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Monday, July 27, 2009
When a patient who has received treatment (radiation and chemotherapy) for carcinoma cheek develops a hoarseness of voice that persists for weeks, it has to be taken seriously because ENT cancers have nasty habit of wanting to go everywhere. That much is simple. An intern fresh out of med school knows as much. But what is difficult to learn is how to explain this to the old man who persists in pretending that he has no idea what you’re talking about. His doctors told him, last year, that his cancer was gone. This heaviness in his throat – couldn’t it be just infection? A sore throat, for God's sake? Why am I making a big deal of it? Who am I, a non specialist youngster in a small hospital in Lonavala, to doubt the wise old oncologists who treated him last year? I draw diagrams, explain concepts like metastasis as simply and as kindly as I can, but he’s just bored.
All I want to do is to write a referral to the Onco Deptt. All he wants to do is to get the hell out of my office, go back to his life and completely forget this unpleasant conversation. We reach a compromise; I let him go, after making note that his son is a junior sailor in the Projects Department. I call the son to the hospital to tell him that he needs to take his father to the Onco Specialist again. Father and son turn up together, looking like yesterday and tomorrow of the same face. I say the same things to the son that I said to the father – that it may just be an effect of the radiation, or it may be that the carcinoma has spread; either way, the hoarseness in his father’s voice needs to be investigated. He listens with a polite resignation and agrees with everything I say. The father listens with the same irritated skepticism as before. I write the referral and call up the boy’s boss so he can get leave.
I would like to believe I did everything that needed to be done but I keep remembering the look of angry despair the old man gave me as he left and keep wishing I had handled this better.