Mullberry Whine

poured out before bed

Cocoa Carcinoma

…bitter either way you look at it (adapted from Cacoa Pod from the US Dept of Agriculture, and Lange123‘s  Thorax CT peripheres Bronchioalcarcinom)…

“Then you should treat her today.”  The young woman glares at Dr. Breathe from beneath eyelids swollen from crying.

Dr. Breathe shakes her head slightly, her lips empathetically pursed.  “I understand that you are anxious to start treatment, but we first have to be sure of what we’re treating.  We need a biopsy first, to make sure this is indeed a cancer recurrence.  And then, of course, we will have to do the CT planning sessions, just like we did before your last radiation treatments.  Treatment today would not only be jumping the gun, so to speak, but it would be technically impossible.”

“But it’s growing in me – it’s in me again,” the high pitch of the little old woman’s voice is discomfitting.

The young woman places her hand on her mother’s shoulder and holds her unblinking stare at Dr. Breathe.

“You already have images of her from last time, plus you have those new PET cat scans from yesterday.  And you said you were 90% sure this was cancer.  You need to treat her.  Now.”

“Ms. Jones, I promise you we will start the treatment process just as soon has we’ve confirmed your mother’s diagnosis.  But we cannot treat today.  We need to be sure of the diagnosis.  And we need to take new images and formulate a new radiation treatment plan that is the best possible plan for your mother and for eradicating the new lung mass.  This will take about two weeks.”

“Two weeks!” the elderly woman’s wrinkled face screws into a scowl and her feet begin an asynchronous tapping rhythm on the exam chair foot rest.

Dr. Breathe rolls her stool closer to Mrs. Jones, places her smooth brown hand on Mrs. Jones’ vein-blued, arthritis knobbed one.

“I know this is incredibly hard for you – I’m so sorry you have to go through this.  But please understand that we lose nothing by waiting two weeks – this thing isn’t going to grow out of control in that time.  But we have everything to gain by proceeding carefully and planning well.”

“But I can’t wait that long!”  Mrs. Jones’ voice is but an octave away from a scream.

Her daughter stands and places her stocky frame between Dr. Breathe and the door.  She sets her jaw.

“We aren’t leaving until you treat my mother.”

“Ms. Jones, I would absolutley treat her if I thought it was the best thing for your mother – but it is not the best thing.  I need you to understand that I will treat her if it is indicated and I will do so as soon as humanly possible, but it will not be today – and that is for your mother’s safety.  We need to make sure we are treating the right thing, and we need to make sure we are treating it the best way possible.  And that will take time.  As I said, it will take about 10 working days to plan, and we will do that after the CT guided biopsy, which I have set up for Thursday.”

Ms. Jones’ jaw softens, unsets.  “Look at her – you have to save her!  You have to treat her!” she chokes through trembling lips, her hands tightly fisted at her sides.  Mrs. Jones is alternately sobbing and pounding her chest near the old lobectomy site.  Her daughter’s sobs join the cacophony as she collapses into Mrs. Jones lap, her head buried in her arms.

Dr. Breathe steals a look at me and nods toward the door.

“We’re going to give you a moment to grieve in private,” she says, touching Mrs. Jones’ arm.  “We’ll be back shortly.”

When we exit the room, Dr. Breathe lets out a long sigh.

“Good God,” she says to no one in particular.  “I need a drink…  And some chocolate.”

She looks at me, her eyes wide and blank.

“Go home, girl.  Have a drink.  Eat something chocolatey.  And think sweet thoughts of me and this damn lung mass.”

5 comments on “Cocoa Carcinoma

  1. on thehomefrontandbeyond
    August 21, 2012

    the things you face!

  2. ahyesplans
    August 22, 2012

    And this is why I can’t do oncology.

    • mullberrywhine
      August 22, 2012

      It takes some kind of earthly angel to have such strong compassion to do the job well and yet still have the ability to distance oneself so to be able to do life well. Oncology is far too emotionally draining for me to do life well beyond the job…

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Creative Commons License
Nothing under the table.
The views expressed on "Mullberry Whine" are NOT intended to diagnose or treat disease.
The med-ed related stories described here are based on real events. Details have been changed in accordance with HIPAA de-identification guidelines to protect confidentiality.
Mullberry Whine can be enjoyed daily; there is no unsafe quantity. Real wine, though, should be enjoyed in moderation. At-Risk Drinking for males under 65 is defined as >14 alcoholic beverages per week or >4/day, with >7 drinks a week or >3/day being the cut-off for females under 65 and for anyone, male or female, who has graced this planet for 65 years for more. Drink Mullberry Whine like there are no consequences. But drink alcohol responsibly. Your friends, your family, your health-care provider, and your liver - heck, ALL of the organs in your body - will thank you.
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