So far so good. Got "lucky" yesterday with a patient who just needed a place to detox and was discharged home today. Since we have so many interns, acting interns and medical students on our team, we usually get only one patient per call. So now I have zero, which means I don't have to be at the hospital until 7 am tomorrow.
We have a good team, which is a relief. I've gotten lucky so far in internal medicine...or IM folks are generally that way. (I prefer to believe the latter, as I'll be one of them next year.)
One of those unforgettable human moments happened in the middle of the rounds today, permanently burned in my memory. We use the phrase "I can live with that" all the time, and think little about the actual, literal meaning. Today, a patient uttered it after being told he might have advanced cancer. Though I don't think he was thinking of it at that level, his statement accepting to live life in the face of looming death echoed in my head for hours:
*A middle-aged patient, generally healthy, productive, well-functioning, with three months of fatigue and weight loss. Our studies so far point to an advanced stage cancer, but we're not sure completely, and we definitely don't have specifics. We enter his room enmass: 4 long coats, 4 short coats; blue, green, white badges secretly denoting our power, knowledge and potential to give rather than take from this man's encounter with us.
The third year medical student presents the case, mentioning cancer. When he stops, we looks expectantly at attending.
- "Do you have any questions?" the attending asks the patient
- "Yes, I'm not sure I understood everything. What tests?"
The attending explains the tests, the reasons, the concerns, and then stops, rewinds, and says "You know, I wish we had better news for you. Just want to prepare you for the worse, though really it's too early to say anything yet".
(I'm reminded of my recent plane trip, where the pilot announced, halfway over Colorado, that that strange noise we were hearing was one of our engines, and that it was probably OK, though he'd keep playing with it, but we shouldn't worry or anything.)
- "So can you tell me, how long? I mean, I wanted to visit my kids this year. Visit this place I grew up. So how long do I..."
- "It's really early for us to know. We need these tests to even confirm you have cancer, and even then, we're terrible at predicting these things. Right now, I want you not to worry, we need to run these tests first."
- "Ok...but I have all these plans. Do you even have a rough estimate? A year or two?" He said this in a way that was a remarkable mix of dignity and almost pleading hope (please tell me it's at least a year. a year is nothing, but please don't tell me it could be less. )
- "We really don't know. I know this is hard right now. The tests will take a few days and then we might know more. Hopefully it will be good news. The reason we are telling you is just so that you begin to prepare for the worse"
- "What is the worse case scenerio, then doctor? Less than a year?"
- "We just don't know. For now, we just need you to be patient with us and ---"
- "So I can hope. Is that what I can do right now?"
- "yes"
- "OK. I can live with that."
*****
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