Stories from the Stethoscope: October 2020

I was fortunate to begin my career in the community I was raised in.  My first job provided me the opportunity to treat patients in the same hospital I was born.  My grandparents lived only a few minutes from my office.  They were like second parents to me and had a tremendous impact on my life.  My grandfather was a farmer and worked a 40 acre farm in our community until the 1960’s.  He was the first person that showed me what a strong work ethic truly meant.  I would often stop by for lunch or coffee when I was rounding on the weekends.  A nice break from the 20-30 patients I would see each day.

This particular visit started out as usual.  A pot of coffee brewing and an Entenmann’s coffeecake on the table.  As we begin to catch up on all the news and gossip, I noticed my grandfather looked different.  I said, “Grandpa your eyes look a bit yellow to me.  How are you feeling?”  He preceded to tell me that he felt perfectly fine and smiled that he was losing weight.  He just saw his primary care doctor because he had some blood in his urine.  They did a check, and his Coumadin level was too high. 

A horrendous feeling overwhelmed me.  I tried to sip my coffee, but the reality of the moment was too powerful to ignore.  An elderly male without any abdominal pain, weight loss, and yellowing of the eyes was cancer until proven otherwise.  I sat there quietly for a long time.  I then asked.  “Did your doctor notice your eyes?  Did he say what he wants to do next?”  My grandmother said none of us had noticed his eyes and his doctor wanted to do an Ultrasound of his bladder.  I asked permission to call his doctor so that I could share my thoughts.

I walked outside and paced in the backyard as the two of us chatted.  I shared the new findings and we both agreed to have the ultrasound order modified to also examine his pancreas and liver.  The order for the test the next day was rewritten to say “rule out pancreatic cancer”. 

I slowly walked back into the kitchen with my grandparents anxiously awaiting my return.  They both wanted to know what the doctor said.   I paused before I spoke.  I knew that the results the next day were going to be devastating for all of us.  The test ultimately revealed cancer with a poor prognosis.  My grandfather did not stay with us long.  In my heart at that moment, I knew what would unfold.  Did I really need to speed up tomorrow?  I wanted this moment, this lunch, and this innocent conversation to last as long as possible for all of us.  I replied, “He said tomorrow will be important and give us the information we need.  There is nothing we can do until then.” 

That comment put everything on hold.  We talked, shared, and laughed for the rest of my visit.  It will always be a special day for me.  Bad news needs to be shared.  As a physician, I never walk away from it.  It was at that moment, however, I realized that the timing of the news is also important.  Hope and fear live in a delicate balance.  How and when we share information is critical.  My grandfather’s smile and laugh at that kitchen table still runs through my mind before I give news with a poor prognosis.  I will often ask myself “is this the best time to share this information?”  I barely remember the difficulty we faced during the last few days of his hospitalization, but I will never forget that wonderful day in their kitchen.  The quality of the time we share together with people should not be sacrificed for the quantity of time we share with those we love.  Thank you, grandpa, for teaching me life lessons even after you are gone.  I love you!