February 18, 2007

i worked the 3pm – 11pm shift last night in the ER. it went by quickly. i saw a patient with what was essentially a toothache, and another with mild pneumonia. we referred the first to a dentist and discharged her home with some percoset, and we sent the second home with some moxifloxacin. routine, typical ER things. because mostly, that’s what fills up the ER.

i also saw a woman in her 40s who had terrible abdominal pain. despite this discomfort, she was really nice, and i spent a while talking to her, as her son was a diabetic and she was all excited that i wanted to go into pediatric endocrinology. her presentation was suggestive of a small bowel obstruction, as she had a distended abdomen, had been vomiting, and was exquisitely tender. she had also had an X-ray done 2 weeks ago at an urgent care where they told her she had a ‘blockage’, so we figured the diagnosis was in the bag. the ER attending and resident went in to see her, and they agreed she appeared obstructed and that general surgery should be notified.

surgery was not-so-nice on the phone, and i didn’t do a stellar job standing up for myself, but that’s unimportant in the grand scheme of this story. what is important is that they had us get a CT scan, and maybe they were correct in suspecting that something about her presentation sounded fishy. because the CT showed a pelvic mass, and abdominal fluid (ascites, for the medically inclined), and enlarged pelvic lymph nodes.

in other words, her ‘blockage’ was ovarian cancer. and it had already spread.

it was (and is) devastatingly sad. and it’s really not fair.


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