Sometimes I have to stop, sit back, and just admire a patient for something. Today it was grace and humor under fire.
Last year when I saw Grant, a 42 year old married father of three and machine shop supervisor, for his annual health maintenance exam, he was feeling fine. His asthma was well controlled despite the fact that he continued to smoke a pack of cigarettes most days. He complained that I had blackmailed him by refusing to refill his asthma medicines unless he came in for a visit, so I asked if there was anything we could address to make the visit worth while? He said: “How about my hemorrhoids. They used to hurt and itch, but now they mostly bleed.” He had no family history of any bowel disease, and his systems review was otherwise entirely negative. On exam he had a few small old external hemorrhoidal skin tags, but no visible or palpable internal or external hemorrhoids on office anoscopy. His blood count was normal.
Three weeks later, the gastroenterologist had called me. She described finding a large and friable obviously malignant mass at the rectosigmoid junction, well beyond the range of office anoscopy, and the obvious cause of his ‘hemorrhoidal’ bleeding. We discussed choice of surgeon and oncologist, after which I called the patient to explain the findings and begin our journey treating his cancer.
This year he came in with his wife for his annual exam. Chemotherapy had affected his memory so she accompanied him at all his visits to make sure nothing got missed. He had had two major surgical procedures, a resection of the tumor with colostomy, followed 8 weeks later by a re-anastomosis. After that had come fairly intensive chemotherapy and radiation therapy, and he was scheduled in a month for his first post-treatment scans to document that he was ‘NED’ or ‘no evidence of disease.’
He was back at work, had regained most of the weight he had lost, was a committed non-smoker, had resumed an exercise program to regain his fitness, and was back at work. His exam was unremarkable other than his well-healed abdominal surgical scars and the port for his previous chemotherapy.
I asked him how he was feeling emotionally, and he said he was doing well and completely convinced he was going to beat this. HIs wife nodded and smiled.
It was then that he blew me away:
“I have to stay healthy doc. I want to hear what you tell me in 7 years when it’s time for my screening colonoscopy.”