The weeks

My practice is growing. I know have about 1100 patients that call me their doctor. Most days, clinic is a whirlwind of patient visits, emails, phone calls, and reviewing labs, imaging studies and reviewing nurses' notes and consults.

Last week, one of my patients called to say that she had felt a lump in her breast that was not there when I saw her for a physical in November. Her insurance was not going to cover an office visit, so she requested if I could just order the mammogram. I did. A mass was discovered in her right breast and a sample biopsied. The result: invasive lobular carcinoma. I called her to give her the results. She would not answer the phone or speak. Instead, her husband was to receive the bad news. I hate this part of my job -- giving bad news. Actually, I don't hate that part. I want to be there for my patients. It's the bad news part I hate. Every diagnosis weighs heavily on both my patient and me -- some like cancer more so than others. Sometimes though, a diagnosis is a relief. I got to call a patient who for years had been suffering with pain in the upper and lower abdomen. He was so frustrated that no-one knew what it was. This week, we finally found out: epiploic appendigitis. It may be chronic or it may respond to treatment, but for the moment, we both savored the pleasure of the end of one journey -- the 'what's wrong with me?' part, before embarking on the 'how do we fix it?' part.

I also got to diagnose hemachromatosis for the first time. This is a disease I had read about in textbooks but never actually seen. Making the diagnosis was like an 'aha' moment that suddenly pulled all of the symptoms the patient had, come together into a coherent picture.

The weeks are bitter-sweet: the treating of patients that get better, the diagnosing of patients who may or may not get better, depending on the diagnosis, the tearful goodbyes to patients who die, expectedly or unexpectedly and the cheerful hellos to the newborn babies born to my patients or as new additions to their families. They all run together in the same day, sometimes in the same afternoon. It is like a roller-coaster ride, emotionally, physically and mentally.

Most nights I arrive home spent. These days I dream of the clinic and the hospital. Some mornings I wake up feeling like it's not fair -- I feel like I just worked all night. Still, I am tired but happy.

I still got to say: this is so cool! Thank you Lord, for the privilege of seeing patients and practicing medicine!