Tuesday, April 22, 2008

Bad news

Sometimes a patient comes along who reminds me why I'm here.

Ettie is a lady of 82 years. She's been widowed for almost a quarter of a century. Apart from high blood pressure and quiescent ischaemic heart disease she is relatively fit and healthy. I've been her GP since I joined the practice in 1999. She only sees other GPs rarely, usually if I am on leave.

But Ettie wasn't well recently. She had what appeared to be a chest infection with some pleurisy. I treated her with antibiotics. She felt better in herself, but the pleurisy didn't settle so she came back to see me a month later. Although her chest was clear I arranged a chest x-ray.

The x-ray showed a shadow in the top of her right lung. It also showed some destruction of two of her ribs, just where she was still getting discomfort. Ettie probably has lung cancer, almost certainly in fact. It would also seem to have spread beyond her chest to her ribs. This is bad news.

I have seen Ettie this morning. I have spoken to her at length about what is going on, what the likely problem is, what will happen next. I have referred her to our excellent local lung cancer rapid assessment clinic.

Ettie is devastated. She is scared. She is sure that this means the end for her. It may well do. But I will be there whatever happens. I will treat whatever symptoms she develops to the best of my ability and will enlist the help of our local palliative care team if I need to (or if Ettie needs me to).

I would prefer not to have to, but I will coordinate her care, to what will hopefully not be the bitter end, but a dignified, peaceful death.

Who better than me, who has known her for so long, who she has a relationship with, who she trusts?

I am her GP.

Enough said.

3 comments:

Jobbing Doctor said...

Welcome back to Blogland.

I am one of the new kids on the block!

Have been faithfully visiting daily.

JD.

Russell Brown said...

Thanks!

Reading yours as well. I especially liked the "blogorrhoea" post.

I am going to start writing again, I got out of the habit, but I enjoy it, though I'm less erudite perhaps than certain others.

Dr Andrew Brown said...

I agree with JD, it's good to have you blogging again. Much as I sympathise with the Dr Rants of this world, I feel that gentle exposition of our point of view is likely to be more persuasive. And I'm just as curious as any lay person about how other GPs deal with things. We are similar but we are also different, and the job is endlessly fascinating.
AB (no relation, obviously :-)