Saturday, 6 February 2010

Sometimes you can't win

I had some interesting patient experiences this week, so I'm going to talk about them but to preserve confidentiality obviously I won't use any actual names and I'm not going to give all details to further ensure the patient is not recognisable (this is also why I never mention what medical school I am at as I do not want people to be able to work out what hospital I have met particular patients at).

On monday in a clinic for a particular progressive chronic disease (again I will not mention what) I met a lovely elderly (ish) couple. The husband was the sufferer of the chronic disease but his prognosis at the moment for that was very good and he had years left before it would become a problem. At the moment he was just attending clinic so that it could be monitored and he could be educated about what choices he had further down the line. This was one of his early clinic appointments so the consultant was suggesting his wife and him attend a group patient education session on his future possible treatments. The great thing about session like this is that they allow the patient to meet other people who are in exactly the same position and so not feel so isolated in their misfortune of getting a chronic conditon. The couple were very positive about the suggestion and so were going to attend the next session. I had really enjoyed meeting this couple and it was nice to see how chronic conditions can be managed positively and effectively. Unfortuanately though when the consultant looked through some recent scans the patient had had (purely to teach me for my education, not because he was expecting to see anything) things did not turn out to be so positive. The scans showed what was very likely to be lung cancer which the consultant pointed out was most likely to be metastatic (spread from somewhere else) as he did not have it just a few months before when he was scanned and now it was pretty big. Metastatic lung cancer is terminal. I felt really bad knowing this before the patient knew and I expect it will be a while before he finds out for sure as they will want to do proper diagnostic tests firsts. I think the consultant also felt bad that he hadn't seen this before the appointment as then he would not have told them they needed to consider the future and sent them for further education. He was trying to do the best for this patient and to help them plan for the future but in doing so he had made the assumption the patient had long enough left for his chronic condition to progress that far. As my title suggests sometimes you cannot win.

The next memorable patient I met was a much happier experience. She was in her mid 90's and body appearance wise was frail but in all other ways was one of the fiestiest most chirpy patients I had met. She turned up with her nails painted and hair dyed a vivid colour and virtually bounced around the clinic room with her energy and happyness - she very much reminded me of the poem that says "when I'm old I shall wear purple" because she had such a mischeivous/rebellious attitude. She was simply awesome. Frankly if I can be as cool as she is (and so sharp and witty still) when I am in my 90's then I will also be very happy! I wish I could share some more specific anecdotes about this patient as she was so awesome but I think if I did so I would make her too recognisable to either her or her neighbour who came to the appointment with her and I don't want to risk that on the ridiculously slim off chance they ever saw this.

On tuesday I had a cardiology clinic. Last time I went to this specific cardiology clinic three weeks ago I completely crashed and burned when I was getting grilled by the consultant. Furthermore it when everything was snowed up so the consultant had loads of time to grill me as many patients were unable to make the clinic. My partner had got the wrong location for the clinic and so I had to face the torrent of cardiac grilling by myself with no one to hide behind... The grilling progressed to the point that I was even mucking up the bits I did know really well and thus making myself look thoroughly stupid. The clinic then ended with the consultant saying (albeit in a very nice way) that I was rusty on my knowledge and I should go away and learn lots and it would be nice if he saw me later on the rotation so he could see if I had progressed...Eeek! So go and try to learn lots I did. I bought and ECG "made easy" book and I'm slowly learning all about the confusion that is 12 lead ECG's and I've been teaching myself about heart murmurs and heart failure. So what did he grill me on today? Well he asked me (and my partner this time) if I knew what Gin was made from, whether we speak italian and what fiction book we were currently reading. On learning that we weren't currently reading any fiction books he was dismayed that it was all work at the moment and told us we should read fiction books because they were the breath of life... DAMMIT! I couldn't agree more that reading is a great hobby and escapism but part of the reason I have not had not had time is because I was trying to know more about heart to avoid getting another embarrassing grilling. As I said, sometimes you can't win!


  1. I love your blog! Please keep positing - I am missing it...

  2. i love reading tooo....but even me im not reading much as i got low grades in my chem so im trying 2 concentrate but the thing is if i dun read i'll do something else other den revise! like now for eg...i shud b dng my workkk....

  3. Your asserted fact that "lung cancer is terminal" is erroneous. One cannot simply make such a blanket statement in medicine. It would be appropriate to edit this part of your blog.

  4. Hi thanks for your comment, I stated Metastatic lung cancer is terminal, perhaps I am incorrect here but from what a number of doctors have told me I am under the impression that if lung cancer has spread to another area of the body that is not the lung it is incurable.

    If that is not the case then please do comment again - the core concept of this blog being a medical students education and introduction into the world of medicine :)