Tuesday, May 22, 2007


Me: So how often does your stomach hurt?

Patient: Well, it's usually after I eat and it lasts for-

[cough! cough!]

Patient: -excuse me... it lasts for several hours.

This patient, a moderately chubby 45-year old woman, is in the clinic in regards to her pancreatic cancer. But with her heavy smoking history, I'm not sure how her lungs will tolerate an operation... assuming that her cancer is even amenable to an operation.

Not only does the exam room reek of stale cigarette smoke, this patient can't go more than a few minutes without going through a coughing fit. As I'm standing there by the exam table deep in thought, contemplating the best way to go about treating this woman, I realized that several minutes had gone by without me saying a word.

The patient's daughter, wondering if I've fallen asleep [standing up and with my eyes open] stares at me intently. I start to tell the patient about my hesitancy to immediately pursue any surgical treatment without a good evaluation of her lungs when she goes into another coughing fit.

[cough! cough! Brwaaaap!]

Patient: [turning deeply red, gasps loudly] OH!!!

The room falls quiet for a brief second.

I raise an eyebrow and I try to confirm that last unexpected noise. The patient's eyes are wide open with surprise. The daughter looks at her mother, horrified.

The patient's daughter then bursts out in uncontrolled laughter. My medical student shortly joins suit.

I do my best to maintain a straight poker face, but I'm about to break. The edges of my lips are quivering. I purse my lips tighter, look down at my feet, and try not to think of funny things... which of course just makes the situation worse.

The patient, greatly embarrassed, starts to apologize between short rounds of laughter when she goes into another coughing fit and passes another audible bout of gas. This spirals her into a laughing, coughing, farting fit.

The small exam room now smells of stale cigarettes and flatus.

By this time, I've lost my professional composure and I'm laughing along with them. As the daughter is fanning the room door for ventilation so that we can breath, I looked on at my laughing patient and her daughter.

They reminded me of me and my mother, eight years ago when we found out she had lung cancer. I recalled the fear and despondency and the turmoil of emotions that tore through us while we sat there at the doctor's office. And the rollercoaster ride of emotions that followed suit during her surgery, chemotherapy, and death.

I looked on at my laughing patient and her daughter.
And I silently prayed for them.