Friday afternoons

I think I may have mentioned my med courses already in this blog but hopefully (without meaning to be repetitive) I will just briefly mention again how they are organized. The majority of classes I take are divided into lecture and problem based learning components which teach systems and pathologies. There are also a number of other unrelated classes that I take, which include: a “patient, physician, and humanity” course (the touchy feely aspects of medicine), a clinical skills course (i.e. how to use a stethoscope, or where to stick an otoscope) and a family practice placement (out in a real live doctor’s office). It is on Friday afternoons that I get to go out to a local family physician and spend the afternoon in the office learning tricks of the trade. It is perhaps one of my favourite courses given that it is outside of the classroom and gives me a bit of a break from the books.

This past Friday I was in the doctor’s office as per usual, seeing patients every 10 to 15 minutes, taking histories and conducting physical exams. Toward the end of the day I had the opportunity to meet an older woman who had come in to have her pain medication increased and who had a little extra time to answer some questions. For this I was glad because she represented a type of patient I haven’t had much exposure to yet.

This particular patient was terminally ill with unmanageable colorectal cancer unresponsive to treatment. She had been through surgeries and bouts of chemotherapy only to find that her cancer was still there at the end of the day, still growing. Since the disease could not be treated any further and there was no hope of remission, she was forced to simply treat the pain and symptoms until her eventual demise only 6 to 8 months away.

She told me that she was angry with the medical profession for diagnosing her disease too late, and angry at her body for betraying her. She was sad that she was dying and sad that she didn’t have more time with her grandchildren whom she was close to. She was also uncomplaining and open to discussing what must have been hard for her. She answered all my questions on how long she had to live, what plans were in place after she was gone, what had she been doing in the time between diagnosis and the eventuality of her death. In one story she told me that as a bit of reward to herself, she had cashed out some savings early and had spent the money buying gifts for those she loved and on a small trip for herself and her partner. It was fascinating to talk to talk to this woman who showed such composure and I appreciate the time she spent with me.

It was hard to leave the room without feeling more than a little sad. This woman is tragically having her life cut short by an insidious and cruel disease and there is nothing that can be done about it. Yet she was upbeat, happy and willing to answer my naive questions. I would have liked to have spent more time with her but I was already behind in seeing the next patient. Once outside the door I had to change gears quickly, from sorrow and compassion, to more of a friendly face. I opened the door to the next examining room and before me was another challenge of a different sort. This one consisted of two little girls aged 2 and 5 with running noses and a distrust of a rumpled med student with a stethoscope.

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