Saturday, December 01, 2012

trapped between two lungs

I'm almost done yet another stint of working in the hospital (as opposed to the clinic, where I spend the other portion of my time), and it's been a strange week. After that last call that landed me a missed Thanksgiving day, I got progressively sicker. It started with an itch of the throat and some sinus congestion, then it turned into sinus congestion and a cough. Then it turned into one of the worst coughs I've ever had- at one point, I actually wondered if I'd forgotten that I have an extensive smoking history (I've never been a cigarette smoker) because I sounded like a 75 year old veteran with emphysema. At another point, after my last call, the coughing fit got so bad that I could not sleep, and my abdominal muscles were actually sore (so at least I got a work-out as a consolation prize).

It's just a virus. I know that. I tried to treat the symptoms with benign over-the-counter medications, none of which really helped. I finally started to feel better when I just gave up and drank copious amounts of Good Earth decaffeinated tea and water, and tried to catch up on sleep. I still have this barking, alarming cough that is scaring most of my patients. And I'm still wheezing, which makes me feel a bit sorry for myself.

Except medicine gives you little room for that. As a general rule, physicians won't call in sick during residency unless a limb is falling off, there's intractable vomiting or uncontrolled bleeding in play. Otherwise- suck it up and soldier on. And if you are even thinking about feeling sorry for yourself, one of your patients will set you straight.

Yesterday, that patient was a young guy, a decade younger than me, who had been diagnosed with testicular cancer this past year. He had undergone surgery, and then he had started chemotherapy because there was still some evidence of leftover disease, and each chemotherapy cycle had taken its toll. Then after his third cycle of chemotherapy, he started developing difficulty breathing, and after an extensive evaluation, it had been determined that he had a bad reaction to one of the chemotherapeutic agents. This had resulted in lung toxicity. So now this 20-something kid with a very treatable cancer is facing respiratory failure. His lungs are totally shot. Over the past month, he went from being what one of my colleagues calls a "walkie-talkie" to being unable to move without oxygen. When I saw him this morning, he was breathing shallow and couldn't say more than a word at a time without running out of air. The frail young boy that was in the bed before me just said we should do what we need to do, he was up for whatever we thought was best. It's one of the hardest things to see a patient exhibit that kind of bravery, that sort of will to live, when you know they are facing something that is largely untreatable.

So, in the end, there wasn't much to lament about my stupid cough.

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