Thursday, November 4, 2010

Miller Emotions at it again...

I need to start off by saying the Miller emotion gene is hyperactive. If you have ever been around my family you will know that it is not uncommon for us to blubber through a hallmark hall of fame TV special, or cheer during the Olympics trying to not let the person sitting next to you notice the tears in the corners of your eyes, or become verklempt listening to Christmas music. I've done so much better and have gained much better control of my emotions than in years past. I rarely cry anymore, and I thought I had suppressed this Millerism. The other day it got the better of me and caused quite a scene.

I was on call and had been at work for 16 hours and had 14 hours still to survive. I was already tired and when I'm tired my emotions are harder to control. I was called to evaluate a 7-year-old who had just been sent to the hospital by her family doctor to be evaluted by a Heme/Onc doctor. I was to go obtain the child's story, do a physical exam and begin the admission orders for the doctor to come review. I walked into the room to find the cutest little family sitting together on the bed. They all had matching blue eyes and blond hair. The oldest daughter sat on her Mom's lap and looked ghastly pale. The apprehension in the room was palpable and I tried my hardest to establish good rapport and to build their confidence in me. I asked the patient about school, her favorite things to do and her friends. I talked to her and her little sister about their Halloween costumes. Then I started asking about her symptoms and how she ended up in the Heme/Onc ward late at night. The symptoms had been present for several months and were all very non-specific: persistent cough not relieved with albuterol and singulair, increasingly tired, strange skin discoloration on the chest and neck, cervical lymphadenopathy. In short the Mom told me she "just wasn't the same".

I was thinking of possible reasons this girl could be here and why her family doctor would want an Oncologist to evaluate her. I thought of ALL (acute lymphoblastic leukemia) which is the most common childhood cancer. I started thinking of some of the complaints associated with this disorder (all of which she had already described). I asked about fever and bruising and other things. I then asked about bone pain and Mom's hand flew to her mouth and she said, "Oh my gosh!! Yes! I had totally forgotten about that. She was complaining about hip pain and leg pain". The Mom started tearing up and she started to lose the composure she had maintained up to this point. And guess who else started tearing up and developing a shaky voice and had to pause in order to continue?!? ME!! My emotions swept over me and I nearly started crying along with this mom who was trying so hard to hold it all together. When I started the exam she had to get up and go into the bathroom to compose herself. When I finished, the attending was outside waiting for me and we talked a great deal about ALL and how this very well could be cancer. We ordered a number of different labs and had to wait until morning to find out what was going on.

I left this family thinking for sure their daughter was going to die. Can you even imagine your Doctor crying when you explain the symptoms you have been having. Hello Kent?!? Can you even imagine how scared and how little hope this family had after I left the room. I tried my best to help them not imagine the worst and to explain some of the other possibilities. The attending talked to them about some of the other possibilities. I'm sure it was the stupid med student crying that stuck in their minds that night - not anything we tried to comfort them with later. So did she end up with ALL and a chemotherapy protocol put into place? No! She had Iron deficiency anemia. She was started on iron and had a nutrition consult. simple. easy. case closed. I was pulled in so many different directions the next morning I didn't get a chance to see her before her doctor discharged her. I'm sure they still think I think she has cancer. Grrr... Miller emotions are not going to be the best thing to have as a doctor.