In denial: heart disease, breast cancer, and diabetes
Every doctor has patients that he or she has treated over a lifetime that can be recalled to memory. Often, it is because the circumstances of their care were particularly troubling or difficult. These memories pop up at unexpected times. Many years ago I was called to the emergency room to see a very pleasant 50 year-old woman for chest pain. Upon arrival, I noted a somewhat "ripe" (like an orange that had "passed its prime") smell to the room, a very lovely well made up lady, seated, breathing quite heavily, and unable to lie down without gasping for air. Underneath my hand when I went to examine her heart was a hard lump the size of a robin's egg in her breast. My stethoscope revealed clear evidence that her lungs were filled with fluid. Her laboratory tests quickly returned demonstrating proof of a heart attack, diabetic ketoacidosis, and a leukemoid (suggesting leukemia) reaction. I still recall the feeling of helplessness as I debated with myself what to tell the patient and her family.
When faced with a posse of "causes of death" it would seem human to flee and sometimes the only real defense is humor. This particular woman used humor and helped me to help her get through a very bad time. Together we treated her heart failure, heart attack, and diabetes. The breast cancer had spread to the bone marrow and eventually took its toll as we knew it would. Although she lamented her lack of previous mammograms and preventive care, she looked forward--not back--and offered a hope that my experience with her would "help someone else sometime in the future" when she was no longer here. Honesty within yourself can be an issue. Each year I think of her when I am faced with a problem that could have been prevented if only someone had turned off that denial button and asked the right question to the face staring back from the other side of the mirror.