Five years ago this month I completed my treatment protocol for colon cancer. A few months later, I was reviewing the latest CT scan with my oncologist. Chest, abdomen, and pelvis. He apparently hadn't read it - or at least not more than cursorily - before I entered the office, because when he flipped to page 2 of the report, he started to laugh.
"You have to see this," he said, as he handed me the report.
Normal findings, except for an enlarged prostate. "Funny they never found that on any of the umpteen previous CT scans, isn't it?" I said. "I wonder what my Gyn will say when he reads this."
The oncologist made a quick phone call to the radiologist's office and found that the Gyn had already called. The whole report had already been re-done by a second radiologist and would be faxed to him immediately. I heard from the Gyn's nurse that he'd had a great deal of fun at the radiologist's expense - but she wouldn't tell me more than that. I've known the Gyn a long time. I can just imagine. His nurse doesn't use that kind of language.
I laughed about that report for years, although it did worry me a little that the radiologist could have made such a whopping error in reading the scan. Turns out he probably didn't. My sister used to type medical reports. She told me that an error of that magnitude in a report would have to be committed by a transcriptionist of exceptional skill. Someone the radiologist really trusted. Someone whose work wasn't routinely proofread, because he or she simply didn't make many mistakes.
She then explained how this almost certainly happened. Experienced transcriptionists tend to type essentially the same report over and over when the results of a scan are normal, because the doctor will dictate more or less the same report in the same order so that nothing is overlooked. In doing large volume, the transcriptionist may save time by calling up the previous normal scan and making the few required changes instead of typing the whole 2-3 page report over again.
It seems likely that the previous normal scan called up by the transcriptionist was of a male with an unremarkable scan, except for that enlarged prostate. Oops.
I have copies of both readings. The first, which will stay with the report, because the radiologist signed it, was a more than adequate reading, except for that enlarged prostate. The second is the most thoroughly documented normal CT scan report you could ever hope to find. The second radiologist not only had to read the scan, he or she had to prove that said scan was on the same patient as all the previous scans in the folder.
None of this would have happened had I paid more attention to other unexpected findings. Over a period of 2-3 years, I ignored some very intermittent, very minor rectal bleeding. I occasionally mentioned it to my internist or one of her partners, but none of us was overly concerned. I also had some problems with constipation and had absolutely no family history of any kind of cancer. Besides, I was way too young to have colon cancer. By the time Katie Couric aired her on-camera colonoscopy, I was 45. She got my attention. I still believed the GI doc would only find internal hemorrhoids, but I wasn't willing to bet my life on that, so I scheduled the colonoscopy. Talk about unexpected findings.
March is national Colon Cancer awareness month.
Trust me, you're not too young to have colon cancer. Having no family history offers no protection. If you have symptoms. Get checked. If you're 50 or over, get checked whether or not you have symptoms. If you have a family history of colon cancer and are within 10 years of the age at which your youngest relative was diagnosed - get checked!
If you've had negative flexible sigmoidoscopies, but never had a colonoscopy, don't think you're safe either. My mom did, so it took over a year to browbeat her into having a colonoscopy. Fortunately her cancer was very small and limited to the distal portion of a polyp which could be removed during her colonoscopy. Now she jokes about her "little cancer" and nags her friends into having colonoscopies.
Your turn!
Monday, March 13, 2006
Saturday, February 25, 2006
Just what part of "She's not here" do you not understand?
Ding-dong! (NICU doorbell - at 3am)
Me: "Can I help you?"
Him: "I'm looking for my sister, she's in labor."
Me: "This is the Neonatal ICU. Your sister isn't here."
Him: "Where is she, then?"
Me: "She's probably in the birthing center, turn around and go to your right."
Him: "I can't get in there."
Me: "Do you have a visitor pass? You need a visitor pass to open the door."
Him: "There's nobody at the desk." (He must mean the front desk. There's nobody there after midnight)
Me: "You'll have to go to the Emergency Room to get a visitor pass. The security desk in the ER."
Him: "I didn't come in that way. She's 8 cm dilated and she's going to have the baby any minute."
Me: "Is this her first baby?"
Him: "Yes. Can you let me in?"
