The power to change a life

Girgenti, Kaylene

I change people's lives every day. But recently, it feels like my job has not been a happy one. In the last two weeks, I’ve had the responsibility of letting three otherwise healthy people know that they have cancer. Each one has their own story. Each one their own journey to now begin, and I am the one who has launched them into this journey. I have dropped the flag and now they're off and racing.

My first patient was a lady in her 70's who had recently visited family - and picked up the same bug that the whole family had. She was not a regular patient of mine, I was meeting her for the first time. Her coughing had settled, but she was left with an ongoing nagging pain in her R chest. I could tell immediately that she had a reasonable degree of COPD, and did my duty of enquiring about whether she had any plans to quit smoking -- the 7 cigarettes that she smoked a day. Ironically, whenever I do this type of questioning, I reflect on the fact that doctors used to RECOMMEND that their patient smoked - one of my patients told that during his wife's labour, her BP was noted to be elevated. Her doctor at that time asked "Mrs X -- do you smoke? - if so, I’d very much appreciate if you'd have a cigarette now to help bring down your BP". I was amazed by this. I digress though. When I asked this lady if she had any plans to quit smoking - she stated that she didn't. I sent her for an X-ray more to err on the side of caution then because I suspected anything would be found other than the COPD. A report came back a short time later showing a R sided primary lung carcinoma. I had her bring in a family member so that I could break the news to her. A woman that I had met and talked with for all of 15 minutes. I then had to give her a life altering diagnosis. There is never an easy way - and the job often seems too perfunctory. You wish you could take longer to talk about it, but when all’s said and done - there are so many questions still left hanging in the air and only so much that can be said.

My second patient was a gentleman in his 50's. He looked like a biker - a tough guy who'd experienced the wilder side of life. He came in for a "Blood Pressure check“. Once in the room together — he told me he'd come for this check... "Oh, and I also have this".... Lifting his shirt, he revealed an obviously advanced R sided primary breast carcinoma. That was as close as I've ever come to saying "Oh Shit" right there in front of a patient, My heart dropped instantly, and at the same time, I'm sure my face told the same story. "It's cancer isn't it?". Although I had no doubt in my mind, I told him that I thought so, but until the diagnosis was clear, you could never say for sure. I asked him how long he'd known there was a lump there. "Eight months". EIGHT MONTHS! I had known this man for all of two minutes before I had to tell him that I thought he had cancer. I have since taken him on as a patient — he is very early on in his journey - and having had the Mammogram showing satellite lesions -- I don’t know how long this journey will be, but I do know that he has a nine year old son. I do know that he‘s going to need a doctor, and even though I know this will most likely not be an easy course, I feel like I owe him at least that much — having changed his life in an instant.

Just yesterday, I saw a woman who had a routine screening mammogram 6 months ago - at that time, two lesions were noted - they were not thought to be cancer - however, a 6 month follow-up was arranged to re-assess. On the reassessment, the lesions appeared more suspicious - so a biopsy was performed on the spot - the two lumps were found to be cancerous. This was probably the most difficult news for me to break. I don't know why -- the diagnosis is just as significant for the other two patients as it is for her, and as her cancer has been picked up very early - she probably has a better chance of cure, maybe it was the cumulative toll that all of this bad news had been taking. Regardless, it was a very hard thing to do. A vibrant healthy 60 year old woman - not expecting the worst - had the rug pulled out from under her. She was shocked. There were tears. I often wonder how I would react to this type of news - I don‘t think it would be pretty. In my opinion - ignorance is bliss.

I love my work, I love my job, but all too often, these tasks present themselves. We have a great responsibility. We are almost like God’s messengers. I feel guilty for bemoaning the fact that I have to break this type of news - when the patients are the ones who have to bear the diagnosis. Maybe next week there will be more good news -- some long awaited pregnancies, a miraculous recovery from a serious illness. Anything to remind me that life is a cycle - and with the bad, comes the good. In the meantime - I will try to be an extra support person for these people whose lives have changed so greatly. I only hope that one day, should I face a similar diagnosis, I can show the same courage, strength of character and fortitude that these people have in their darkest hours.

Theme: Death and Dying | Décès et le mourir
Theme: Patients | Patients
Theme: Relationships | Relations

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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