Helpless/Hopeless

The Set-up

I’d say it was the toughest day that I had on ACS. They asked me to go see a consult for a middle-aged lady for what we thought was rectal cancer.

She had a mass in her rectum on the CT. I remember going to see her and she understood very few English words. She spoke the same language as my partner and his family speak. She was there with her young daughter who couldn’t have been older than maybe 19 or 20. I was trying to get a history from her, and it was all going through the daughter. I was trying to prepare them a bit that it could be something not so good. I just remember feeling nervous that we have to break the news to this lady today that she has cancer. I interviewed them as best as I could and headed back. We got the CT report and went back as a team to go see her. There was senior and the junior with me. We pulled them into this one of those small rooms in the emerg. It was the three of us, and then the mum and the daughter. All five of us were in there for some reason. I don't know why there were so many people in there.

It came time to tell her that she rectal cancer and so we told the daughter. I remember the daughter telling her. As a mom, she didn't really react like we had said something very serious. We see a mass on your CT scan. You have rectal cancer. I was really surprised and I was thinking, “What does she think of this?” Then me and the one resident left the room and as I was walking down the hall, I remember hearing her scream. Yeah, and it was just so tough to hear because she was trying to hold it all together. There were so many of us in there and it was probably so overwhelming for her and I'm sure she didn’t register for a second what we are telling her.  On top of that, the fact that her daughter, her young daughter, was the one that had to actually tell her because we couldn't tell her. It just really broke my heart to hear her scream. 

How do you think this is going to impact you and the care that you provide to patients in the future? 

I remember going home that day, and thinking, “Why were there so many of us in there? Why wasn't it just one resident, and then even a translator so the daughter didn't have to tell her own mom that she has cancer?” That could have been set up so much better. Like, what kind of set-up was that? It just really, really upset me. Of course, setting it up doesn't necessarily change the fact that she has cancer. But I'm sure it would have made all the difference for her and her daughter if we took the time have a quiet place, maybe having a translator, and not more than one health care provider in the room. It was also hard because she was the same age as my partner’s mom and spoke the same language. What if that was my mother-in-law? How would I feel if she got sensitive news in that way?  

I think in general, as physicians get more into their practice, they almost become desensitized. I remember shadowing emerg in first year, and there was a man that was having an MI. The doctor just was like, “Yes, your husband's having an MI. We’ll call cardiology.” The wife was crying because she's like, “Oh, my God, is he going to die?” I was standing there thinking that this is not how medicine should be practiced. How you set it up and leaving time for questions and acknowledging their emotions, I think is huge. My overall takeaway from this is that I never want to lose the human aspect of medicine. I want to look at people as people, not patients. A “55-year-old woman with rectal cancer.” No—she has a daughter, she has a career, she has a life. It’s the whole world to her that she has cancer. To us, it's just another day.