The Nut Whisperer

The oncologist that I have been working with on my current rotation has a tendency to collect a lot of patients with psych issues. As someone who at one point wanted to be a psychiatrist, I think I have delt quite well with these people. I have a knack for figuring out what they need and giving it to them. 90% of the time they just want to be heard. If they have irrational fears, they don't want to be patted on the head and told not to worry. They want the opportunity to sit with a doctor and tell them how they just know that they are going to die tomorrow from a cancer they never even had. So I give them that opportunity. Once they have voiced their concerns, they are usually more receptive to gentle reassurance. This is what I have been doing for the past 6 weeks.

Yesterday, a 54 year old female pediatrician came to see the gyn oncologist. She had basically referred herself. She has an obsessive fear of ovarian cancer. She has no relatives with ovarian cancer, or cancer of any kind. She had no symptoms, and her Ca-125 (a marker for certain types of ovarian cancer) was normal. All she had was an ultrasound that showed a small, complex ovarian cyst.

Being in the medical field can easily turn you in to a hypochondriac. I think most doctors have had some experience, usually in medical school, of being completely convinced they have some horrible, rare disease. Too much information can be dangerous and burdensome when coupled with an obsessive mind. For example, when I recently felt some loss of sensation on my left toe, my first thought was that I am an undiagnosed diabetic. Then I came to my senses and bought a new pair of looser-fitting work shoes.

I sat and talked with the pediatrician for quite some time. Her husband had died 8 years earlier of a rare and gruesome disease, leaving her with a young son to raise alone. She started taking Prozac after his death. I listened to her vent her darkerst fears. I kept my demeanor serene and pleasant. I doubted that she had ovarian cancer, but I didn't share that. I simply told her that the gyn oncology attending was one of the best in the field, and she could trust his opinion.

After her physical examination, the pediatrician, the attending and I sat in his office to talk. My attending gave his usual speech about ovarian cancer. The pediatrician listened patiently. When her opportunity came to speak, she said with a grave look, "bottom line. I have a 12 year old son. All I ask is that I be alive for the next 10 years to see him into adulthood. That is my only concern."

I found this very touching.

In a private moment, my attending, who has 20 plus years of experience as a gynecologic oncologist, turned to me, a 2nd year resident and said, "So. What should I do?"

My response: "It's unlikely, but not impossible, that she has cancer. But she is not going to sleep at night until her ovaries are out. Take her to the OR."

He booked her for next month.

The oncologist shared with me that the pediatrician told him that I was an excellent resident. I thought this was particularly high praise coming from a fellow doctor.