Case Study: 55-year-old man with abdominal pain in the right lower quadrant for over one month. No nausea, vomiting or diarrhea, no fever, no urinary symptoms. No foreign travel. No trauma. Pain non-radiating. No exacerbating or palliating factors. He was very vague. His wife says ‘it’s been 5 weeks, but he won’t go to the doctor.’
Well, after a benign physical exam, I ordered labs and a CT of the abdomen. His labs were generally normal, along with his CT. No chronic appendicitis. No diverticulitis. No mass. That was it. No mass. No tumor, no death sentence.
He broke into barely muffled sobs. He had a strong family history of cancer. Since Christmas he had been convinced that he was dying. He wouldn’t come to the hospital for fear of confirming that fact. Faced with hope he wept and shook with his weeping. He admitted that he needed some counseling. His wife said, gently, ‘it’s like this whenever he has an illness. He always thinks it’s cancer.’
I suppose he lives his life under a constant shadow. Even when the Sun creeps in, he hears the voice that says, ‘sure it’s sunny and you’re happy, but you still may have cancer…are you getting thinner?’
We all have that death sentence, don’t we? But in his family, death comes too soon, and comes in the form of creeping, life-draining malignancy. He was petrified. I didn’t really treat his symptoms. But I treated his mind and heart.
Much of what we do is just that. Alleviate worry. For all that we pronounce dead in medicine, for all the bad news we give, we probably give far more good news. It isn’t a tumor. You’ll get through the heart attack just fine. Your baby just had a febrile seizure, it’s not a huge deal. It’s sprained not broken. It’s just the flu, not pneumonia. The list goes on and on.
But I think we should remember, often as we can, how important it is to give hope and comfort. And how enslaved to fear and anxiety we are! Oddly, in a culture with awesome medical capacities, in which we live longer and longer, better and better, we are consumed with fear and anxiety about the well-being of our bodies. You’d think we’d fear less, but we fear more. Maybe our expectations are higher. Maybe we want to avoid suffering. Maybe we want to see our great grandchildren. Perhaps, we’re just cowards when it comes to death, as if it were a new plague that had just arisen, and about which we knew nothing.
I know that if I made a man stand up straight under the burden of fear, then I accomplished something. I suspect he’ll find another thing to be afraid of until he gets the therapy he needs for his mind, and for his heart and soul.
The real battle over worry, however, is not one for physicians or even psychiatrists or counselors. It’s a battle only God can win for us. He and I discussed this a bit. I’m certain he needs that view. He needs to sit down with a wise Christian counselor in his church or affiliated with his church. Because only with an eternal perspective and the tools of scripture can he, or any of us, endure the fear that swirls all around, and that is such an effective tool of the devil.
Great post Ed, it struck a chord with my recent experiences. I’ve been placed with an oncology preceptor for the past few weeks and I’ve been getting a lot of worried, upset, frustrated and tired people. Learning what my role is as an empathic human being, never mind as a physician, in the face of such horrible experiences has been extremely valuable. It’s nice to remember every once in a while that I’m a person under that short white coat.
EEJ
16 years ago
Dr Leap,
I’ve really enjoyed reading your blog, and I hope you continue to publish thought-provoking and heart-felt posts such as this one.
However, your post has given me a quandary which I have been pondering of late. I am not a doctor, but am curious about the way you would have addressed the issue with this patient had he not been religious?
I am personally not religious, and would appreciate knowing how you address a patient that is not religious in times such as these, where possible death and depression are involved?
I have seen that right now, more and more people are being attracted to video cameras and the area of digital photography. However, being a photographer, you should first spend so much time period deciding the exact model of camera to buy plus moving out of store to store just so you can buy the lowest priced camera of the brand you have decided to select. But it doesn’t end generally there. You also have to think about whether you should buy a digital digicam extended warranty. Thanks a lot for the good ideas I gained from your site.
This is absolutely brilliant! Congratulations on trying to revitalize the written word no texting, no email, no whatever’s next! I do not own a computer proud of being “computer free”. Maybe old fashioned, but receiving a hand written letter is likely to be so refreshing! Thank you for focusing on a rapidly declining art the hand written letter and/or note.
Can’t wait around to receive my first letter! Judy Robertson
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Great post Ed, it struck a chord with my recent experiences. I’ve been placed with an oncology preceptor for the past few weeks and I’ve been getting a lot of worried, upset, frustrated and tired people. Learning what my role is as an empathic human being, never mind as a physician, in the face of such horrible experiences has been extremely valuable. It’s nice to remember every once in a while that I’m a person under that short white coat.
Dr Leap,
I’ve really enjoyed reading your blog, and I hope you continue to publish thought-provoking and heart-felt posts such as this one.
However, your post has given me a quandary which I have been pondering of late. I am not a doctor, but am curious about the way you would have addressed the issue with this patient had he not been religious?
I am personally not religious, and would appreciate knowing how you address a patient that is not religious in times such as these, where possible death and depression are involved?
Thanks for your time.
Whenever i have diarrhea, i just take some Diatabs or Imodium tablets and it gives me some relief after a few minutes.*”`
I have seen that right now, more and more people are being attracted to video cameras and the area of digital photography. However, being a photographer, you should first spend so much time period deciding the exact model of camera to buy plus moving out of store to store just so you can buy the lowest priced camera of the brand you have decided to select. But it doesn’t end generally there. You also have to think about whether you should buy a digital digicam extended warranty. Thanks a lot for the good ideas I gained from your site.
i love action movies and my idol is none other than Gerard Butler. this guy actually rocks“
There is perceptibly a lot to realize about this. I assume you made some good points in features also.
This is absolutely brilliant! Congratulations on trying to revitalize the written word no texting, no email, no whatever’s next! I do not own a computer proud of being “computer free”. Maybe old fashioned, but receiving a hand written letter is likely to be so refreshing! Thank you for focusing on a rapidly declining art the hand written letter and/or note.
Can’t wait around to receive my first letter! Judy Robertson
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