No. 6: The first time I told a patient he had cancer

6 Minute Read
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Intern Year Day 70:

There is a particular patient I remember more vividly than most. We’ll call him Mr. K. He was a dark brown man in his early fifties, his thick beard speckled with silver hairs. He had a heart warming smile. His wife was at his bedside every single time I went to see him. His room smelled faintly of vanilla, and I remember wondering if he had brought incense to the hospital with him or if the smell had simply hitch-hiked on his clothing from home.

He came into the hospital with a relatively common complaint: maroon-colored stools. After ignoring them for some time, his wife finally forced him to go to the hospital. He had been healthy his entire life, he told me, so he had never seen a doctor before. “I just smoke a little Mary Jane from time to time,” he whispered in my direction with a wink, pretending he didn’t want his wife to hear. She playfully swatted the back of his head and said, “Boy, you know you smoke daily, ain’t nobody messin’ with you. Tell the doctor the truth.” I remember liking them immediately.

As I asked him more about his symptoms, I learned the following: he had lost a lot of weight over the last few months, he often felt very tired (which he attributed to work stress), and he had mild lower and mid back pain that had been getting worse for awhile.

“I’m not too worried about any of this stuff, doc,” He smiled a large smile. “My wife likes to worry. Do what you gotta do so we can go home soon, there’s a game on tonight!”

A little later, I got a call from the lab about his blood work (the lab only calls you about a result when it’s critically abnormal) saying that his hemoglobin was around 5, which was much lower than normal. This, along with the history of bloody stools, indicated to us that he was likely bleeding from somewhere in his GI tract. We transfused him multiple units of blood, admitted him to the hospital, and started investigating the cause of his dark stools. Given his history of weight loss, fatigue, and the fact that he had never seen a doctor before, I was worried about him right away.

We scheduled him for a colonoscopy the next morning (a procedure in which a flexible tube with a camera on it’s tip is passed through the anus to look at the inside of the large intestine). When the gastroenterologist paged me directly to talk about the results, I knew it would be bad. He had found a large polyp, or projection from the wall of his colon, that was bleeding and looked like cancer. He sent samples to the pathology lab, where doctors would look at them under a microscope, but it would take some time for the results to come back and confirm a diagnosis.

The bad news continued to flow over the next few days. The CT scan of his abdomen showed multiple masses in other organs and in the bones of his back. He needed more blood transfusions as he continued to bleed from another spot in his GI tract. Finally, the pathology report came back and confirmed our worst fear: Adenocarcinoma, a form of colon cancer. He would need surgery, chemotherapy, and radiation. Even with all of that, his five-year survival rate (which tells you what percent of people live at least 5 years after the cancer is found) was only about 15% since the cancer had already spread to distant sites.

My heart was broken. Ofcourse, I had been sad about patients’ diagnoses before, but this patient and his family had touched me in a different way. After taking care of him for a few days, seeing him and his wife every morning had become the highlight of my day. They told me about their kids, their love for travel, and even cute stories of how they had fallen in love (“She had a man when we met, doc! But from the first moment I laid eyes on her, I knew she was mine. Now look at us!”). They flirted and snuck small kisses, and his wife curled up next to him in the hospital bed. She brought blankets and clothes from home, made sure his beard stayed trim, and brought him food he liked every day.

Once we had confirmed the diagnosis, my attending told me to go and break the news to the patient. BY MYSELF??!! I was FREAKING OUT inside. In general, it is very hard to decide how to break bad news to a patient. I had done it before, but it had never been cancer. Cancer. That scary six-letter curse word. What will I say? How will my face look? What will they think if I start crying? Why won’t my attending just come with me?!

I walked towards the patient’s room feeling as though I was swimming in water. As I entered the room, he smiled that big smile of his, and I almost ran right back out. I took a deep breath, and pulled a chair from the corner of the room so I could sit down as I talked, remaining eye-level with him and his wife. With a heavy heart, I settled on: “Mr. K, I’m so sorry to tell you this, but we have the results of your pathology and… you have colon cancer.”

He sucked in his breath. His wife’s eyes welled up with tears. My eyes started to fill with tears and I fought to hold them back. There was no space for my sorrow in this moment. I needed to remain strong so I could give them whatever information they would need moving forward.

“How bad is it, doc? Tell me straight.”

“We believe… that it has already spread to other organs in your belly and into the bones in your back.” At this, his wife burst into tears. He held her, with a stunned look on his face. I asked them if they wanted privacy, if they needed time. I told them I could come back. Admittedly, this suggestion was as much for me as it was for them. They both shook their head and said they wanted to know what was coming. What was next?

At that, I took a deep breath and gave a brief overview of some of the further investigation he would need. The cancer had spread far enough that surgery wouldn’t be enough- he would need chemotherapy. I watched them, fighting back tears, as they tried to listen to me. They were silent, eyes glazed over. They were hearing, but they weren’t processing. I told them that when I came back the next time, I would have an Oncologist (doctor that specializes in cancer) with me to give more detailed information about the next steps.

When I left their room, I went to the bathroom and cried.

The next morning when I entered their room, Mr. K greeted me with a wide smile. He was standing up, wearing his clothing from home, looking as though he was ready to leave. “Where… where are you going?” I asked.

He and his wife looked at each other. “We’re going home. The cancer doctors came by this morning and said that we can follow up in their clinic in a few days to discuss getting more scans and starting treatment. We bought tickets to Hawaii and we need to pack. He may be too sick to travel once he starts the chemo, so we’re flying out tonight.”

They both started to laugh, probably because I had an incredulous look on my face. I started to say with a small voice “Are you guys sure about –” Mr. K’s wife cut me off by walking over to me and grabbing both of my hands.

“You have been wonderful, Dr. Oye, and we are so thankful to you. I honestly don’t know how these last few days would have gone if you weren’t the one taking care of him.”

“But… I have to go TODAY,” Mr. K chimed in. “If I’m going to die soon, I want to have taken this fine woman to Hawaii first.”

“Don’t say that!” I found myself blurting out without thinking. I looked at the wall in slight embarrassment and sighed. “I’m sorry.”

“Don’t be sorry! You care, and that’s why you’re such a great doctor already. And don’t you worry about me! I have lived a wonderful life, and will continue to for whatever time I have left. This is the shock of my life… but I’m grateful. But now the best thing you can do for me is help me get my discharge stuff ready.”

In a little less than an hour, I had their paperwork done, created a list of follow up appointments for them, and went through any pertinent information. Before they walked out, the two of them embraced me together. As I watched them go, I couldn’t help but send up a prayer for him, begging God to make it alright.

The most touching part of my experience with Mr. K was that he was grateful. I thought of all the times in my life that I grumbled and complained about things much less important, and couldn’t find reasons to be thankful. Yet here was a man who had just heard the worst news of his life, and all he could do was give thanks while making plans to enjoy his time and do the things he enjoyed. The human spirit never fails to amaze me.

I’m still figuring out this “doctor thing”, and learning how to be compassionate without taking each patient’s problems on as my own. It’s a work in progress. In the meantime, I’m happy that despite my inexperience, I’m able to make people smile during a dark time. That alone is worth it.

Dr. Oye

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By the way, the American Cancer Society recommends getting a colonoscopy at age 45 if you have average risk, and even earlier if you have family with colon cancer. If you have family that needs to be screened and hasn’t, please encourage them to talk with their primary care doctors about the screening they need. Here’s a link to all the guidelines for age-based cancer screening.