“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….”

I nodded.

“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…


Imaging confirmed. 

“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…”


87 thoughts on “Missed

  1. I wanted to pull the psych card on u and say u weren’t empathetic enough, but the truth is that the truth hurts (and I was identifying a bit more w/ the patient rather than you as a physician myself as I read your post). I dont know what more i would’ve said had i been in your shoes. You offered to be a phone call away if needed and that’s more than most docs would offer.

    Liked by 1 person

  2. Oh how awful, for everyone concerned. My FIL recently died of colon cancer. It’s flat-out ugly and just gets uglier. I’m glad you were honest with her, though. It’s natural to want to find fault, to lay blame, but it doesn’t change anything, and it doesn’t help. So sad and frustrating.

    Liked by 2 people

  3. Dear God. Is there no hope possible at all? I know, having noted it in a previous comment, that there is hope, and then, there is hope. Can we live one day devoid of hope? For something, for something. And yet . . . have just finished reading a YA book from the early 80s, Homeward Bounders, by Diana Wynne Jones, where only where all hope has been relinquished and the boy takes the only step he can, that the world, ‘life’ can go on . . .
    Very difficult.
    Such a reality we navigate. (Almost) too much to bear.
    Blessings, courage!

    Liked by 1 person

  4. Sometimes the factual truth already takes part of the shock and pain away. As long as you are there to help the other person, even if short you already make his or her situation more bearable.

    Buddhism in particular emphasises compassion as the most important virtue. A bit of compassion does so much…

    Liked by 3 people

  5. Receiving that news is devastating enough, but perhaps receiving it from a really good, feeling doctor like yourself took just a wee bit of the pain away, allowing her to focus on what needs to be done now rather than on what may or may not have been done previously. When I thought I was about to get that diagnosis, it was comforting to know my doctors were caring, sympathetic people.

    Liked by 2 people

  6. Doc, at least you were able to help her progress to what is to be her natural demise. You did not cause it or could prevent it. I would want someone like you to be the one who tells me.
    I cannot imagine how hard that is to say to someone, but I am sure you were as empathetic and compassionate as can be, with a dose of here’s what we can do to make you comfortable.

    Liked by 1 person

  7. At least she now has a diagnosis and even if the prognosis is not good, she and her family know. Loose ends can bigger tightened. Plans made. Love shared. And prayers said. You’ve helped her, at least that much.

    Liked by 1 person

  8. Pingback: My Article Read (9-3-2015) | My Daily Musing

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