Friday I spent the afternoon "riding shotgun" with a local oral surgeon. Usually it's fun (for me anyway) to watch someone w/ the skills to shuck out four wisdom teeth in the time it takes me to do one. Today was a little different. He was kind enough to see a patient from the non-profit who we were pretty sure had oral cancer.
The slim, middle aged woman is "between homes," as we say, but had recently started a new job and was pleased to be getting health insurance. Unfortunately, even though she'd noticed the sore in her mouth a year ago, and even though there were resources to assist her in seeing someone, she "put it off because I didn't WANT to know for sure...I was scared."
Increasingly, the difficulty swallowing increased, the pain under her tongue and in her jaw became more severe and frequent, and she finally sought help. The ulcerated, bulging lump ventral to her tongue and the nodular involvement appreciable in the submandibular and cervical areas were hardly subtle. Even the greenest dental student would raise an eyebrow with the symptoms and presentation.
While waiting on the oral surgeon, I made small talk with the patient. We both had family in Ohio. Our places of employment are nearby one another. Yep, it sure is windy today.
The oral surgeon confirmed our suspicions without needing biopsy. "T3 or T4," he said, soberly shaking his head out in the hallway. "I'm sending her to Dr. ---- in Boston. She needs a head and neck surgeon - probably radiation, maybe chemo...."
We returned to his exam room to try to gently tell the patient that we would do what we could to facilitate her treatment. "Can I wait 'til my insurance kicks in?" she asked hopefully. "Two months?" my colleague said incredulously. "Ma'am, I don't want you to wait two weeks. We need you down in Boston next week." He wrote out a script for a strong narcotic so she could sleep at night.
Dr. ---- was in surgery, so the oral surgeon dismissed the patient, promising that his office would call her as soon as they reached the Boston doctor. I shook her hand as compassionately as I good, encouraging her to not hesitate if my agency could do anything to facilitate her transportation or other needs. She left smiling unconvincingly, with a hint of tear in her eye.
It's easy to scoff at people for smoking too much or not seeking care. Harder when the person has a face and a family. I wish she'd come in sooner.
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When I was in my GPR I was doing my anesthesia rotation at a local VA hospital... went to intubate this guy who was in for some random surgery... looked down at his vocal chords to see a huge mass of cancer. It was a T4. He died a couple weeks later. Sad indeed when you put a face to cancer.
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