinate care amongst other specialists and comeforth with a care plan. The wait can be frustrating, I wish we could move things faster to get a definitive answer, but you know, it just doesn’t work that way..
Will I not be able to work again? Your voice was quivering..
Sir, we don’t know the diagnosis yet, I repeated. I guess I sounded like a broken record . Sir, we’d have to figure that out first , then discuss the treatment options which might include chemotherapy and radiation if it turns out to be a malignancy..Again, its premature to discuss that without having the definitive diagnosis at hand..
I felt like I was hedging. I didn’t want to go too much in detail about the lung cancer prognosis..
I could only imagine what was going through your mind. Here you are in the hospital with a potential diagnosi s of cancer given to you in the ER when you came in expecting to go back home after a shot. You have no idea what the future holds for you. You are alone - you have no one at home, no wife, no kids, no one to take care of you. No one to discusss this with . Your only sister who is on vacation , is some place faraway and you cant even reach her by phone. And you had the whole night, the next day, and probably the whole week strectching in front of you, leaving you in angst, in the throngs of fear – fear of the unknown, fear of of a deadly disease, and the fear of death. You have been young and healthy all your life, you are just 55 and never expected this coming.
RD, I felt really bad for you, I wish I could help you . I was crying inside when I left you room.
My 7 day shift was over that night.
Later I learned that you had bronchoscopy done the next day, it was inconclusive. You had a CT guided biopsy done which showed squamous cell CA.
One my next week on, you were admitted briefly to get a port in place. You were discharged the same day before I could see you.
A couple of week s later, I just opened your chart in Epic again and was flabbergasted.
You are entering the chart of a deceased patient, read the pop up notification on Epic, our electronic medical record system.
This was a shock RD… I knew things could move faster, but not this quick..
RD, I’m sorry. I wish things were different. I wish no one has to go through this again. But again, all of us will have to face this - fear and apprehension, desolation and despondency, in varying degrees for no fault of our own. llness will most often be a trigger , and I’ll be there witnessing this over and over again in myself and my patients, wondering why this happens and never ever knowing the answer..
Some questions, I understand RD, do not have answers.
RIP RD
You will always be remembered.
Sir, it looks like you have a lung mass, I broached the discussion.
"Well, what does that mean? "You asked me, earnestly
I cannot say for sure, but it very concerning for lung cancer, I said slowly.
I could sense your trepidation.
"I came in for the cough and I thought I could go back home after getting a shot or something," you said, in disbelief.
Sir, I am sorry. Things are a bit complicated now with the mass – so we have to get some tests done to figure out what this mass is. I’ll need to get the lung doctor involved, we’ll most likely need a bronchoscopy – you know – when they sedate you and pass a small tube with camera down your wind pipe, to try to get a sample from this mass..
Will it hurt? You were apprehensive.
Not really..You will be sedated during the process.
So the mass? Things were staring to sink in.
I’m sorry…The mass, as I said, we need to know what exactly it is so that we could give you the right treatment.
The transport person had come to move you by that time. And I didn’t have the heart to go over the adrenal lesion and the likely metastatic CA part at that time.
In an hours time, I was back in your room.
You looked so worried. You reminded me of a little boy, lost in the woods – you had such an inncocent face, and it almost looked as if you were on the brink of tears..
What should I tell folks at work ? I guess I should take a day off from work tomorrow.
Sir, I think it would be longer than that..you know, the diagnosis has not been made yet, and depending on what it turns out to be, we will have to coordinate care amongst other specialists and comeforth with a care plan. The wait can be frustrating, I wish we could move things faster to get a definitive answer, but you know, it just doesn’t work that way..
Will I not be able to work again? Your voice was quivering..
Sir, we don’t know the diagnosis yet, I repeated. I guess I sounded like a broken record . Sir, we’d have to figure that out first , then discuss the treatment options which might include chemotherapy and radiation if it turns out to be a malignancy..Again, its premature to discuss that without having the definitive diagnosis at hand..
I felt like I was hedging. I didn’t want to go too much in detail about the lung cancer prognosis..
I could only imagine what was going through your mind. Here you are in the hospital with a potential diagnosi s of cancer given to you in the ER when you came in expecting to go back home after a shot. You have no idea what the future holds for you. You are alone - you have no one at home, no wife, no kids, no one to take care of you. No one to discusss this with . Your only sister who is on vacation , is some place faraway and you cant even reach her by phone. And you had the whole night, the next day, and probably the whole week strectching in front of you, leaving you in angst, in the throngs of fear – fear of the unknown, fear of of a deadly disease, and the fear of death. You have been young and healthy all your life, you are just 55 and never expected this coming.
RD, I felt really bad for you, I wish I could help you . I was crying inside when I left you room.
My 7 day shift was over that night.
Later I learned that you had bronchoscopy done the next day, it was inconclusive. You had a CT guided biopsy done which showed squamous cell CA.
One my next week on, you were admitted briefly to get a port in place. You were discharged the same day before I could see you.
A couple of week s later, I just opened your chart in Epic again and was flabbergasted.
You are entering the chart of a deceased patient, read the pop up notification on Epic, our electronic medical record system.
This was a shock RD… I knew things could move faster, but not this quick..
RD, I’m sorry. I wish things were different. I wish no one has to go through this again. But again, all of us will have to face this - fear and apprehension, desolation and despondency, in varying degrees for no fault of our own. llness will most often be a trigger , and I’ll be there witnessing this over and over again in myself and my patients, wondering why this happens and never ever knowing the answer..
Some questions, I understand RD, do not have answers.
RIP RD
You will always be remembered.
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