10 February 2010

The Internist

Soon after the ER doctor gave me his diagnosis of pulmonary embolism, he informed me that I was being admitted to the hospital so they can monitor and dissolve the clots and administer more tests. Another doctor was taking over my case. He wished me well and left.

A while later, a tall, stoic, man in his 40's, wearing a crisp white coat, walked in with even, measured strides, carrying all the authority of a 5-star general. He introduced himself as Dr. Z, the Internist assigned to my case. My GP did not have a hospital practice and, therefore couldn't look after me while in the hospital (how bureaucratic is that?). Great! More strangers to poke and prod at me (and another person for whom to repeat for the the umpteenth time, the events that led me to the ER that day).

Now, using the word "stoic" to describe Dr. Z is quite the understatement. If Spock and Ripley (from Aliens) had a love child, it would be Dr. Z. Let's just say that he did not radiate warmth of any sort, but rather he was stiff, authoritative, measured, and very "business-like"-- in that 60's TV show doctor sort of way. This was the man who "delivered the news."

After we discussed my pulmonary embolism and the protocol for treatment to dissolve the clot(s), he told me that my surgeon had sent the biopsy results to the hospital for review by my medical team (of which now Dr. Z's in charge). Dr. Z then asked me whether I wanted to know the biopsy results (Uhm no...I don't want the answer to something that's been preying on my mind every waking hour for the past week...) Of course I did!


He stood there, towering over me with his arms folded. "It's not good," he said robotically. Gulp...."Cancer?" I asked. "Yes. And it's bad," he replied. Now, even though I'd been thinking "cancer" since I heard the word biopsy, there was always a tiny glimmer of hope that it wasn't. And hearing that it was indeed cancer from a doctor sure was another thing. It was official! A sentence had been pronounced and a gavel had been struck. Cancer! It felt like someone had taken a baseball bat and swung it at me. Every other word I heard (though the good doctor never said it) was "dead." I'm dead. What cancer was this that was going to kill me? With guillotine precision, Dr. Z enunciated: Stage 4, non-Hodgkins Lymphoma.

Whatever did that mean? Why is it a Stage 4 rather than a 2 or a 3? Lymphoma, I'd heard of before, but did not know the specifics. And I certainly wasn't aware of stages. None of those words meant anything to me. All I kept thinking was that I'm dead. And, for the life of me, I couldn't articulate the questions that were milling about my head, except one: "Is it curable?" The cancer had apparently wreaked havoc in my lymphatic system, as well as my chest, pelvic, and abdominal areas. So no, it was not curable, but that it was "stoppable." That did not make sense! What stuck was that it was not curable and that it was everywhere in my body. (There went my head rolling off the guillotine!). I'm dead!

You'd think at a time like that the whole world would have gone black. Instead, everything seemed to slow to a stop, then turned gray, quiet, and cold. I should have been screaming or crying or something. But I was dumbfounded. All I could do was stare at the unblinking, almost blank eyes Spock's love child, trying to find life, hope, or even warmth. I'd like to have heard an "I'm sorry" or something to that effect. But nothing. He just stood there. Unmoved by what should have been my violently shivering body and frightened eyes, Dr. Z continued, in his his well-cadenced speech, to say that I was going to meet his chosen oncologist the next day to discuss the cancer further, as well as the suitable course of treatment. The oncologist would be in a better position to answer any more questions I had. He bade me "good night" and walked out of the room in perfect stride. That was February 25, 2009.

From where I stand now, I think that the Internist did me a big favor by being the way he was: calm, cold, and calculated. Because if he had shown me even an ounce of sympathy (or even blinked!), I would have fallen apart in his arms completely and probably would not have been able to keep it together for everything that was to follow. Looking back from a year's distance, I can see how important it was that I did not fall apart at the hospital and the very important part that Dr. Z played in that. So, thank you Dr. Z, for your cold comfort. Live long and prosper!


Karen said...

Yes, I have met a few of those "Dr. Z.'s" along the way myself! I remember the tears that fell after the cold doctor - or nurse, or technician - left my room. I like your perspective on it: That if the doctor had been more human-like, or more empathetic, you would have probably caved.

Fortunately, my oncologist is one of the warmest people I have met. Very competent, but she never forgets to hug me before I leave her office. Now that I'm 4 years post diagnosis, she's more of a friend than a physician to me.

Congratulations on your first year! Wishing you many, many more! :)

ce_squared said...

Thanks, Karen! During my recent battle with cancer (and the events leading up to its diagnosis), Dr. Z was an anomaly more than anything. Hence the post about him. Almost any other doctor I had encountered in the past year had some ounce -- if not a lot-- of humanity in them. :-)

I like that you're now friends with your oncologist.


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