Blog | Monday, October 10, 2011

Painfully aware


She didn't look well. No one "looks well" sitting in an crowded ER, but she really didn't look good. At first glance from across the room I assumed her to be fairly old, how old I wasn't sure. Scrawled atop her clipboard in red Sharpie was ADMIT TO MEDICINE. I pulled the board and walked over to her. She was sitting up on the gurney, rocking and moaning. Many others were doing the same, a keening ritual in a bloody church. But she was my only parishioner for the moment.

The clipboard reported her vitals, an age of eighty, a few scrawls from various medical professionals and her previously stated disposition. The rest was mine to learn.

"I got cancer," she said between moans.

"Do you know what kind?"

"In my pancreas, they said."

As I observed her, I saw the truth of it. Her skin was a papery grey-yellow, her belly looked absurdly pregnant given her age, and her eyes gave off an unhealthy fluorescent glow. And she didn't smell right.

"When did they tell you about this," I asked. "Do you have a doctor who's taking care of you?"

"Well, musta been about a year ago. I never been much for doctors, but the pain is so bad," a sudden sob accentuating the obvious.

"Where is the pain? What does it feel like?"

"Doctor, it's in my belly, and it feels like someone is pushing in with their fist and never stopping. Like I just want to die to stop it. I can't eat, I can't drink, I can't sleep cuz of the pain."

Following the usual line of questioning I asked, "Have you tried anything to help with the pain?"

"Heroin."

She said it the same way I might say "Motrin."

"Uh, OK, uh, how did that happen?"

"Well, I tried it once back in the day and I never took to it, but I figured maybe it would help. One of my nephews got me some."

"OK, well, did it help?"

She looked at me for a second, stopped her rocking, and using the voice I'd imagine she would use on a simple grandchild, said, "Doctor, if it'd worked, I wouldn't have come here. I told you I don't care much for doctors and such."

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.