Today I’m back in the emergency department, and that’s a good thing, because outside rain is whipping against the glass front. If I were riding along in the ambulance, I’d end up getting wet sooner or later. My immune system is still sensitive; the cold I could catch would be a bad one.
What if I’m already sick? If my cancer is back and I just don’t know it yet?
Three days until the follow-up examination.
Trying to focus on my work, I step up to the emergency coordinator’s desk. ‘Hey, are the test results back yet for the woman with the swallowing difficulties in treatment room five?’ I ask the tall man in scrubs.
‘That was patient P030424-031, right?’ I nod, and he glances at his monitor. ‘They should be done any minute; I’ll let youknow. By the way, I’m supposed to tell you that Dr. Franks wants to see you before Jaden shows up and you don’t have any time left.’
Jaden. He’s going to spend part of my shift with me today, and I don’t know what to make of that.
‘Okay, then I’ll take care of that right away,’ I say, and head for my boss’s office.
When I reach Dr. Franks’s office, I knock. He calls me in.
‘You wanted to see me?’ I ask, whereupon he reaches for the medical file on his desk.
He gestures to the conference table next to the sprawling plant in the corner of the office. ‘Have a seat.’
Although he looks at me with his usual friendly expression, I feel a little queasy. I slide onto the chair and watch as he opens the file.
‘Is there a problem?’ I ask.
He clears his throat, puts on his reading glasses, and begins to read from the file. ‘Female patient, 42 years old, presents with recurrent and now for four days persistent mild swallowing difficulties without fever or weight loss.’
At once it’s clear to me that he has my patient’s file in front of him, the one who is currently waiting for her test results. I frown, he gives me a searching look for a moment, then lowers his gaze to the file again.
‘The throat is slightly reddened, otherwise no further symptoms, no known allergies or chronic illnesses, no family history of disease. Non-smoker, no medication.’ He turns to the next page. ‘Vital signs within the normal range, throat essentially unremarkable. Works as a teacher in Spryfield. Single mother, three children.’
‘Yes, and at the initial examination there were no neurological abnormalities and no problems in the abdominal area either,’ I add, to show him that I am sufficiently familiarwith the case. ‘However, she seemed very tired to me, had pale skin and deep circles under her eyes.’
He regards me with a serious look. ‘What does all that suggest to you?’
I slide forward on my chair. ‘Well, given that she’s a single mother and works at a school in one of the worst social hotspots in Halifax, she’s probably under a lot of stress.’ She even came to the emergency room with her complaints because she couldn’t get away during her family doctor’s office hours. ‘Since no other alarming abnormalities have been found so far, a functional dysphagia is the most likely explanation, but …’
‘Exactly.’ My boss takes off his reading glasses and thoughtfully folds the arms together. ‘This woman is suffering from a swallowing disorder without organic causes. She needs relaxation techniques, methods of stress avoidance, and possibly help with her children.’
That’s true, but only if that really is the cause of her symptoms. I’m about to explain exactly that, but Dr. Franks signals to me that I’d better not interrupt him now.
‘Then let’s see what you prescribed for the woman instead.’ His fingers close more tightly around the medical record, his knuckles standing out. ‘Extensive lab diagnostics including tumor markers and thyroid function tests, MRI of neck and head, thoracic CT, an ultrasound of the thyroid, and and and.’ Discouragement dominates his expression as he fixes his gaze on me. ‘What were you thinking?’
I have an inkling where he’s going with this, so I raise my hands in a calming gesture. ‘Functional dysphagia is only one possible explanation for the symptoms, and I wanted to make sure I wasn’t missing anything.’
I notice that he’s trying to stay calm, but also how little success he’s having. ‘These tests cost several thousand dollars.’
‘The patient could be suffering from a serious illness. A brain tumor, a severe infection, tracheal cancer,’ I reply earnestly. What kind of doctor would I be if I didn’t examine her thoroughly? The woman’s life could depend on it. ‘The tests were necessary, there’s something wrong with her, as I said, she was extraordinarily pale and exhausted.’
‘The woman leads a strenuous life; of course she’s tired,’ my boss counters. ‘Any other doctor—including myself—would have sent her home. The tests you ordered are excessive.’
They are not. ‘And what if she is sick after all? The illness might be just beginning.’ Are we supposed to wait for the condition to progress? The sooner we treat, the better.
He shakes his head; again, he looks worried. ‘You’re seeing ghosts.’
‘But we don’t even know if…’
‘This woman is healthy, and the test results will show that.’ With a quick movement, he rises from his chair and indicates that we’re done here. ‘From now on, you will submit your planned tests and examinations to me in advance for approval. Something like this must not happen again.’
Incredulously, I stare at him. ‘She is sick, I’m sure there’s something.’
