If you asked my a year ago, I probably would of never guessed that I would ever feel this affected by the reality of powerlessness that physicians face. I probably would have brushed it off, and thought that it was just physician's egos getting in the way of reality... physicians trying to play god and not accepting the limitations of science and humanity.
But I had my first dose of powerlessness yesterday. The feeling that I have no good advice, no plan, no alternatives, and that I couldn't help a patient get better. No matter HOW much they were willing to help themselves.
Yesterday my group participated in the simulated case review of a patient. Only this time we had a "real" patient (standardized patient actor) in the room with us. 10 students, 1 SP, and our professor. The case (based off a real case from 10 years ago), was a 20 year old female, presenting to the surgery clinic with blood in her stool for the past 6 months and increasing fatigue. No other signs or symptoms, no associated pain, no blood in vomitus, no history of fever, alcoholism, etc. So we did all the normal stuff, CBC, stool analysis, urinalysis, the eventually a Chest Xray, EKG, and onto a sigmoidoscopy and colonoscopy. Turns out she has familial adenomatous polyposis... a genetic condition in which part of the intestines (in this case the large intestine) gets covered with hundreds of little sac-like polyps. These polyps are essentially just tissue growths, and while many or most may be benign, some of the polyps will most certainly become cancerous over time. Treatment options are pretty much nil (no drugs, no removal of the polyps)... so we had to tell her that she could either... 1) opt to do nothing and hope she doesn't die... not exactly appealing. Or 2) opt for surgical removal of her entire colon, thus requiring that she use an ileostomy bag for the rest of her life (a "poop" bag that hangs outside the body, that you must empty instead of passing feces through the rectum). Clearly... neither of the options were good.
As a group we had to break the news to her through one person we selected as a moderator. Frankly, I wouldn't have wanted to be him. I don't know his background, but I'm guessing this was his first time breaking horrible news to a patient... and he had to do it in front of all of us and our professor. Truthfully, he did a damn good job. Or maybe it just seemed that way since I was so relieved that I didn't have to do it. But you could hear every one of our hearts thumping through our short white coats.
It was really surreal... imagining a 20 year old coming in because she was concerned about blood in her stool and a little fatigue. And now her life is different forever. My pulse raced as I thought about how I would feel if it were me.... and all the things that I would eventually have to deal with and think about. Would it be painful? A poop bag? Would it smell? Would it leak? Could I swim? Would I be stuck wearing bulky clothes to cover it up? I guess my future wouldn't include any spontaneous sexual encounters with some hot guy I barely know. Would I even want to have sex? Would anyone ever want to have sex with ME? With an ileostomy bag? And what about changing my diet? And going to the doctor regularly forever.
Everything changed for her in just one doctors visit. Which certainly begs the question.... what if she simply ignored the signs and never went to the doctor? Is there a chance that she wouldn't have developed any more complications? That she would have lived a long life blissfully ignorant of her condition? Perhaps. Most likely the cancerous cells would have invaded some other important organ and she would have died at an early age.... perhaps suddenly, perhaps painfully.
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