Tuesday, January 3, 2017

Guest Post: I have a new patient

- Donna J. Schue, MD

I've been in a busy rural private practice for 15 years. Outside of new obstetrical patients, the children I deliver, and the occasional close relative or close friend of an existing patient, my practice has been full.

I received a phone call on a Saturday from one of our Emergency Department physicians. Our practice was listed that day to provide an ED follow-up visit for those patients who were seen and had no physician. My colleague had just seen a delightful and independent 80 year-old woman who had come to the ED, not having seen a physician for over 25 years. She had discovered a breast lump about two years before. She had witnessed her husband die of cancer 15 years before despite all attempts at treatment, and had decided that she would continue to have good days until she wasn't having good days anymore. The ED evaluation had revealed an obvious large breast cancer, extensive ascites, and a large pleural effusion. A CT scan showed scattered bony metastases. She did not want to see an oncologist and did not want to be admitted to the hospital, but knew she would need care in the months to come. I told him I would accept her as a patient and saw her in my office on Monday.

Now, four months later, my new patient has undergone a thoracentesis and several paracenteses. She is beginning to have discomfort related to metastases, and we are managing her pain. She has completed a Medical Order for Life-Sustaining Treatment form and prepared her legal affairs. She has also continued to live independently, attend daily Mass, volunteer at a hospice home and a clothing donation center, and has visited out of town family three times. She has told no one of her diagnosis. She does not want those around her to worry. She tells me repeatedly that she is grateful that it is winter and her sweaters can hide the changes to her body that would be more obvious otherwise.

The clinician in me wonders what might have been the outcome if she had presented to care earlier. However, having had two patients die in the last year from opportunistic infections while immunocompromised due to chemotherapy, I remind myself that treatment does not guarantee longer survival.

We talk at each visit about telling her family. As I lost my own mother due to side effects of cancer treatment a few years ago, I share with her that as a daughter I would want to know that this was happening to my mother. She agrees that at some point she will tell them, but not yet. She mentions that she may need help with that when the time comes.

I remain impressed by her fortitude to continue her daily routines. I realize, again, that sometimes we family physicians are called to comfort and not cure. I see how filling her remaining days by helping others continues to bring her a sense of purpose. I have learned a great deal from her in a short time and am grateful that I accepted a new patient.

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