Me: "I think you have time to go to the ER to get the visitor pass. Besides, she's not in here. This is the Neonatal ICU. We only have premature babies in here. She's probably in the birthing center."
Him: "Where is the birthing center?"
Me: "Turn around and go to your right, but if you don't have a visitor pass, you'll have to go to the ER to get one. I can't open that door from here."
Him: "You're being insensitive to the situation."
The conversation went on for a few more minutes in the same vein and he finally figured out that arguing was getting him nowhere. Or maybe he finally was fully awake. Whatever. I can be pretty darn insensitive some times. I still can't open the door to the birthing center from the NICU no matter how many people ask or how nicely.
Me: "Can I help you?"
Him: "I'm looking for my sister, she's in labor."
Me: "This is the Neonatal ICU. Your sister isn't here."
Him: "Where is she, then?"
Me: "She's probably in the birthing center, turn around and go to your right."
Him: "I can't get in there."
Me: "Do you have a visitor pass? You need a visitor pass to open the door."
Him: "There's nobody at the desk." (He must mean the front desk. There's nobody there after midnight)
Me: "You'll have to go to the Emergency Room to get a visitor pass. The security desk in the ER."
Him: "I didn't come in that way. She's 8 cm dilated and she's going to have the baby any minute."
Me: "Is this her first baby?"
Him: "Yes. Can you let me in?"
Me: "I think you have time to go to the ER to get the visitor pass. Besides, she's not in here. This is the Neonatal ICU. We only have premature babies in here. She's probably in the birthing center."
Him: "Where is the birthing center?"
Me: "Turn around and go to your right, but if you don't have a visitor pass, you'll have to go to the ER to get one. I can't open that door from here."
Him: "You're being insensitive to the situation."
The conversation went on for a few more minutes in the same vein and he finally figured out that arguing was getting him nowhere. Or maybe he finally was fully awake. Whatever. I can be pretty darn insensitive some times. I still can't open the door to the birthing center from the NICU no matter how many people ask or how nicely.
Tuesday, January 03, 2006
Thanksgiving
If you read my previous post, you may be wondering why we try so hard in what seem like hopeless circumstances. We believe in miracles. We've seen them.
Thanksgiving eve, in a community hospital many years ago. A tiny baby lay very still in his intensive care warmer bed. The night before he had been active, but no more. I hadn't seen any movement in hours. His fontanel was bulging. His pupils were fixed and dilated. His heart rate should have been over 120, but it was in the 80's - and had been for hours. His limbs cooled, despite the heat of the radiant warmer and it seemed that nothing we did would ever make a difference to this tiny child. The IV pumps continued to drip fluids into his tiny veins. The ventilator forced oxygen into his tiny lungs. None of it seemed to matter.
The neonatologist had been fighting this losing battle since early evening and finally decided to go home about 4am to get a little sleep before approaching the family about terminating life support. He was just coming in as I was leaving - about 7:30 that morning.
I shocked my youngest sister by expressing my hope that he would not be there when I got back to work that night. I couldn't see any hope for him at all. If he survived - which seemed impossible - surely he would be profoundly brain damaged.
When I arrived at the NICU that night, I heard the story: The doctor had been unable to contact the parents. He tried repeatedly, but there was no one at home. This was in an earlier era - no cell phones, no voice mail, not even answering machines. Nobody was home.
About 11am, the family arrived, but there was no consideration of terminating life support. Yes, the baby was still there. At about 10, he had started to move again. His pupils began to react. His heart rate returned to normal - and so did his fontanels. There was no evidence of his brush with death. He looked like a typical preemie again.
Where were the parents when they couldn't be reached? They were in church, giving thanks to their Creator for all the gifts they had been given - but especially for this very tiny child.
Thanksgiving eve, in a community hospital many years ago. A tiny baby lay very still in his intensive care warmer bed. The night before he had been active, but no more. I hadn't seen any movement in hours. His fontanel was bulging. His pupils were fixed and dilated. His heart rate should have been over 120, but it was in the 80's - and had been for hours. His limbs cooled, despite the heat of the radiant warmer and it seemed that nothing we did would ever make a difference to this tiny child. The IV pumps continued to drip fluids into his tiny veins. The ventilator forced oxygen into his tiny lungs. None of it seemed to matter.
