Bread and butter

Today was a funny day in work. Maria and Otto (my hungarian bosses) were both off. They actually had to be forced to take a day off cause they’re kind of workaholics. Maria even rang in at one thirty in the morning to make sure a patient got a certain drug.

I work in an AAU (acute admissions unit) where we see folks who usually need a few investigations and chucked out the next day. An attempt to cut prolonged admissions to hospital. It’s a decent place to work. Fewer old demented crocks than usual.

So today the AAU was me and Bob (the ED/A&E boss). Bob spent most of the time running the ED so I was kind of my on my own. And i’ve been kind of baby sat since I started. I think maria and otto have me sussed as a bit of a muppet doc and are trying to stop me killing people. They’re probably right.

Today there was no such baby sitting so I kind of had free reign with the patients. Which is more what i’m used to. First guy. Mr A. He’s fat, a smoker, a diabetic, knackered kidneys, dodgy ticker and low on blood. His lungs are knackered from smoking. This is your standard medical patient. This is my bread and butter.

Except Mr A has a 10p piece on his chest x-ray. And I don’t mean he choked on it. It’s what’s described as a ‘coin lesion’. Lesion is a word doctors use to disguise cancer when we’re talking about it. Everyone knows what tumor and malignancy means these days so we use ‘lesion’ or ‘neoplasm’ to hide it from people.

Mr A doesn’t know this yet. I know this. I know it’s not definite, few things are in medicine but i’ve seen enough to know i’m not wrong. He’s a dead man. So he gets a scan of his chest and it shows he’s got one lesion on the periphery of his lung that’s spread from another one near his wind pipes. I know this. He doesn’t yet. This means he’ll be a dead man in a few months and there’s little anyone can offer him.

Mr A is fed up with hospital. He’s had his blood transfusion and Hawke’s bay are playing rugby tonight and he has work to do in the garden. He has no intention of staying. Mr A can’t complete a sentence without stopping for breath. He’s going no where.

He has to know some time. And Bob (the boss) has gone to a funeral and there’s just me. If it were me i’d want to know. So I go in and I sit down and explain that we saw a ‘shadow’ on his lung and we did a scan to check it out and that we think he has cancer. And that last word sticks in my throat. Like my voice has never said it before. Like it’s not quite sure it should be forming the sounds. The atmosphere changes. We make eye contact. And it’s not like there wasn’t eye contact before but it’s clear now he’s really listening.

He rolls his eyes and sighs. Then mutters an angry comment about how long he’ll have to stay in hospital then he looks at me again and he’s petrified. Anger, denial, acceptance and fear in seconds.

He asks me to ring his daughter and tell her to come over. I ring her. I fear she’ll ask me why I rang her. But she spares me that.

I have this fear of unexpected phone calls form unknown numbers from people I don’t know at odd times. I’m convinced the worst has happened. My heart thumps till the person on the other end of the line explains why they’re ringing.

So his daughters turn up, and his wife. And I tell them and him the same thing as before. I use the word cancer again. And still it sticks in my throat. If I didn’t say it then they wouldn’t get it. Until you mention the word everything you say to them will be meaningless. His wife cries, he cries. He thanks me. He thanks me. He thanks me for telling him he has cancer. My eyes fill with tears and I make myself look in his eyes and I make myself hold his hand cause he deserves it and so much more.

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October 2006
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