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Sunday, June 12, 2011

PA Reflections: Surgical Oncology Rotation Mrs. M.

I don’t often write about encounters gone badly. But, honestly I don’t really have a lot of insight into when encounters go badly.

Mrs. M is a 47 year old with metastatic breast cancer who was sent to our office for a consultation for palliative mastectomy. Those two words seem diabolically opposed to me. Basically her disease was likely going to overtake her in the not quite forseable future. She was undergoing chemotherapy and her disease was stable, not advancing. However, it was so diffuse initially that this was not entirely hopeful news.  The medical oncologists thought I guess was that in select cases of metastatic disease removing the primary site can prolong survival. (not cure the patient was increase their lifespan).  However, in my attending’s quick and appropriate judgment the decision was no or at least not yet until further medical treatment could be employed to shrink the primary tumor further.  

Let me back up to my role in the encounter. I rushed in. Spanish speaker ok, Lo siento Me espanol es muy mal. I checked off the breast CA risk factors she had, asked about new complaints, and did my physical. I didn’t explain why I was there or ask her why she was at our clinic.

When my attending shared her assessment with Mrs. M, she burst into tears. Thinking back over the encounter I realized Mrs. M I never asked Mrs. M why she wanted the surgery or what she thought the surgery could do. What if Mrs. M. thought this surgery was going to cure her. . . We decided to wait on the surgery because it was not in her best interest, it could make her last months more painful, the surgery would be extensive due to the size of her tumor and this may be a bigger risk to her health than if the breast stayed. We decided to wait until the last rounds of chemo and further medical treatment that was planned. If the tumor shrank at that time the surgery would be a better option. However, I didn’t even understand all of this until the Doctors explained this to me. So what if she thought we were saying no we were not going to do this not because we didn’t want to… We never asked. We didn’t explain our rationale.

I just finished a book about communication in healthcare. But it didn’t sink in. I failed Mrs. M. I didn’t realize it, the sleep deprivation and stress of being uncomfortable on my new rotation let me get in the way of my strengths compassion and communication.

2 comments:

Lauren said...

Your patients are very fortunate to have someone that reflects and works to realize how they can care more. You are inspiring my friend.

Cynthia Lee said...

Thank you for your encouragement. And congrats on the new addition to your family! I am excited to hear about all the escapades of having a furry ball of fun!