The neonatologist had been fighting this losing battle since early evening and finally decided to go home about 4am to get a little sleep before approaching the family about terminating life support. He was just coming in as I was leaving - about 7:30 that morning.
I shocked my youngest sister by expressing my hope that he would not be there when I got back to work that night. I couldn't see any hope for him at all. If he survived - which seemed impossible - surely he would be profoundly brain damaged.
When I arrived at the NICU that night, I heard the story: The doctor had been unable to contact the parents. He tried repeatedly, but there was no one at home. This was in an earlier era - no cell phones, no voice mail, not even answering machines. Nobody was home.
About 11am, the family arrived, but there was no consideration of terminating life support. Yes, the baby was still there. At about 10, he had started to move again. His pupils began to react. His heart rate returned to normal - and so did his fontanels. There was no evidence of his brush with death. He looked like a typical preemie again.
Where were the parents when they couldn't be reached? They were in church, giving thanks to their Creator for all the gifts they had been given - but especially for this very tiny child.
Tuesday, December 27, 2005
Hello, Baby! Goodbye.
23 weeks, male, mom had prolonged rupture of membranes and chorioamnionitis - an infection of the fetal membranes and amniotic fluid. It doesn't get much more grim than that in the NICU. This baby has about as much chance as a snowball in Death Valley in August. The perinatologist's recommendation was that we simply do nothing. The parents want us to do "everything possible" and that's what we are going to do. The parents cannot possibly understand what "everything possible" means - or why we do it reluctantly, but with all possible skill.
It's not my favorite part of the job, this fending off death for a few hours until there is simply no more to do. Even more difficult is facing the parents and trying not to destroy their hope -- but trying harder still not to offer them hope that simply does not exist. They want so much for me to say "yes" when they ask if the baby is doing better now. He's not really. He looks it, but I've seen the lab results. I know about the unofficial, but devastating head sonogram - the docs haven't shared that with them just yet, so I dance quickly away from that minefield.
I see the dark spots - the petechiae and hematomas that result from the overwhelming infection that has destroyed most of his clotting factors and platelets. We're replacing fluids, platelets, red cells, electrolytes - but not as fast as they're leaking through his gelatinous skin and being destroyed by the infection. I handle his tiny limbs as gently as possible so as not to cause any more damage, but I must turn him frequently, because lying too still causes his head to flatten. I titrate his dopamine and give more boluses of saline solution and sodium bicarbonate to sustain his blood pressure and reverse the acidosis that will surely kill him if it is not corrected, but I know that his serum sodium is rapidly rising -- approaching dangerous levels and soon there will be no more to do.
An aunt comments that this place is filled with angels. I pause a moment and realize that she is right. It is alway so when one of these little ones hovers between life and death. Perhaps it is always so and I am most aware of it at such times.
With great reluctance, I try to start an IV in veins almost smaller than the catheter, because we must give insulin now, and it's not compatible with the fluids in the existing IV lines. I call the doctor to do it, because I cannot bear to try a second time when my first attempt fails. She is as reluctant as I, but there is no one to whom she can pass this. She succeeds on the second attempt and we are able to continue our efforts to postpone the inevitable.
I leave in the morning knowing that he will not be there when I return less than 12 hours later. My husband asks how I feel about this baby dying. My answer: I'm sad for his family, but happy that he has moved on to a better place.
It's not my favorite part of the job, this fending off death for a few hours until there is simply no more to do. Even more difficult is facing the parents and trying not to destroy their hope -- but trying harder still not to offer them hope that simply does not exist. They want so much for me to say "yes" when they ask if the baby is doing better now. He's not really. He looks it, but I've seen the lab results. I know about the unofficial, but devastating head sonogram - the docs haven't shared that with them just yet, so I dance quickly away from that minefield.
I see the dark spots - the petechiae and hematomas that result from the overwhelming infection that has destroyed most of his clotting factors and platelets. We're replacing fluids, platelets, red cells, electrolytes - but not as fast as they're leaking through his gelatinous skin and being destroyed by the infection. I handle his tiny limbs as gently as possible so as not to cause any more damage, but I must turn him frequently, because lying too still causes his head to flatten. I titrate his dopamine and give more boluses of saline solution and sodium bicarbonate to sustain his blood pressure and reverse the acidosis that will surely kill him if it is not corrected, but I know that his serum sodium is rapidly rising -- approaching dangerous levels and soon there will be no more to do.
