Thursday, December 23, 2004


As long as I can remember, I've always wanted to be a doctor. I saw how people respected their opinions, how much money they made, and how they can make those who need help feel better. I wondered, how could I choose anything else? I've always heard that the one thing that affects every doctor is how to give someone bad news.

When he was still a student/intern, my Internal Diagnosis professor's first patient was a middle aged woman who was complaining of back pain. After taking a history and physical, he wanted to snap a few X-rays. When the film was developed, there it was: what appeared to be an aggressive lesion that resembled metastasis. This patient previously had breast cancer, had a mastectomy, and was considered "cured" after 5 years. Unfortunately, some time after the 5 years, it came back. It had metastasized to her spine. He had to tell his first patient that she had metastasis. 6 months later, she died.

When I heard this story, I thought to myself that I wouldn't have any problems telling someone bad news. The reason being is because I've seen what people generally want. Usually, they don't want information to be sugar coated. They want to know straight up what's wrong. So, everytime I give someone bad news, I've tried to never start out with "You need to sit down" or something like that.

Zelda got off the phone with a friend of hers from New York. The look on her face told me that she just got bad news. Someone she was close to, named Rebecca, was diagnosed with spinal cancer. This was just a 17 year old girl. She was a friend to Zelda's family. I've met her and her family. They are among the kindest people I have ever met. Zelda told me that this particular family had lost so many relatives already.

Without much detail, Zelda asked me what I thought her chances were. Knowing that she's 17 years old and it involved the spine, my top 2 choices were Osteosarcoma and Ewing's Sarcoma. I told Zelda that Osteosarcoma was the most common malignant bone tumor. I didn't want to tell her about Ewing's Sarcoma because chances of survival was slim if it wasn't localized. Osteosarcoma is nothing to take lightly either, but I knew that Ewing's Sarcoma was notorious for killing kids. It's also the second most common primary malignant bone tumor in kids. Osteosarcoma, however, is rare in the spine. Ewing's Sarcoma is not.

One night, after drinking a bottle of wine with Zelda, we were talking about Rebecca. I thought that one day, I'm going to have information about someone that I have to reveal. I told Zelda that there's a good chance that it wasn't Osteosarcoma and that it may actually be something else. A much more notorious form of pediatric cancer. That's when I told her about Ewing's Sarcoma. Zelda was even more scared. I then told her that I could be wrong. I didn't know enough about the case to really give anything specific.

A few days later, Zelda got the phone call, I was right. They're starting chemo therapy on her right now. It's taking a huge toll on the family. It all made me wonder if I should have told Zelda about it to begin with. I didn't really know if I was right, but it was there in the front of my mind. Since I wasn't sure, I didn't want to worry her. Now, I'm wondering if I should've told her so that she could've had time to prepare. I just wonder what the right move was.

Then, I realized. This part of the job is going to be a lot harder than I expected.