Mr. J was a pleasant 60-something year old man who was admitted to our medicine service for a fairly simple problem: a diabetic toe ulcer. However, he also had unrelated but more sinister complaints: cough, trouble swallowing, weight loss, and fatigue. He had been suffering from these symptoms for several months, but none of his other doctors had worked them up.
His toe was quickly fixed with some cleaning and antibiotics. However, our team was perplexed on what to do about his other problems. We kept him another day to work him up, first starting with a barium swallow. Unfortunately, he aspirated during the study, so we cancelled it and instead referred him to the ENT doctors for a laryngoscopy.
Meanwhile, he thanked us profusely for taking care of him, and not ignoring his complaints as others had done before. While checking on him that afternoon, he told me: “You’ll be a good doctor. I can tell because even though you probably have a dozen patients, you make me feel like I’m the only one.” Those words resonated strongly with me, and I thanked him generously.
“This guy is too nice,” my intern said. “That means he has to have cancer.”
The next morning, his laryngoscopy results came back – a large mass at the base of his tongue, partially obstructing his airway. Likely squamous cell carcinoma, yet he hadn’t smoked a day in his life. Expedited workup – MRI, PET-CT, biopsy, started. All the while, he maintained a positive outlook. “I’ve lived a good life. I have no complaints.”
Mr. J was discharged a few days later, with follow up scheduled with his oncology doctors once his biopsy results returned. As I bid him goodbye, I felt distraught that such an agreeable man had to deal with such horrible news. However, I took solace in the fact that I made a small but significant contribution to his life. I can only hope that his treatment course will be short and successful.