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Monday, July 27, 2009

Denial


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.

10 comments:

  1. Empathetic and beautifuly written......Bravo Doc :)

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  2. That was kinda touching ... the life of you doctors is difficult.

    You couldnt have handled it any better - I cant think of any doctor who would draw diagrams and explain things to patients who dont want to listen. Making the son understand was the perfect solution.

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  3. Brrrilient insight...

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  4. you cud wish there was a magic wand to cure all difficult situations like these...

    pray its only a minor infection.. that angry despair should change to relief when they realise that advice was in their own interest

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  5. you gotta do what you gotta do, doc.

    and you did it well, with utmost kindness and patience.

    wish more doctors were like you.

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  6. I agree with Jitu

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  7. doctor's life sure is not easy,but talkative doctor is better than the one who tells nothing.you did best in the situation.

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  8. hey manu ma'am,
    i am sure i would have done the same or prob less than this...life is a mixed picture n we as docs face it everyday standing n watching all this ups n downs....n still able to smile n greet the next patient...atleast cheerful people like u(n me too)give lot of solace to pt...isn't it?....Ruma

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  9. hey manu ma'am,
    i am sure i would have done the same or prob less than this...life is a mixed picture n we as docs face it everyday standing n watching all this ups n downs....n still able to smile n greet the next patient...atleast cheerful people like u(n me too)give lot of solace to pt...isn't it?....Ruma

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  10. Hey, my mom died of cancer, my dad got it too. Like it or not, denial is the way we deal with the mortality of our loved ones. I always thought a doctor's job is pretty thankless - in the cases where you CAN do something, there are chances that YOU screw up, and where you can't do anything - how do you deal with that?

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