the ER has everything, including cancer

I used to think I would hate the ED, in part due to my “processing issue” (as John calls it) and in part because I thought having continuity of care would be important in my career.  But, while the ED doesn’t exactly have constant continuity, there certainly is an element of it that exists beyond the drug seekers, addicts, and gunshot victims–although those patients too make for fulfilling/exciting work.  For example, there are the patients with inflammatory bowel disease with unexpected flares…having a familiar face during a crisis (and small bowel obstruction can be a crisis) is like a gift from higher power to them.

And then there are the cancer patients.  Is it possible that I’ve seen more cancer patients in my three weeks in the ED than I did in eight weeks of internal medicine?  Between the constantly evolving disease, complicated diagnostic procedures and treatment regimens, and metastases, these patients have good reason to need the ED on a regular basis.  I was the one to inform one woman of her diagnosis because she had either not heard it or not understood it from her other physicians.  I thought it was a good, though of course never pleasant conversation.  I was gentle but direct, using words like “cancer” rather than “adenocarcinoma.”

At the end I asked, “So, can you tell me a little bit about what you understand about you disease right now so I can make sure we’re on the same page.”  She responded, “I had an x-ray in the emergency room today, and it didn’t show anything.”  I guess my analogy of an x-ray being like a mirror that can only show objects that are within its frame and not blocked by something else was not the best (and it’s also inaccurate, but it was what I could think of in the moment to address her confusion about cancer being in her body but not on x-ray).

My point is not that I desperately crave for the careful delivery of bad news to be a main component of my medical practice.  But I’m attracted to a field that includes it among so much else.  You can have profound relationships with your patients in the emergency department and, what makes it all the more challenging, you have to establish them at breakneck speed.  My husband is really good at that.