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.
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