Just call me the Grim Reaper

Today I saw a patient in the ER who was 64 years old. He was complaining of right chest pain, right abdominal pain, and right thoracic pain. He was also complaining of shortness of breath. His physical exam revealed absent breath sounds in the lower right lobe and a distended abdomen. He was in the ER on Sunday for the same problem and they told him he had pneumonia. The physical exam I did didn't really point to pneumonia so I expressed this concern to the PA I'm working with. She too thought there was something off. We ordered a CT of the chest, abdomen, and pelvis. The results revealed a 7 cm mass in his right upper lobe, a large pleuarl effusion, and a 4 cm mass in his sigmoid colon. :/ People don't have a tumor in their lung and in their colon and NOT have cancer. It's most likely metastasized at that point. The PA I'm working with took this information and turned it into a learning experience for me. She said that she and I would have to break the news to him since we were the ones that found it. Off we went to his room...

He took the news much better than I thought he would. We recommended that he be admitted and start the testing right away. I think he was in a state of shock and was denying that it was actually going to be cancer. One of the things he stated was that he shoudln't even be in the hospital because he was a scientologist and they don't believe in this sort of thing. They believe the body will heal itself. At this point in the conversation the attending walked into the room and told the guy not to be a "dumb shit" and let us at least figure out the severity of the situation. The patient tried to talk us out of it but eventually he seemed to grasp the seriousness of the situation and agreed to stay. I felt terrible when I left that room. This is the part of medicine that nobody talks about. I always figured the docs were the ones that had to deliver these kind of devastating blows. Unfortunately that probably won't be the last time I have to do this sort of thing. I don't think I'll ever forgot this guy.