My Brilliant Feat

Did you ever have a moment of pure satisfaction at gaining a skill only to have it overshadowed by the reality of your situation?  I was working the day shift in the E.D., and it had started getting crazy as usual.  Between trying to efficiently manage and dispo my patients I was looking at CT scans and chest x-rays trying to rule out head bleeds, diagnosing pneumonias, and evaluating injured extremities.  Abdominal scans can still be challenging from time to time, so when I was looking at the scan of an elderly patient brought in with nausea and vomiting, I was talking out loud to the attending… “I see distended loops of small bowel, and I can’t see the cecum.  It looks like it’s higher than it should be and fuller;  maybe there’s an intussusception.  Possibly I also see some lesions in the liver as well…”  I had just finished my wet read of the scan when the attending read off the just-finished official CT read from the radiologist:  “Cecal intussusception most likely secondary to neoplasm with probable malignant metastases to the liver.”

For about two seconds, (ok maybe five), I jumped around in joy (ok, not literally jumping but I did pump the air with my fist), reveling in my diagnostic skill, my medical acumen, my attending saying, “You go, girl!”  (ok, maybe not those exact words, but that’s what I was hearing in my head.)  But, then I stopped;  suddenly aware of  the realization of this unexpected finding.  I was going to have to go talk to this very nice family and tell them that their loved one most likely had cancer.  They would have to be admitted for further work-up and biopsies, etc.  There would be a lot of questions about surgery and prognoses.  Some answers I would be able to provide, others I wouldn’t.  I’d be in the room for a while offering what little support I could and then arranging for surgery to admit, calling their primary, etc.

Some days reality just sneaks up on you like this.  Soberly, I went to go talk to the patient’s family, but in my head I could still hear a quiet applause as I left the work arena and headed to the patient’s room.

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  1. #1 by betty - August 28th, 2009 at 23:53

    awesome you got the diagnosis; sad it was the diagnosis it was 🙁


  2. #2 by De - August 29th, 2009 at 09:52

    WTG on the diagnosis, now you are all prepared to work in Phoenix :)…but sorry you had to deliver bad news. De

  3. #3 by Lisa - August 31st, 2009 at 11:53

    Nice job on the diagnosis but very sad you had to reveal such sad news.

  4. #4 by Sam Ko - September 7th, 2009 at 18:08


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