Sunday, July 12, 2009

zone 1/2

finished my third shift in zone 1 at the SFGH ED, it was very busy (the way i like it) and full of new developments. one of the most surprising cases was a 55 F who came in c/o left flank pain, we thought that it was a UTI resistant to the ciprofloxacin that she was taking, but my ED attending suspected diverticulitis and the pt got an abdominal CT that revealed a right cystic ovarian mass concerning for ovarian cancer. after informing the patient of the CT results, I questioned the patient further and found that she has been experiencing abdominal bloating for two years and a sensation of abdominal fullness. she had never been pregnant. all of these symptoms (insidious and innocent as it seems) are all risk factors for ovarian cancer, and after the radiology results, things started clicking in place in a serious way. it was really sad.

working in the ED is nice, I really enjoy the fast pace and being busy busy busy while i am at the hospital (downtime is not as fun for me, although i do need my coffee ritual in the morning). the other aspect that i am really relishing is the speed of test results (labs, CT, etc), the decision-making and diagnosis, as well as discussing the plan with nurses, consult teams, attendings.

2 comments:

Dr Benway said...

With age, you get to be a patient as well as a doctor.

Couple years ago I had a funny looking pelvic ultrasound. Well, three years ago, I had a big cyst on an ultrasound. I went, "oh cyst," assumed it was nothing and forgot about it. My gyn apparently wanted me to follow-up with another study. We didn't connect. This is because I am a terrible patient.

When I started having bouts of severe pelvic pain with trips to the ER months later, at my gyn follow-up, the doctor seemed worried. She sent me for an ultrasound the next day, which happened to be a Friday.

I tried to glimpse the monitor as the tech did the study. At the end, I asked for the tech's impressions. She was coy, as no doubt she was trained to be. I said I was a doctor and understood she couldn't say anything definitive, but wondered about the cyst. Actually, I had three of them, size of oranges. They were "complicated."

That word "complicated" woke me up. I immediately got the cancer heebie-jeebies. In hindsight, it seems a little strange that I'd never considered cancer as part of the differential until that moment.

I spent the rest of Friday evening and most of Saturday morning worrying and crying and thinking of Gilda Radner. My husband did his best to comfort me. I made some calls, but couldn't get hold of my gyn. So I went to the ER to see if I could get a wet read from the ER doc or maybe even a report from the radiologist.

The ER doc was snarky. He thought it was inappropriate for me to bother him, that I ought to wait until Monday and follow-up with my gyn. Lab results aren't emergencies. Plus the radiologist wasn't in until later that afternoon.

Could I call back? No, I could not.

Long story short: endometriosis, not cancer. Hysterectomy fixed, but menopause has its downside.

Moral of story: being a patient sucks, even when you're a doctor.

Stephanie said...

Thank you for sharing your story. I think all med students would benefit from more exercises to see how patients feel at the hospital/ED. Glad to hear that your cysts were okay! Have fun on your boat!