Thursday, May 15, 2008

Diagnositic dilemma

More than 17 years ago I made the diagnosis of my mother's lung cancer. This happened inadvertently on a trip home. I was seven months pregnant with my youngest child and it was to be my last excursion before I could no longer travel.
As my mother greeted me when I arrived her fingernails jumped out to me. They were clubbed. At first I didn't believe it but through dinner and as we cleaned up afterwards I couldn't take my eyes off of her hands. I would look away hoping that when I looked back they would somehow be different.

I knew the differential diagnoses for clubbing of the fingernails. There were many illnesses on the list that were not lung cancer. I also knew that with all her years of smoking, lung cancer was the most likely cause of the clubbing. Over the years the worst dilemmas I have encountered as a physician are all the illnesses I diagnose in those that are not my patients. It is especially difficult to manage the role of family member and physician simultaneously.

I suspect that my mother had not been feeling well but she was not one to complain. She even denied feeling ill when I began to question her about her health. She had not seen her primary care physician in several months confessing to me that she did not really like him. So much for my first idea of calling and making an appointment with my parent's local physician, telling him what I suspected so that I could resume my daughter role.

By the time my visit was over, I had convinced my mother to return with me to my home where I could get her into see physicians I knew. Both my parents felt very comfortable with this arrangement. I suspect they were very relieved and even wanted me in charge of my mother's care.

While my parents were comfortable, I was miserable. The radiologist called me personally while reading my mother's chest X-ray rather than talking to the internist with whom she had an appointment. This left me to deliver the diagnosis to my parents rather than going with them to hear someone else break the news.

One of my closest friends ask me how I felt about all of this. The truth was I had been waiting all my life for my mother to get lung cancer. Since elementary school I knew that smoking could lead to lung cancer. I was not surprised. I was angry. I was angry about many things but I believe that most of all I was angry that I made the diagnosis.

I loved medicine. I loved my mother. I wanted someone to give me the diagnosis gently, holding out some hope, comforting me in some way as well as comforting my parents. Giving all this up seemed unfair. It also seems selfish but at the time and even now I regreted being a physician.
Diagnositic dilemmaSocialTwist Tell-a-Friend

No comments: