It was the final hour of my shift, and I was cleaning up for my colleague who would be taking over. Glancing at the clock, I decided I could see one of the “easy” fast-track patients just to help offload the board a bit. I figured he wasn’t going to take long, as his complaint on the board was “sore throat.” What I came to find out was that he was being worked up for stomach cancer. And, his sore throat wasn’t really a sore throat but difficulty swallowing because food was taking a long time to go down. Of course. He has a big cancer blocking the entrance to his stomach, and food goes down slower as the passageway gets blocked. All he wanted was some relief so he could enjoy eating something of substance, but even now, he is barely able to swallow soup.
This is the frustration: the complete inability to help someone despite everything. I could do nothing for this seventy-something gentleman who was so calm and gentle in his demeanor. I know he had been sitting out in the waiting room for hours, waiting his turn. He didn’t have an urgent complaint. All my other patients were definitely more urgent than him, but I could almost see him sitting in chairs, smiling politely as other patients were called into the ED, and hours later finally getting his turn, only for me to tell him, “I’m sorry, there really isn’t anything I can do.”
I didn’t say that, of course. Having had an aunt who died of esophageal cancer and having been a surgical resident, I knew what maybe could be done for him. The offer of surgery to remove part of his stomach and esophagus and create a new path for food. But, he is seventy, and the complication rate is high. He’s already lost thirty pounds in six months. He might be offered a feeding tube to bypass his stomach and give him some nutrition. But, I more than most understand his complaint. I enjoy food and can’t imagine what it would be like to suddenly not be able to even enjoy something simple like soup. Imagine a world with no more ribeyes!
But I digress. His records showed pathology for a serious kind of stomach cancer. Recent workup showed that it hadn’t spread, but still. There was nothing I could do for this gentle man. I ordered some blood work to check the patient’s level of hydration. It was the end of my shift, and I signed him out to my colleague. But, before I left, I brought my patient a cold apple juice. At least he could have one small pleasure as he waited for the results and for the inevitable, “There’s nothing else we can do right now.”
Veronica Bonales is an emergency physician.