I don’t always do the right thing. I don’t always figure it out. That’s the worst part of this job. The not being perfect part because not being perfect means I’m flawed and flawed people make mistakes and my mistakes can hurt people.
One time I almost missed a lung cancer. Oh God, the gut-wrenching weekend that I spent after that one. I must have lost 5 pounds just from the nausea that I felt. How could I eat? How could I breathe? My mind ground the details of the entire chart into a fine powder and then I sifted through that. Trying to account for every dust particle. How could I have failed so miserably? I could have just died. Truly. What a miserable wretch I was.
The crazy part is it couldn’t have been helped.
She had lung cancer a decade before. It came back. My angst came from –could I have caught it earlier? Should I have been doing more surveillance on her? It was back. It was bad and now she had blood clots. I took every ounce of blame onto myself.
How does one surveil someone after lung cancer? One can order CT scans periodically as a screen, but her insurance wouldn’t pay (it went to deductible). And it had been over 10 years. She did have the occasional chest X-ray. The last one just 6 months before and it was normal. She neglected to follow up with her oncologist or pulmonologist. She didn’t get mammograms or colonoscopies. She continued to smoke. Was it all totally my fault? I just didn’t find it early enough. Even if I did, lung cancer is so hard to treat…
This was such a lonely experience for me. Who do I talk to? I can not show anyone my weaknesses. I could not show that maybe I wasn’t diligent enough. Other better doctors would have done a better job. I couldn’t let them know. I just wanted so much to bounce the case off of someone else, like talking to a best friend. Confidentially. But I couldn’t. We just don’t do that.
It stayed with me. It churned in my gut. It gnawed at my mind. It stole my rest. It consumed me. And it wasn’t even that big of a deal. Except for her. It was a very big deal for her.
Photo Credit: Lorenzo Gonzalez