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Prognosis and Prediction

When doctors don't tell

Naked in an air-conditioned box, wrapped in a degrading paper gown; cold room, cold hands, cold table.  The pain is there, an ache in my side, more when I move, but always.  A sickening mirror of sickness.  It’s worse.  Is it worse?  Am I dying? 

Late; no knock, the door swings open too quickly.  My heart jumps, stops, and The Doctor sweeps in.  Sharp suit.  Shined shoes. 

“Good morning, Steve, how are you doing?”  Feeble short handshake, fingers cooler than mine, eyes watch the chart where I apparently lie. 

“I am OK, I guess… but I have a…”

“How did the chemo go last week?’

“Ah, I was nauseas for a couple days and I’m still tired, even if…”

“Any fever?”

“No.”

“Any shortness of breath?”

“No.”

“Any new pain?”

“I have pain in my side, it aches and it feels like it…”

“That’s the old pain, right?”

“Ah yes.”

“Any new pain?”

“No, not really.”

“How is your appetite?”

 “Food tastes like cardboard, but I force myself to drink a lot like you said and I can eat some foods, but I…”

“Make sure you are drinking a lot of fluids. It is very important to drink.  Flush those drugs right out. Drink. Now your blood tests last week look fine, look great, best you have had, so you should be OK for chemo today. OK.”

“Did you get the CT scan report back?”

“CT Scan?”

“I had a CT Scan on Tuesday.”

“Oh, CT Scan … well I have not seen the final report yet.”

“Did you get any report?”

“Well I got a part of a partial preliminary report but they did not report a comparison to the old film.  It sounded benign.”

“Benign. I’m confused. I have cancer.  Did it say anything about the cancer?”

“Well, it is just a preliminary report so it is vague, not exact.  It failed to report three-dimensional uptake or wash out data and did not mention the posterior mediastinum at all. It sounds like there may be a volume averaging artifact.”

“I don’t understand. What did it say?”

“It said your lungs are fine. Fine.”

“I have a lung problem?”

“Absolutely not, your lungs are fine.”

“So, we don’t know anything about the cancer?”

“Not until they read out the final CT scan report.”

“When will the final report be back?"

“It usually takes a few days. I will call you when I get the report. When is your next chemo?

”In two weeks.”

“That is good, we can get the report before then, in case we need to change the chemo.”

“Change the chemo?”

“Did you get your flu shot yet?”

“Ah, no.”

“How about the pneumonia shot?”

“I think that was last year…it should be in the records.”

“Yes, here it is, so you just need the flu shot.  We can do that today. Do you need any refills?  Do not run out of pain meds, we cannot fill narcotics on the phone. Do you have your next appointment?  Plan to see me before the next chemo.  Maybe your wife wants to join you.  Don’t forget to have your blood drawn before today’s treatment.”

Cold room.  Cold day.  Cold.

 

 

As published in Sunrise Rounds.

 

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