Esophageal Cancer

The phrase immediately makes me uneasy, as my thoughts gravitate to my first "patient", Mrs. B.

I was a ball of nerves, as I always am before doing something for the first time. But when I walked in I had gathered myself and I was all smiles. Other than some ugly tubes coming out of her neck, she was a calming presence. White hair slightly matted by days in a hospital bed, skin worn by hard work and a nasty cigarette habit, she looked frail. But she came alive when she saw me, the power of her spirit seemingly transforming her. We hit it off immediately, and talked like old friends about what had brought her to the hospital, and all the details of her harrowing past year.

It started with trouble swallowing. Food and eventually some liquids would just "stick" in her throat, and she wouldn't be able to swallow them. It started gradually, but after a couple weeks she knew this was no fluke. Something was seriously wrong.

The rest of the year was test after test, and liquid nutrition drinks - the only thing keeping her from wasting away - then the treatment (radiation+chemo). At first it wasn't too bad, but her long course of treatment quickly drained what little life she was pulling out of her Ensure cans. During the interview she made it clear she never wanted to go through that again. One more test. The tumor is still there, but smaller....a good sign.

Fours days after a complicated surgery and recovery, she was feeling great, swallowing most liquids and preparing to leave. i was smiling too. My first patient, an affable lady with a coherent story of her illness (most patients benefit from a little guidance I am learning), was a cancer survivor. How wonderful!

I proudly presented my ideal first patient - my success story - to the group. The attending gently but pointedly asked the group what we knew about esophageal cancer (nothing).

As I researched her illness that night, pride gave way to the icy truth. Esophageal cancer progresses especially quickly and silently, easily passing into nearby tissues and taking up residence in distant lymph nodes - gathering strength off the oblivious patient. By the time symptoms arise, most esophageal cancers have progressed substantially, resulting in an overall 5-year survival rate of only 10% - nine out of ten patients die within five years, treated or no.

Mrs. B was dying in front of my eyes, passing from living breathing companion to a ghost. My research for the following session became a form of grieving...figuring out what could be done, and what her chances really were. I was fighting - if only metaphorically - for a breakthrough to "save" her.

True, all of this was mental exercise, dealing with the newfound possibility of patients dying. I was supposed to be practicing the medical interview. I have years until I actually provide medical care to anyone. But it became real when I learned her story and took on her struggle.

I still think of her sometimes when I'm trying to sleep...never certain of whether I am recalling a survival story or a eulogy.