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.


  • Reply Anonymous February 18, 2007 at 1:16 pm

    Whoever said life was supposed to be fair?!

  • Reply atilla February 18, 2007 at 2:51 pm

    key in the history that she was going to do poorly is that she was nice. you still have to feel good that you helped get her diagnosed and into treatment and you can always hope she has a lymphoma or gets good palliation from aggressive rx of her ovarian tumor

  • Reply Sarah Hart-Unger February 18, 2007 at 6:15 pm

    a: no one said it was fair, but i definitely forget how lopsided things really are sometimes. when things like this happen, it is a reminder of how nothing is certain and of how lucky i am, at least right now.

  • Reply A. The one and only February 20, 2007 at 8:31 pm

    A is usually clever and funny albeit cynical, not fatalistic, meaning that A didn't write the first comment on the blog. A agrees with Atilla in that the karma usually goes that:1) you cannot kill scum2) if people are very nice, something drastically undeserved is about to happen.Also, Percocet, not Percoset; although it will often be pronounced "purplesets," as in, "the only thing that helps my toothache is purplesets." This is similar to "Peanutbutterballs," which, much like Phenobarbital, can be used as anticonvulsants. Oddly, people will sometimes lose their purplesets re-skip-ins and need you to write one in the middle of the night on Saturdays, but this rarely happens with peanutbutterballs. Huh.

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