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So many lawyers, so little time...

"The prospect of hanging focuses the mind wonderfully"--Samuel Johnson

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Location: Louisville, KY, United States

Gastroenterologist, cyclist, cellist, Christian, husband, father, grandfather.

Wednesday, January 26, 2005

The Launching Pad

1980 was the year of my junior residency: the year of training right after internship, when we're just a little older if not a whole lot wiser. I trained in a hospital that was built in the 1930's: large open wards where patients lived and died in full view of about thirty other patients and anyone else wandering in and out.

In November, as the days grew short and my Seasonal Affective Disorder resumed its annual siege upon my well-being, I was assigned to the Cancer Ward for two months. Few trainees liked this rotation, and one way we coped with it was to descend into a very Dark Humor. The open ward had a private room attached to it that we called the "Launching Pad". This room was reserved for folks dying in such miserable fashion that it would have been inhumane to leave them out on the ward. No patient assigned to the Launching Pad ever walked out of the hospital that I know of.

One day we admitted a particularly sad case. A young woman, in the sixth month of her pregancy with her third child, visited her obstetrician and told him that she had a little breast lump.

"Don't worry about it", he said. "We see this all the time in pregnancy, and it almost always goes away after you deliver. If its still there, remind me to take a look at it".

After the delivery it didn't go away. In fact, it expanded so rapidly that literally the entire breast was replaced by a rock hard mass. Biopsies revealed "inflammatory breast cancer", an unusually virulent form of the disease which seems to double in size about every thirty days. It also metastasizes early and often.

Our attending, fresh from his own training in cancer medicine at M.D. Anderson, assured the patient, her handsome young husband, and three small children that this kind of thing often responds really well to therapy, as long as the special protocols from M.D. Anderson are used.

On her first day on the Ward she was given the special protocol.

On the third day she was reassigned to the Launching Pad.

On the fourth day she died.

My intern and I withdrew to our tiny little office to indulge in another moment of Dark Humor: the Scoreboard. The two teams of doctors on the Cancer Ward kept track of every death that occurs on their team, a weirdly competitive way to deaden the pain. We mark her up.

"You know", the intern says, "one of these days I'm going to have a good long cry about this, but we have twenty other patients on the service, and if I cry about this now, there ain't no way I'm going to be able to go out there and face the rest of them".

I agree. Too many patients, too much misery, not enough time. I'll cry about it some other time.

I'm still waiting for the day.


Anonymous Anonymous said...

Ugh! If you start it may be difficult to stop. RCC

8:26 PM  

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