they thought it was a neck mass but on my physical exam i found his tonsils and tongue to be huge. it was actually a throat and tongue mass that had gotten so large it was pushing on his neck vasculature.
Mr. L ended up in the ICU the day after we admitted him because he stopped breathing overnight and needed 1 on 1 care. He was a very sweet man. It was weeks of CT scans, cardiology consults, surgery consults, anesthesia and more...weeks of us knowing it was most likely squamous cell carcinoma but just needing to prove it with a biopsy. weeks of this man hoping it was nothing but knowing it was probably something very serious.
the biopsy was risky because his airway was so affected...it was eventually done but he needed an emergency tracheostomy during the procedure because his enlarged tongue and tonsils were impossible to get the endotracheal tube through. a tracheostomy that he eventually left the hospital with, prohibiting him from being able to speak.
the biopsy gave us a final diagnosis.....squamous cell carcinoma of the tongue and tonsils that had spread to his lymph nodes and lungs. stage 4 cancer.
i spent weeks seeing Mr.L because he needed a lot of care and preparation before he could go home and see radiation oncology as an outpatient for his daily radiation therapy. every morning i went in giving myself ample time to spend with him because he had to write everything down. and every morning he cried. and every morning, i had to fight to not cry.
my last saturday shift was from 10 to 11pm. we had a lot of time in the afternoon to relax, study, whatever, while we waited for admits. i decided to spend a couple hours with Mr.L. we chatted [well, i chatted, he wrote] he joked about how he better get good at spelling [he couldnt spell worth a damn] and when i asked him if he knew how to type he smiled and wrote, “a computer? whats that? i just conquered the fax machine”...we both laughed. he was in good spirits but he admitted to having a lot of ups and downs. he said he had experienced the death of both his parents and he wasnt scared. he wrote “i am not afraid of the outcome. i am just hoping for the best.’
after our conversation i went outside the hospital, found a secluded staircase and cried. i cried for Mr.L. but i also cried because of other insignificant things going on that same day, like getting in an argument with one of the guys on my team. he is another 3rd year who i have grown to despise... someone i have had many rotations with. he made me very upset. earlier that day we were discussing hours and i told him i was going to ask to leave early because i had friends in town. this conversion ended in him telling me to stop whining about hours, saying “why did you want to be a doctor? didnt you realize that you would be working a lot.” after analyzing this conversation, i realize now why i was so upset. i was upset because this guy was making me feel bad about the fact that i was having a hard time with long hours of work and isolation from friends and family. i hate that fact that he made me feel like its not ok to be sad. sad that I miss my friends, family and life. sad that i just spent an afternoon talking with a man that is a complete stranger yet i havent spoken to my best friends in weeks.
it was an emotional afternoon, one that my hormones probably didnt help.
that night, i got off at 10pm. i drove straight to sarah’s house. she was having a party and everyone was there, including beth kelsea and julia. the minute i walked in the door people screamed my name and i got a huge hug from 6 of my best girl friends...literally, we all had a big huddle. it was the best cure for a bad day. i love my friends and i love that they know exactly what i am going through. the best.
we discharged Mr.L on Wednesday of my last week. i tried to do a quick goodbye because i knew it would tear me up inside. he cried, of course, like he always did.
i hope he does well but realistically, he will not live to see next year.
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