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Unmasking Death In The ER

The patient with a loving family, a job, good insurance and an abnormal test.  Terrible.

When they come in, with their abnormal test (a sono in this case) from an outside place, from a doctor who sends them to your ED with ‘you need more tests’, it’s hard to keep the stiff upper lip.  The family, well dressed and pleasant, just make it worse.  I know what’s coming.  I’d encourage them to run for the door, if I thought it’d help.

The sono usually says “…blah blah blah mass in the blah blahfurther imaging is recommendedblah“.

While this usually isn’t a true emergency, let’s face it: the patient deserves an answer and their doctor has given up (or in) and has sent them to me.  (And it’s not like I don’t know how to order CT’s, I do).

While waiting for the CT you imagine it’s all going to be nothing, unlike the ones before.  Very very occasionally it’s good news, and relief all around.

The vast majority of the time that CT has been utterly horrible news for everyone involved.  There are tears, and referrals, and ‘…I don’t know for certain, you need a biopsy, because diagnosis leads to prognosis…’ and I feel rotten for about a week.  Unlike the family, for whom I’ve just unmasked Death, who get to have him as a constant companion.

I don’t know if it’s because they seem so normal, or I see myself in everyone in the room, or guilt.  Dunno.  But it’s horrible.

*This blog post was originally published at GruntDoc*

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