Recently, a patient came in around 11 p.m., just as the chaos of the day had settled, and I was thinking of rest after 16 hours of work. He was an older gentleman with vague and concerning complaints that would demand a thorough workup. I suspended my thoughts of self-preservation and stepped in to evaluate him.
After an hour and a half, I had found a source of infection that explained most of what was going on. But on a CT scan looking for blood clots, there was an advanced cancer that had grown silently and painlessly and was not at all in my differential diagnosis. Suddenly — my closure talk would go from “looks like a simple infection that’s perhaps gotten in your bloodstream, and we should be able to get you better quickly,” to “I’ve found a source of infection that’s easy enough to treat, but … (buts are never good from a physician’s mouth) on that CT scan, we just happened to notice a large mass that is very likely a malignancy — a cancer that appears to have already spread.”
There’s no easy way to tell someone who’s come to your ER for a presumed infection that they are now facing a much more evil, insidious foe. Through the years, I’ve had to tell many people they have a tumor, a mass … cancer.
There is no script and no easy way. I just tell them as I would want to hear it: straight up without any beating around the bush. This night was no exception. I watched shock melt into fear and sadness in about two minutes. Of course, I always say that there will have to be a biopsy or more detailed test to confirm it, not to give them false hope but as a matter of fact.
Walking back to the desk I was overcome with pessimism. I had come to accept this darkness as just how I am and what my job had done to me through the years. A rite of passage, it’s the price we all pay as ER doctors who deal with the ugliness of life for a living. I thought this had served me well all my life but with honest introspection. I’ve been psychologically devastated by it. I’ve been tired, unsettled and generally unhappy for far too long and had to find my way back to life.
To this end, I’ve recently started reading positive psychology books, looking for the upside to every situation and getting out of my head long enough to see the good in life. It was always fleeting in my past, and I was chasing an unreality that remained an oasis on an infinite horizon.
Sitting there staring at this tumor and the family members of this patient, I closed my eyes and began a silent mantra of “see the good, find the positive.” I was exhausted, and my last patient came in with great expectations for help and got a possible terminal diagnosis. What the hell is positive about that? I’ll tell you what is positive and good: life.
This family trusted me with his life, and I’ve given a large portion of mine to have the necessary skills to do what I do. I love what I do and feel. I was born to be a physician. I’ve always said that and truly believe it. The fatigue and stress I’ve come to expect and have actually been able to use them as motivation to keep going, moving, reading, learning. Had this man not come in that night he may well have ridden it out at home or gone somewhere that this tumor would go undiagnosed. He would not have presented until it was far too advanced for any treatment and died an agonizing death. For now, he has a diagnosis and was sent to the appropriate facility for timely treatment that may save his life. He’s alive another day, and I pray he has hope that otherwise would have never been.
I hate cancer. It is the silent and invasive army that turns our own cells against us and remains largely a medical mystery despite the advances in treatment. It steals the most precious gift of life daily. However, it can be defeated, and I know many of us ER doctors have played an unscripted role in early detection and perhaps saved a life or two along the way. I have to cling to that hope.
Life is beautiful.
When we fight, life is beautiful.
When we cry, life is beautiful.
When storms gather, life is beautiful.
When we fall, life is beautiful.
When we lose faith, life is beautiful.
When death nears, life is beautiful.
Life is fleeting, hard, relentless and beautiful. Think about your life, the love you have surrounding you. My beautiful family, my health, my mind and my purpose are blessings that remain strong and steadfast and I thank God for them now every day. On nights away at work, I remind myself it’s a privilege to serve my fellow man and that even the longest shifts will end and life will be waiting. It doesn’t hurt that I can call my best friend and woman I’ve loved forever and hear the strongest and most reassuring voice that lets me know it’s going to be OK.
We chase tomorrows that may not come. We project ourselves far into the future and neglect the baby steps along the way. We do not plan on laying in an ER with a grim-faced doctor in the room. Just walk for now, slowly and deliberately toward the dawn, grateful for each moment that comes before. Don’t take a second for granted.
I finally did lay down that night, but only after I knelt and gave thanks for a most beautiful and precious life.
James Nichols is an emergency physician.
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