Ambivalence and Me

I can't believe how uneventful my weeks have become of late. I meander to class, then to the library, then come home and annoy the Hunny Bunny with my antics. Thankfully she loves me and puts up with me. Someday I'll learn how to not push all of her buttons...all the time.

Anyways, the bulk of my weekly entertainment has been coming from my preceptor. It seems I can always get a good laugh from some old fashioned scatological humor. Normally its just me and the Doc, but this week was busy. We had 2 residents farting around with me. One seemed as if he had been around a few years and had a funny name so we will refer to him Vladimir. Well Vladdy apparently likes to ask questions, which led to me getting "pimped" for nearly the entire time I was there. For those of you unfamiliar with that term in the medical setting, I will define it for you:

Being "pimped" is when an attending physician/resident/wife gives you the Third Degree in front of everyone. They just keep asking question after question until you run out of responses. Its a very humbling (and uncomfortable) situation that you want out of as soon as you can.

After a couple hourse of this, we finally came to our last patient of the day and I assumed the position so I could be "pimped" again. The patient was a referal from another doctor in the hospital who had hydronephrosis (the patient, not the doctor). I was grilled for a good 10 minutes on what could possibly cause this. I rambled off a good 2 answers and my brain juices were exhausted. That obviously was not good enough and Vladimir gave me another 10 to match my 2. We also had the luxury of looking at her CT scan before going into the room. As we browsed the films we noticed splenomegaly (enlarged spleen) and some unknown mass at the back of her abdomen which her referring doctor claimed was "Idiopathic Retroperitoneal Fibrosis". This was the mass that was pushing on her ureter and giving her hydronephrosis. It was now time to see the patient and see if the doctor was right...

Now that the spotlight was off of me, we asked the patient a series of questions trying to get the bottom of her problem. In the midst of the exam we asked if she had experienced any recent weightloss. She answered yes and said it had been about 20-30lbs in the past couple of months (Red Flag). She also complained that she "hasn't felt like herself" (another Red Flag) and that foods just haven't "tasted the same" (yet another Red Flag).

I thought back 20 minutes to when I was being grilled by Vladimir and one of our possibilities for this mass was cancer. In that short 2 minutes of information I knew that the previous doctor was wrong and this poor woman had cancer.

Thus, enter my ambivalence. On one hand I was elated becuase everything that I had learned in Pathology had just been manifested right before my eyes in an actual patient. She had all the symptoms I'm supposed to think of when I think about cancer. I felt for once like I was a medical professional. Yet on the other hand this was an actual human being. It wasn't some made up scenario or example out of a book. I was sitting two feet from her, I knew her name, and had her entire history on the table in front of me. And now we had the job of telling her that we now had to seriously consider that she had cancer.

As I think about it even more, thats what medicine is all about. Its the study of disease. Its what we love to do becuase it fascinates us to think about how the body can go awry and given the right circumstances, our intervention can actually help a person get better. But its still grounded in reality. Medicine is not a game becuase these are real lives and we can't take them for granted or treat them as a disease and not give these people a name.

As for this woman, a round of tests and a few more doctors await to just delay the inevitable, the official word of cancer. But in Vladimir, the Doc, and my mind...we already know what is coming.

Ambivalence is a funny feeling...unfortunately, I think it's here to stay.