An aunt comments that this place is filled with angels. I pause a moment and realize that she is right. It is alway so when one of these little ones hovers between life and death. Perhaps it is always so and I am most aware of it at such times.
With great reluctance, I try to start an IV in veins almost smaller than the catheter, because we must give insulin now, and it's not compatible with the fluids in the existing IV lines. I call the doctor to do it, because I cannot bear to try a second time when my first attempt fails. She is as reluctant as I, but there is no one to whom she can pass this. She succeeds on the second attempt and we are able to continue our efforts to postpone the inevitable.
I leave in the morning knowing that he will not be there when I return less than 12 hours later. My husband asks how I feel about this baby dying. My answer: I'm sad for his family, but happy that he has moved on to a better place.
Tuesday, December 06, 2005
I'm not exactly proud of myself
But I'm not really sorry either.
Early last month, I had blood drawn for what was to be my very last CEA level. Hopefully ever. Yes, that's Carcinoembryonic antigen. It was 4.9 when I was diagnosed with colon cancer 5.5 years ago. The highest it's been since then was in the range of 0.7. Until last month. It hit a whopping 1.9. Normal, but still enough to worry me a little, considering that for the last 4 years, it's been < 0.5. All I really wanted was to repeat the test, but my internist referred me to the oncologist who, for reasons unknown to me, did not return my phone calls. For 3 weeks.
I dropped by his office on Monday and asked the secretary whether he'd gotten the messages. She said she'd see if he had a minute to speak to me. Half an hour later, she returned, chart in hand, to inform me that the doctor said I had nothing to be concerned about. The result was normal. Wrong answer. Even from him it would have been the wrong answer. I can read lab reports and I've been very much aware of the normal values for this particular test for more than 5 years.
"Probably nothing to worry about, but if you'd like we can repeat it in a couple of months just to be sure" would have been OK, but by the time a patient, or in this case former patient, calls 4 times and drops by twice, with no response from the doc, sending out a secretary to pat her on the head is definitely NOT the best approach.
I don't remember everything I said, but the gist of it was that I didn't plan to bet my life that he was guessing correctly. Pretty much what I'd told the internist who thought I didn't need that first colonoscopy. I also remember demanding a copy of my chart. The secretary said she'd have to talk to her manager and 20 minutes later ushered me back to speak to the oncologist.
That's how I ended up in the PET/CT scanner this morning. Overkill, I know but I hope the doctor was right.
Update, 12/13: The doc called today. He was right. Now I just have to worry whether the insurance company will consider this medically necessary. If I have to pay for it myself, it will be worth it for the peace of mind - but don't tell them.
Early last month, I had blood drawn for what was to be my very last CEA level. Hopefully ever. Yes, that's Carcinoembryonic antigen. It was 4.9 when I was diagnosed with colon cancer 5.5 years ago. The highest it's been since then was in the range of 0.7. Until last month. It hit a whopping 1.9. Normal, but still enough to worry me a little, considering that for the last 4 years, it's been < 0.5. All I really wanted was to repeat the test, but my internist referred me to the oncologist who, for reasons unknown to me, did not return my phone calls. For 3 weeks.
I dropped by his office on Monday and asked the secretary whether he'd gotten the messages. She said she'd see if he had a minute to speak to me. Half an hour later, she returned, chart in hand, to inform me that the doctor said I had nothing to be concerned about. The result was normal. Wrong answer. Even from him it would have been the wrong answer. I can read lab reports and I've been very much aware of the normal values for this particular test for more than 5 years.
"Probably nothing to worry about, but if you'd like we can repeat it in a couple of months just to be sure" would have been OK, but by the time a patient, or in this case former patient, calls 4 times and drops by twice, with no response from the doc, sending out a secretary to pat her on the head is definitely NOT the best approach.
