My patient was a 60-year-old woman with lower abdominal pain. Her evaluation led to a CT scan which showed a very large pelvic mass, thought by the radiologist to be worrisome for ovarian cancer.
I frequently tell people we don’t diagnose cancer in the emergency department, which is technically true. But in a case like this, where it is very likely to be cancer, I have to be honest with the patient about what I have found. I pulled up a stool at the bedside and calmly told her what the scan showed. I clarified that it was most likely cancer and that I had made some phone calls to arrange to send her to see a gynecology/oncology specialist to get a definitive diagnosis and start her on the treatment she might need.
As the gravity of my news set in, she started to quietly weep. She was a nurse and understood, better than most of my patients, just what she might be facing. She quickly got hold of her emotions and then said she would not be taking me up on my offer to transfer her to see the cancer specialist. Her husband had cancer, she said. He was due to start his next round of chemotherapy the following day and she needed to be there to care for him. She had no time to care for herself. She would just go home and deal with her own problems when she could.
As I sat at her bedside, I was really moved emotionally. I saw a person who understood that delaying her treatment could lead to her death. But she cared more about her husband’s welfare than her own and felt she really had no choice in the matter.
I discharged her with the information about the specialist, with hopes she would find a way to go and get the consultation she so badly needed. I was unusually sobered and emotional when she left. As I recognized the effect this was having on me, I tried to understand why this affected me so much more than I would have expected.
One part of it, I am sure, was just the beautiful selflessness. All she cared about was taking care of her husband. Also, I could really relate. I am about her age and am married to someone I care about much more than I care about myself. I think her situation really hit close to home, leaving me very empathetic, with all the associated emotions.
Fortunately, this story has a happy ending. She came back a few days later. She had gotten her husband all set with his chemo and rounded up some social support as well. She went on to have surgery and was told it was not cancer, after all. So, fortunately, this story doesn’t have a tragic Shakespearean ending like I originally feared it would.