one of THOSE days...

After spending last week at the Coronary Care Unit (more about that experience later), I was very excited to re-join my Internal Medicine team for Week 6/8 of inpatient medicine. I was ready to start following some new patients as today was our call day, which turned out to be a 14+ hour call day.

My first patient was a very nice gentleman who had had a rough time with addiction issues in his middle-aged years but seems to have cleaned up his life quite a bit since then. He has been HIV+ for 20+ years and has been on anti-retrovirals since then. He is doing very well in that aspect of his life. He came in with a very non-specific complaint of some pain in his left arm that bought him a chest x-ray in the Emergency Department. The x-ray results bought him an admission into the hospital - something he was not too happy about, and a CT scan of his chest.

My resident, intern and I walked into the radiologists' office to get a read of his CT scan. Somewhere within us, all three of us knew what to expect. The CT scan confirmed a very high suspicion of a primary lung cancer in my patient. This can't be confirmed until a biopsy of the mass is done, but the radiologist was pretty sure this will turn out to be malignant - Here's hoping he is wrong.

We also wanted the radiologist to read the abdominal CT scan of my fellow medical student's patient. It turns out that that patient had the classic signs of metastatic ovarian cancer on her CT scan.

In a 5 minute visit to the radiologist, we bought ourselves 2 high suspicion scans for malignant cancers.

The universe was not done yet. My second patient was a very nice old lady who came in with some very non-specific complaints that had bought her a chest x-ray at a different urgent care center. The results of that chest x-ray bought her a visit to our Emergency Department, and a CT scan of her chest. I didn't have to go to the radiologist's office this time. The report was already in the system. Our patient had a humongous pleural effusion (fluid in the membranes surrounding her lungs) with a high suspicion that this was caused by metastatic cancer that had spread to her pleura. We will tap the fluid and analyze the cells in the fluid to see if it is malignant or not.

Neither of my two patients have a confirmation of malignancy yet, but if clinical suspicion is anything to go by, that might be changing tomorrow for both of them.

This was definitely one of those days. Yes, one of THOSE days.