Hematology-Oncology
signout | June 27, 2007"How many times you poke me?" she asked. Then, in her heavily accented English, "Dr. Better never took this long for LP. Five minutes, always."
I made empathetic noises, apologized a few times, and tried to focus on the needle I was moving in and out of her back. I'd done four lumbar punctures before, and felt I was good at them. Wasn't I in the exact space where I needed to be? I stopped and felt again for her spine.
On my first day on the adult hematology-oncology service, she'd been described to me as an anxious, passive-aggressive woman who hated our hospital. She created traps for us,…
signout | January 13, 2007I just finished a rotation in pediatric hematology and oncology, where almost all of the kids I was taking care of had cancer. Most had leukemia or lymphoma with prognoses that were varying degrees of good. A few had other, highly curable solid tumors. Only one kid--a boy I've written about here twice before--had a bad cancer. But boy, was it bad.
His tumor, called a neuroblastoma, is a cancer of the sympathetic nervous system. Its prognosis can vary significantly with the age of the patient it affects and with characteristics of the tumor itself. This boy's problems had started at the age of…
signout | January 7, 2007There's a 3-year old kid on our pediatric hematology-oncology service who has a high-risk, stage IV, disseminated neuroblastoma: a bad cancer with a terrible prognosis. The mass in his liver is huge, and distends his abdomen way out of proportion to his limbs. He is otherwise a truly beautiful child, with big, blue eyes and an open, winning smile.
I went in last night at about 3 a.m. to examine him because he had spiked a fever. When I laid my hand flat on his belly, he opened his eyes and said, in full voice, "Don't hurt me!"
In my training, I do both adult and pediatric medicine. However,…
signout | December 25, 2006I'm an M.O.T., so for me, Christmas, meh. It's just kind of another day. I'm neither especially cranky about having to work nights through the holiday, nor is my heart filled with the dazzling light of yuletide joy.
But last night, a colleague reminded me of something that brought home the true meaning of Christmas: today, I am exactly halfway through my intern year.
Hallelujah!
We even had our own Christmas miracle: we got a kid with a huge neuroblastoma in his liver down to the CT scanner at 2 a.m....and he wasn't bleeding into the tumor. (The real miracle is the first part.)
Huzzah! I…
signout | August 1, 2006On Sunday, we admitted a new patient to my team, a young, kind of hip lady with an 8-month history of progressively worsening abdominal pain, fever, night sweats, and weight loss. All signs pointed to pancreatic cancer, which generally has a very poor prognosis. So it was a little confounding when the initial CT scan failed to show a pancreatic mass.
My team spent about an hour and a half discussing her differential diagnosis-the list of diagnoses she could possibly have-with two different attendings. It occurred to me at a certain point that I so badly wanted this woman not to have cancer…