In My Hands by Steven A. Curley

Author:Steven A. Curley
Language: eng
Format: epub
Publisher: Center Street
Published: 2018-05-22T04:00:00+00:00

19

The Rancher

“You know, you don’t have to look like everybody else to be acceptable and to feel acceptable.”

Fred Rogers

Acceptance: Agreement with or belief in an idea or explanation; willingness to tolerate a difficult situation

Sitting in my office I scanned the day’s list of patients I was scheduled to see before walking over to the clinic. I noticed one new patient had been diagnosed with rectal cancer. Other than the gentleman’s name and age, I had no additional information. I was in my first month as an assistant professor of surgery after completing nine years of postgraduate training. After graduating from medical school, the next almost-decade was divided into five years of general-surgery residency, two years of basic science-laboratory cancer research, and two years of surgical oncology fellowship. I finally had what my parents called a real job. I realized the new rectal cancer patient was scheduled to see me in ten minutes. I ambled over to clinic.

A nurse in the clinic informed me that the patient was already in an examination room because he had arrived early. I rapped on the door and entered the room. The patient was a man in his late sixties sitting on the end of the ubiquitous, bland exam-room table. A woman, who I soon learned was his daughter, sat in a chair beside him. He was dressed in frayed but clean denim overalls; a faded, once-colorful, pearl-snap-button Western shirt; and well-worn cowboy boots. A sweat-stained straw cowboy hat lay on the adjacent desk, resting properly on the crown (never on the brim). The man was bent over at the waist and holding his chest tightly with his right hand.

Usually when I first meet a patient I shake his or her hand and introduce myself. With this gentleman my first words were a question: “How long have you been having chest pain?”

“It’s been getting steadily worse for the last ten minutes,” he replied. “I took a nitroglycerin tablet, but it is not letting up.”

The patient’s daughter informed me he had suffered a “minor heart attack” two years previously and he saw a cardiologist every few months. She reported he occasionally had chest pain when engaged in strenuous labor on their “farm,” but after a few minutes of rest and sometimes a nitroglycerin tablet under his tongue, he was usually good to go. I quickly examined him. His heart rate was ninety, his skin was cool and clammy, and he was clearly having severe chest discomfort.

Crescendo angina. I had seen it once before as a surgical resident. These symptoms indicate a critical obstruction in one or more of the major coronary arteries providing blood supply to the heart. An impending, potentially lethal myocardial infarction was unfolding in the man before me. I quickly walked out the door and yelled for a nurse to call 911 and get an ambulance. A seemingly odd request given we were in a clinic building physically attached to a hospital. However, the hospital was a dedicated cancer center, well equipped to

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.