I don't remember everything I said, but the gist of it was that I didn't plan to bet my life that he was guessing correctly. Pretty much what I'd told the internist who thought I didn't need that first colonoscopy. I also remember demanding a copy of my chart. The secretary said she'd have to talk to her manager and 20 minutes later ushered me back to speak to the oncologist.
That's how I ended up in the PET/CT scanner this morning. Overkill, I know but I hope the doctor was right.
Update, 12/13: The doc called today. He was right. Now I just have to worry whether the insurance company will consider this medically necessary. If I have to pay for it myself, it will be worth it for the peace of mind - but don't tell them.
Tuesday, November 29, 2005
Thank you one and all!
Thank you for being so calm and reassuring when you answered my 911 call. Thank you for asking all the right questions to keep me focused and breathing. I was terrified.
Thank you for coming so promptly. It only seemed like forever - it was probably about 5 minutes.
Thank you for being so gentle with my son. He was frightened too. Probably not as frightened as his mom, but scared.
Thank you for not laughing when he scored his pain as a 2. We thought he was just being a tough guy. Fortunately, the truth was that your ice pack was pretty much all the treatment he needed.
I felt so bad when the little guy caught his foot in the strap of my purse and fell headlong onto the concrete garage floor. I was afraid he'd broken a bone or torn ligaments because he hit so hard. When his EMT brother cut away his sweats and we saw the rapidly swelling bruises, he ordered me to the phone to call 911 -- probably as much so Matthew wouldn't see how frightened I was as because we didn't think we could safely move him in one of our vehicles. Matthew thought the ride was "cool" - must be because you were so nice to him. Thanks for that too.
Thank you for coming so promptly. It only seemed like forever - it was probably about 5 minutes.
Thank you for being so gentle with my son. He was frightened too. Probably not as frightened as his mom, but scared.
Thank you for not laughing when he scored his pain as a 2. We thought he was just being a tough guy. Fortunately, the truth was that your ice pack was pretty much all the treatment he needed.
I felt so bad when the little guy caught his foot in the strap of my purse and fell headlong onto the concrete garage floor. I was afraid he'd broken a bone or torn ligaments because he hit so hard. When his EMT brother cut away his sweats and we saw the rapidly swelling bruises, he ordered me to the phone to call 911 -- probably as much so Matthew wouldn't see how frightened I was as because we didn't think we could safely move him in one of our vehicles. Matthew thought the ride was "cool" - must be because you were so nice to him. Thanks for that too.
Wednesday, October 05, 2005
The Sword
I just came from Maddog Medic's story about Bouncing Babies and Bleeding Heads. I do like happy endings. He reminded me of episode at my house several years ago.
I left my youngest son in the care of his older brothers (then teenagers) while I was taking a shower. As I was getting dressed, the little guy started pounding on the bathroom door:
"Mom! Mom! Big brother cut himself ..........
With a sword!
There's blood everywhere!
3 big puddles!
Needless to say, I wasted NO time getting downstairs where I found.........
Not a drop of blood anywhere and the 2 older boys sitting at the kitchen table calmly discussing whether or not they needed to call 911.
I made the mistake of peeking under the dressing covering the wound. No, that injury didn't need a 911 call, but mom very nearly did. The brother who controlled the bleeding and applied the dressing is now a student in the paramedic program at our local community college. The other one is barely has a scar, despite the many sutures required to close the wound, and he's still collecting swords - but he has learned to be VERY careful with the sharp ones.
I left my youngest son in the care of his older brothers (then teenagers) while I was taking a shower. As I was getting dressed, the little guy started pounding on the bathroom door:
"Mom! Mom! Big brother cut himself ..........
With a sword!
There's blood everywhere!
3 big puddles!
Needless to say, I wasted NO time getting downstairs where I found.........
Not a drop of blood anywhere and the 2 older boys sitting at the kitchen table calmly discussing whether or not they needed to call 911.
I made the mistake of peeking under the dressing covering the wound. No, that injury didn't need a 911 call, but mom very nearly did. The brother who controlled the bleeding and applied the dressing is now a student in the paramedic program at our local community college. The other one is barely has a scar, despite the many sutures required to close the wound, and he's still collecting swords - but he has learned to be VERY careful with the sharp ones.
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