Beat: favorite patient has pancreatic cancer

[Skipbidder]

Depressing story follows:

I've been drinking a lot today. My favorite patient has pancreatic cancer.

This guy was almost dead two years ago. Bad emphysema, requiring home oxygen. Intubated while in the intensive care unit. Angina (heart pain) frequently. His wife had died recently. Claudication (pain in his legs on walking a certain distance) but not a candidate for a revascularization procedure because he can't handle the dye load because he's got only one kidney (other removed from cancer). He told me that he was ready to pack it in. He told me that he wasn't able to do anything that he liked anymore and asked what the hell was worth living for. I found out that among his physical activities, he missed golfing the most. I told him that I thought I could get him back to golfing again. I got him down from 2 packs a day to 3-4 cigs per month. (His pulmonologist vehemently disagrees with me, but I told him that this was okay.) Then, got him off the home oxygen. Got him a pacemaker. Got him on the right cardiac meds. He was no longer needing nitroglycerin. Got him eating better. He golfed last summer and fall (with a cart). Woohoo, I'm a [censored] great doctor.

Last week, he came in bright yellow. I now have the confirmation that he pancreatic cancer. The 5 year survival is something like 5% for all comers (and with his comorbidities, his will be less than this).

I've had plenty of patients die before, but this is the hardest by far (even though he's still alive). I really, really like him, and I feel like [censored] for getting his hopes up. I painted a pretty grim picture for him yesterday, but I'm still not sure that he understands.

Carry on.

[hobbes9324]

You got him an extra year - that's more than a little. C of the P is the worst....sorry.

MM MD

[Ikaika]

[ QUOTE ]
You got him an extra year - that's more than a little.

[/ QUOTE ]

Agreed 100%. Sometimes, despite your best efforts, things work out in what seems like the most unfair way possible. Best of luck to both of you.

[inside??]

Sorry to hear of your circumstance. I am now going thru the same sort of thing with my mother-in law who has inflammatory breast cancer that has recently spread to her liver. I remember an episode of MASH when Hawkeye lost a patient he was close to. Henry Blake told him there are 2 rules of doctoring. Rule #1 is that some patients die. Rule #2 is that doctors can't change Rule #1.

Good Luck

[THEOSU]

HAY HAY HAY

[TyFuji]

I think it's fantastic that you a) set a goal (golf), and b) got him there. You did a great job.

[dylan's alias]

Man, that sucks. But the truth is that your hard work has dramatically improved his life. He was going to get pancreatic cancer anyway. Remember, there is plenty more you can do to help him. If your relationship with him has been strong (as it seems) he's going to need a lot from you. See if he has advanced directives that his family can understand. Hopefully you can keep him out of my realm (ICU). Be sure that his emotional needs are discussed - his oncologist probably won't. This is by far the worst part of the job, but it may be the most important.

But first, have another drink for me - I prefer single malts. I'd do it, but I'm off to the unit for a night shift in a few hours.

[Skipbidder]

[ QUOTE ]
See if he has advanced directives that his family can understand. Hopefully you can keep him out of my realm (ICU).

[/ QUOTE ]

I've got this part covered. He not going to end up in the unit. He's Do Not Rescusitate, Do Not Intubate, no Intensive Care Unit transfer, no dialysis. (The only thing we added after this diagnosis was the no ICU transfer.) No involved family. Wife's dead, no children. One niece who is healthcare power of attorney (but lives in another state).

[ QUOTE ]
Be sure that his emotional needs are discussed - his oncologist probably won't.

[/ QUOTE ]
His oncologist WILL. She's extraordinarily good about end-of-life issues (which is why I referred to her). There are three oncologists that I refer to (well, four if you count the specialist in melanomas). I use them specifically because they have balanced and reasonable outlooks (which does not seem to be the norm for oncologists).

[ QUOTE ]
This is by far the worst part of the job, but it may be the most important.

[/ QUOTE ]
I don't consider it to be the worst part of the job. I do agree regarding its importance.

[ QUOTE ]
But first, have another drink for me - I prefer single malts. I'd do it, but I'm off to the unit for a night shift in a few hours.

[/ QUOTE ]
Had the weekend off. I drank both your share and mine (and probably someone else's). No scotch, however. It's wasted on me. I did have a nice Belgian ale, much rum mixed with various fruit juices and sodas, Kahlua and milks, some port, as well as a ridiculous raspberry lambic.