The successes make the challenging cases more bearable

I first met her in the urgent care at the cancer center when I was on call one night. She was beautiful: 53 years old, four adult sons, and in incredible pain. She had stage 4 breast cancer, and unbeknownst to her, she had a metastatic lesion in her femoral neck, which she had fractured about four weeks ago. But she’d just had a spine operation for mets in her lumbar vertebral bodies a month before that, so she thought it was a complication of surgery. Like the pulmonary embolism she’d had. She squirmed and winced on the bed, clearly uncomfortable, but she had it; as an intern, my chief resident called it sparkle or grit. Those patients who, no matter how ill, have that will to live; either because they are incredibly tough or because they are truly someone who just shines with life. In her case, it was a mixture. Although in terrible pain, her eye makeup was perfect, she was in control of her situation and her sons acquiesced to her preferences. Because of her PE, she’d been started on Coumadin; after one dose, her INR was 5.6. After two days of correcting her coagulopathy, I performed a complex hemiarthroplasty of her hip and removed her fracture, replacing it with metal. It went as smoothly as could’ve been expected, but she also had liver mets; she third spaced all her fluids and was 6 liters positive at one point in her hospitalization. Eventually, she started to mobilize the fluid, but I could never dry out her incision. Continue reading ... You...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Physician Cancer Source Type: blogs