Heme/Onc: Difficult patients

This morning I paired up with Dr. BR, but before we saw any patients I got to listen as Helena and Dr. RY discussed a "horrible" patient who turned up the drip on her Taxol (?) chemo so that she could finish a 3 hr treatment in just 15-30 minutes. "Did she not realize that she could have died from that?" said Dr. RY. Apparently this is not the first time this woman acted up though; there were stories being exchanged about her left and right for a while. We saw our pancreatic cancer lady again (fortunately she didn't bring any vases or flowers; the flowers she gave Dr. BR yesterday have all dried up but are still pretty), and then we got a patient that really made Dr. BR groan.

Mr. C was a 78-year-old former lawyer with head and neck cancer that has metastasized to his facial nerves and given him a right face droop, and one side of his vocal cords is paralyzed so that his speech is really soft and hoarse. Now he has trouble swallowing and will need a PEG tube for nourishment, which he is not too keen about. He and his wife were reportedly "angry" about the delay in treatment that led to his present symptoms when in fact he was the one who wavered between surgery and Cyberknife (he was afraid surgery guaranteed his facial nerve paralysis, and he "fired" the neurosurgeon b/c the neurosurgeon was pushing for surgery), and now he didn't want the PEG tube. He described having a PEG tube like being a "cadaver with blood flowing," which made no sense. Dr. BR patiently explained that many people have continued to lead fulfilling lives s/p PEG tube insertion and that it was not the end of the world. Even after the 20-30 minute discussion, however, the patient wasn't convinced, and his wife later contacted Dr. BJ, his previous oncologist (the former president of the Center who retired earlier this year) "just to talk" about their frustrations. *sigh* It was funny when Dr. BJ forgot which doctors worked which days; he said, "Guess that happens when you don't have a regular schedule." This was, of course, referring to the fact that he was retired, and the other doctors were quick to tell him to leave the workroom (for rubbing it in)

I got to follow Dr. LM in the afternoon and got pimped on CML and even the AML: M3. He asked me what the translocation of AML: M3 (aka APL) was, and thank goodness for Dr. Barone's lectures; I remembered the 15:17. Dr. LM looked impressed and said I was on a roll, and I later shared the story of the 15-17 year old teenager wandering in the "trans" district of some street looking for some DIC and hopping in a black sudan. The stain was "Sudan black" so Helena and Dr. LM didn't get that part at first, but they both got the DIC part down, hehe.