“I was sent to cardiology. Then pulmonology. I had chest X-rays and even a heart catheterization. When those were all negative he said he didn’t know what to do next. So my daughter said I should come see you….”
“The thing is, doc, the pain was only in my lower chest. Now it is also in my upper abdomen and I have nausea. It’s getting worse. Much worse. And the cough has not gone away…”
She was young. She was scared. She had everything to lose.
“Did you have any blood work done?” She had not brought any records with her.
“Any imaging of your abdomen? An ultrasound or a CT scan?”
“Here is the plan: start on an acid reducing medication twice daily. Let’s get some lab work done, including an H. pylori test looking for a bacteria that can increase your risk of stomach ulcers. Back in two weeks. If you are not starting to feel better, we will do some imaging.”
When the labs came back the next day, they looked awful. I already knew what was wrong…
“You are amazing, Doc. You figured out in two days what my previous primary care doctor could not figure out in six months….”
I thought for a second about basking in the dubious glory of delivering her death sentence. In fact, I almost hung up the phone, leaving it there. I wanted to be the best, the smart one. Brilliant. The hero.
“Truthfully, I am not special. Anyone would have picked it up at this point. All of the other work up was already done and your symptoms had progressed to the point that it could not be missed. The early stages are tough. The generic symptoms could be almost anything. Your other doctor did all of the right things.”
There was an uneasy silence.
She wanted someone to blame, someone to be at fault, someone to be angry with. I understood. I was taking that away.
“Well, like I said, I am going to make some calls to see if we can get you into one of the experimental studies. I am not sure it is much hope but it is something. I am here if you need anything at all in the meantime…”