Thursday, October 19, 2006

Mr. Montoya

I see the rainbow in the sky
The dew upon the grass;
I see them and I ask not why
They glimmer or they pass.

I met Mr. Montoya in the Emergency room. He was concerned about some indigestion he'd been having, and my diagnosis was an ulcer. He had some concerning factors in his history though, so we admitted him overnight for a EGD in the morning. He is a great patient, easy going, upbeat, nice to the medical student who presumes to act as liason between the real doctors and him, and with an interesting, bread and butter problem.

So I got him up to his room, checked in on him, and then went on about my business. I came and went a few more times, met his wife, his son, son-in-law, and two grandchildren. The next morning he went down for his scope, and in all likelihood, his life changed forever.

See the scope found ulcers, so I was right about that. What it also found was that the ulcers are likely cancerous. Gastric adenocarcinoma allows only about half of its victims another five years.

The tell us in med school that patients often know what is wrong with them, if you just ask. So when I gave the news to Mr. Montoya, I wasn't surprised that he wasn't surprised. He just asked me some intelligent questions about prognosis, prefacing his comments with "assuming the worst here doc..." I've told him I'm not a doctor, and he has repeatedly said "you're a doctor as far as I'm concerned." At the time, I didn't know much, as I hadn't done a lot of reading on this type of cancer. But now, having done my reading on the subject, I will talk to him tomorrow about the hard facts. This is not a conversation to look forward to.

He's been a wonderful patient. He asked me today to give him my home address so that he and his family could send a Christmas card to me. I'm praying he lives to send many of them.

But I understand why he's staring out the window at the horizon praying the rosary when I come by.

The autumn wind's
Icy morning breath
Is on the hill of Sanu.
I wish, to you about to cross,
I could lend my coat.


zhoen said...

It is a strange backward blessing to know your time is short. A time to savor each moment, make peace, express love, come to terms. For the family as well. Much more shocking to lose someone not old in a moment.

Thainamu said...

May God give you grace and wisdom.

medstudentitis said...

It's strange that patients are never as surprised as you think they will be. I guess it's human nature to prepare yourself for the worst and hope for the best. I'm glad he has an excellent compassionate med student taking care of him who will try to work with him and help him understand what the future may hold for him.

Zwerver said...

My internist father often said that patients know when they are going to die; that if a patient in the course of an illness says at some point "I think now I'm dying," they are usually accurate.