Paul's Heart

Who Is The Doctor Here?

I will be the first to admit that I have no idea how long it takes to become a doctor or be a doctor. And with the exception of my family practitioner and perhaps a few others especially at major cancer hospitals, I have no problem stating that the majority of doctors have no concept of what it takes to care for a cancer survivor.

Yes, I am very frustrated right now. Over the years I have seen so many cancer survivors go through so much torment trying to convince their doctors that something was wrong, but because of the unusual circumstances of being a long term cancer survivor, and developing late term side effects, understanding our symptoms is not something always easily figured out. Chances most likely going to an emergency room with a cough as a cancer survivor, the patient is probably going to be checked for pulmonary issues only, regardless of the likelihood of congestive heart failure to due either chemotherapy or radiation therapy. Taking preventative steps to reduce the chances of infection due to a compromised immune system may just make the difference between life and death.

Like I said, I have seen so many cancer patients over the years go through so much. Most of our time is spent arguing for our medical advocate to keep looking, that we are not making our symptoms up.

Recently, I gave a couple of residents that very lesson. The patient was in the hospital with a persistant and productive cough. The obvious direction would be something pulmonary related. And probably in many cases that would be what it would end up being. But when you factor in a prior and major heart attack, combined with a recent lobectomy for lung cancer, chemotherapy and radiation, you need to look at every possibility, not just “nickel and dime” the diagnostic process. If there is something major going on, time is too important to waste like that. I argued for the patient to get an echocardiogram only to be told that an EKG had been done, and it should the heart had normal rhythmn. That was not what I was getting at.

On the third day in the hospital for the patient, still dealing with the chronic cough and confirmed fluid build-up in the chest cavity, a new symptom popped up. The patient had a 20 point difference in blood pressure from one arm to the other. While this may happen, the fact that they were recording a reading from the arm which was giving the higher numbers, kept them from realizing that his blood pressure was actually low, just as what originally prompted the emergency room visit. With hemoglobin numbers also borderline low, enough to warrant a transfusion, I had finally had enough of no one paying attention to the possibility of a cardiac issue as the probably cause.

I pulled the patient’s nurse aside, and explained a recent case that was hauntingly similar as far as the onset of symptoms. And I punctuated my concerns with the fact that this other patient had died at a very young age. While doctors originally chased that former patient around for a pulmonary issue, he was dying from a cardiac issue. I did not want to see another patient who was already mirroring the other with symptoms meet the same end. I wanted the patient to get an echocardiogram. With tears streaming down her cheek, she agreed that a cancer patient like this, needed to have the extra surveillance and consulted with the doctor, and it was ordered.

Now this is not going to be a very clean ending, because the echocardiogram did reveal some cardiac issues, issues that need follow-up at the very least. Cardiac symptoms that no one was aware of, and no plans to follow up on in the near future. They were not the cause of his appearance in the emergency room, those causes have yet to be found.

In all my years counseling cancer patients, this is one of the most frustrating things for me to understand, following up on patients and what should be done. I try not to be cynical to those that feel too much is done to diagnose patients, but as this example shows, cutting corners for a diagnosis, left unnoticed could eventually cost this person his life. Blood tests are done before treatments begin to make sure our bodies are strong enough to handle the poisonous toxins and dangerous radiation. If blood counts are too low, treatments are modified or delayed. But why are imaging studies not done when a treatment is known to have possible side effects on a particular body organ. If damage is occurring, would it not be wise to take a moment, study it, and then decide which is the best solution, either to press forward, or look for an alternative? And then of course, what about when treatments are done? Bloodwork is still done even at the first follow-up, but not the imaging studies.

This patient still has a long way to go. But he now has the doctors’ full and undivided attention. Am I pissed off? Absolutely, a young patient never had the chance, and now another is in the fight for his life, and getting the proper diagnostic care should not be this difficult to get.