cancer

She is a 53 year old female. I am a 55 year old gastroenterologist. I was consulted because she had suspicious tumors in her liver on a CAT scan. She has been feeling increasing distress in her upper belly and has not been able to keep anything down in her stomach for last two weeks. The pain was not the severe pain that curls you up, but it is gnawing, that eats you from inside, it is the pesty visitor who visits you at the most uninviting of the moments, it is the conversation that one has to carry on in the most importunate of the situations. I reviewed her labs and scans carefully before I enter her room. I take a pause and a deep breath and tell myself: “Hey you, cheer up, have a smile on face, and make sure your patient does not see you gloomy or anxious”.  Having obeyed my own advice, I apply several soft knocks on the door. “Come in” I hear from outside and I enter the room. Laying flat on the bed was a thin lady, ashen looking, covered in white freshly cleaned hospital blanket and the protuberant abdomen sticking out like a sore thumb from under the sheet betrayed her frail physique. Next to her sitting on the rocking chair was her male companion wearing a red bandanna on his head; his white long unkempt beard and cigarette stained handle bar mustache giving out an impression that he would be better fit to the next Duck Dynasty episode casted outdoors in the midst of nature than belonging to this claustrophobic beige colored hospital room with its fours walls closing in on the small space all the times. I have always found hospital rooms to be very interesting. Some rooms seems to be bright, others dim and dark although when I counted they exactly have the same number of flood light fitted on the ceiling and on the sidewalls. The healthcare architects are great in consistency and meticulous in attention. Master of their trade, from faucet to air conditioning vent to a small emergency switches, all of them in exactly placed in the right position, they have an uncanny skill and attention to details, nothing seems to distract them, nothing seems to make them forget even the smallest of the things in pursuit of their job of designing and planning a hospital. I never had much luck in picking their fault as far as hospital patient rooms are concerned. When I cannot explain by science, I always resort to my inner superstition: I concocted the same about the hospital rooms, since architecturally and physically they are all the same and immaculate. I came to believe, the rooms that are bright, or at least appears to be so in my eyes, patients tend to do well and the rooms that are dim and melancholic, they take their occupants into the abyss of dooms. Sometimes I wonder how the admission clerk assigns the room to the patients, is it first come first serve? Or is it at her whims? Or may be she has no choice, the computer assigns it randomly like many things now a days. In my own obsessed physician’s moments, when I get carried away with my own physical symptoms and there are times when I felt calling the EMS to take me to the hospital, not as a doctor, but as a patient. Then in my mind, like an well orchestrated Broadway drama, I go through the rehearsal: As soon as the EMS takes me to the hospital I ask the admission clerk, “I want room number……..” She will be surprised and I will look at her with authority and make sure I have the stethoscope on my shoulder, or my physician ID still displayed somewhere visible and insist, “You have heard what room number I wanted Ma’am!”. Then she might say, “But Dr. Meah, that room is taken, there is already a patient in there!” . Well, my imaginary Admission Clerk certainly got me, after all I cannot ask her to expel the existing patient, I am only a doctor, not a savvy apparatchik national figure who can order around. That’s when I feel like I should develop a secret list of good and bad rooms in the hospital, my own top secret, I will share with no one, although unethical, its use is my nuclear option, only to be used when my own life is at stake, and I come to this hospital and I will tell them give me this room number…..! “Taken”, she will answer,  “No problem, give me number……” I will say keeping my smile hidden.  “Taken”, she might say again.  “No problem, then give me number…..” as I pull out another room number from my secret private list, I know something has to work out, US hospitals have always rooms empty since most of them are made to an excess capacity.  Thus I have thought about making a secret inventory of hospital rooms, that is good and bad rooms, although, my laziness had not yet come around doing this in actuality. I introduced myself, interviewed her and after obtaining her consent, examined her confirming all the ominous signs that in medical literature we summarize as, “Stigmata of chronic liver disease” with “signs of hepatic decompensation”. She had a large liver, double the size of normal; it was filled with many marble sized tumors and beneath her wasted skin, these felt as firm as the glass marbles that I used to hide away from my younger brother underneath a cotton blanket in my distant childhood.  Normal liver feels slippery, soft, gentle and soothing to palpating finger tips of the examiner, unlike these bold and hard knots, there was something aggressive about them. I noticed her feet were swelling too and one area on the right shin had started oozing clear fluid, a sign that her liver was not able to make enough protein to keep her own fluid inside the body. Her chest was full of dreaded “spider