What Really Matters

Last week I saw man in his 50s for a tingling sensation over his left chest.  He had well controlled high blood pressure, was a very active, fit, and generally nice person (always a red flag: being a nice person).  He came to clinic in December 2011 complaining of the same, and that the sensation started after doing a work out heavy on push ups. He was told it might be some sort of musculoskeletal strain, and that he should keep an  eye on it.  Fast forward about 4 months, and the sensation had spread across the left chest, under the armpit, and to his scapula.  He said sometimes in the morning he woke up with a sore left shoulder after sleeping on his left side.  He said, "Maybe it's nothing.  I don't know."

I examined him and found, as described, he had a patch of numb skin from his left chest, around to the left shoulder blade.  His left chest also felt slightly asymmetric compared to the right, which he called "swollen," but not painful.

I scratched my head all the while the wheels turning, my internal monologue alternating between "is this something bad or not bad?"  I couldn't give him a satisfactory answer on the spot, but I suggested he get a chest xray, then go home, and in the meantime I would contact the neurologist to see if he or she had any ideas on what the next best step would be.

The day churned on, and during my lunch break (in between pumping breast milk, feeding myself, and completing my morning charting), the xray result popped up in my in basket:
Fourteen centimeter mass in the chest, likely pleural  based, malignancy until proven otherwise.



Gulp.

I called the patient and told him about the mass and that he needed to have a CT scan that day to better characterize the lesion.  My words were nervous and rushed, and I spoke too much, attempting to fill the quiet on the line.  He said calmly, "Well, it wasn't nothing."  You can say that again.

The CT scan showed the lesion originates from the bone, and he has since had a biopsy, the results of which are still pending.  But he and I and anyone else involved in his care both know the news won't be good.  I wish this was some sort of Dr. Seuss like fantasy world where the biopsy results would come back something insane like "silly putty" or "lump of cheese" and then we would all have a good chuckle and go back to our daily routines.

But the truth is, this kind man's daily routine will never be the same.  And it still baffles me that this career of mine puts me in a position to cross paths with people and change their lives profoundly and inextricably.  It is a burden and it is a privilege and it, not all the other trivial complaints I have about my job, is what really matters.