“You know the story, cauda equina syndrome, onset since 36 hours ago, excellent response to dexamethasone. Large sacral mass with extensive soft tissue infiltration on MRI, no obvious disease elsewhere on CT CAP,” I started as the consultant walked in, Saturday morning.

Earlier that morning when I arrived at the nursing room, the first thing Jon the oncology nurse did was point with his eyes the lady on the bed across the hallway. “I think that’s the lady you’re looking for,” he smirked.

“Yeah, got a few calls about her last night,” I said as I put my bag down. Six hours of sleep on a weekend was definitely painful. I brought along with me a packet of Up&Go for breakfast which I didn’t get around to even drinking.

I sat later that morning on the bed beside her, hoping to explain the situation for urgent spinal irradiation. Young, fit and well, and suddenly hit with severe back pain. Finally she brought herself to see a doctor two days ago, then in a whirlwind trip of two hospital transfers one on each day, here we were having this discussion. “We found a large lesion in your sacrum, the part near the bottom of your spine, which explains the symptoms you have. It looks bad,” I paused, watching for a response, then continued. “It looks very much like cancer.”

She sort of knew. Afterall, before I said hello to her, from the nurses station I saw her cry, then trying to hide the tissues, then cry again. Yet she had no doors she could close, or a private spot she could withdraw to — there she was, bound to her bed with newly weakened legs, curtains wide open, vulnerable to all the eyes of people walking up and down the hallway.

The conversation last night with the referring hospital’s doctors played back.

“So lower back pain, foot drop, urinary retention and dermatomal parasthesia consistent with imaging findings. I presume she has been started on dex?” I asked against the wind while walking towards the car.

“Yes, 8mg q.i.d,” the neurosurgical resident replied over the phone. She wasn’t on after-hours duty, yet was still at work. Poor her!

“When was it started?”

“Today.”

“I mean what time?”

“Um, around 11am this morning.”

“And has she improved since?”

“I don’t know, we haven’t seen her yet,” she replied, then added, “she’s been in CT most of the day.”

It’s past 8pm now and you haven’t seen her since 11am this morning? “Could you check her neurology again? Or if you’re knocking off can you please get the cover person to do it as soon as possible?”

“No I can do it. The reg and I will be doing a ward round soon so we’ll examine her again and I’ll let you know. Can I call you on your mobile when we see her?”

“Please do,” I replied, a little anxious, “and who am I speaking with?”

“I’m Tam.”

“Thank you Tam. Speak to you soon.”

But I didn’t speak to her again. It was the neurosurgical registrar who called me about an hour later. It turns out dexamethasone has reversed most of her neurological deficits. Thankfully. That buys us some time, and she will less likely be paralytic for the rest of her life if we could treat her urgently the next morning.

“Is it common for you to do ward rounds at 8pm on a Friday?” I asked at the end.

“It is when we finish operating at 7,” the neurosurgical registrar replied, without hesitation and almost with a hint of pride, ever so confident as a surgeon.

Yeah, but you let an inoperable young patient with an oncological emergency sit under your care since early this morning, and only seek radiation oncology input now at your convenience!

I hate criticising in thought and I hate it when I become grumbly. I am just as prone to the mistakes that I criticise in other people. I remember the many times when I so easily get swamped by the “jobs” that have to be worked through in the day, and neglect less obvious but more important matters.

Even that morning when I was talking to her while answering the interrupting phone calls and trying to keep the Saturday morning chaos under control, it came to me how easy it was to forget that this lady was a professional gymnast turned high school teacher. That that she had two children and one granddaughter who love her and were trying to keep track of where she and her clothes were after all the hospital and ward transfers. That her mother was still alive and lucid at 89 years old, living alone in an independent unit, not yet informed of the bad scan findings. And here, there was a chance she could never have been able to stand again, or have control of her bladder and bowels again. It is frightening how the impacts on her life — irreversible and unspeakably huge — do not register, and become so distant, when I forget.

“What happened 3 years ago?” I was asking her that morning, after she told me she used to be a busy woman and gym fanatic but stopped, 3 years ago.

“Aw, had a shift in priorities? My granddaughter was born that year… and I realised I just want to spend lots of time with her, and family, when I get home everyday.”

I stopped prodding more because it felt too much like one of those tragic flashback foreshadowings in an animated film.

I couldn’t sleep well that night. The pillows were stacked too high, the duvet was too warm, the cheap fan was creaking too loud. Somewhere along walking back and tossing around in bed, I realised too that when we find ourselves so detached and numb that patients become just another printed line of capital serif letters on the paper list that we look at and think the shorter the better, it is time to probably take a break, and fill our emotional gauge — with love, and peace, just maybe. Amidst the frustrations and busyness, and more frustrations, people are still important, and it is easy to forget.

4 responses to this post

  1. OD
    // reply // #

    Very touching, definitely shouldn’t treat patients as “jobs” and “just another printed line of capital serif letters” on the patient list. I guess this is how society or a civilization works, with delegated jobs for different people, providing service to one another, and as time goes by one becomes preoccupied with the aim of wanting to finish one’s work as soon as possible. Surgeons, in my opinion, live out lives like this – ‘getting things done’ and that’s it. On the other hand, getting too involved may compromise your performance. Hope you get enough sleep!

    • // reply // #

      Thanks for the comment OD. Yeah I am sleeping so much today haha. I wouldn’t be so quick to judge surgeons. Getting things done and knowing your boundaries / capabilities are definitely right. There are many surgeons who care for their patients well too.

  2. yining
    // reply // #

    very kind of you to lend the listening ear, and not turfing out sobbing patients for psych to sort out the sobbing. lol I think once we are able to derive emotional satisfactions from listening to the bad stuff of life, the experience becomes more blessing than burden. even losing sleep (hopefully just occasionally!) over the bad stuff is quite worth it. :)

    • // reply // #

      mind you off my head i remember referring a few anxious patients, one angry patient, and one cocaine-addicted patient (and manipulative, oh the joys of addiction medicine) to onc psych services heheh. sounds like you are seeing your role in psych as a blessing, which is awesome! thanks for sharing your thoughts too, yining.

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