Friday, April 30, 2010

What a week!

Wow! It's the last day of April and I haven't written for so long...

One 'surprise' of being out of residency is that the 80-hour work-week ends. I was on call for Peds Thursday through Sunday. So I am so looking forward to this weekend off.

Last weekend I was on call and it was Prom weekend. Some teenage girl angst that I do not want to get into right now.

This may have been one of my worst weeks since starting in practice.

This week alone, I diagnosed 2 cases of breast cancer, one case of an atypical pre-cancerous breast mass, 2 new cases of diabetes and one unexpected prostate cancer.

I have done a lot of breast exams before this week, but I am changed in how I do them now. There is a pit at the bottom of my stomach when I am doing them now.

This 60-something gentleman came into my office for a physical (his wife made him come). He was on no medications and warned me that he did not want any tests. I talked him into a prostate screening test, and a diabetes screening test. He has prostate cancer and severe uncontrolled diabetes. I almost feel like I gave it to him and in a sense, I did. He was living his life without any labels and now he has two he did not want in the first place.

I've said this before. Medicine is a funny thing. In a day's schedule filled with 15 patients with 20 minutes per patient sometimes, you have to be able to go from one room where you said "I have bad news: you have prostate cancer" to a 2-month old well child exam where you get to say "He's doing great!" For me, it's when the day is over and I am spent, that it hits me.

I joke with my patients a lot. We try to keep the encounter light. I can't forget though, that this is serious business and under the veneer of the routine physical exam, cancer and death may lurk.