Friday, August 17, 2007


Monday the head breast surgeon came back from vacation for a full day of clinic. All of the patients were follow-ups, having had breast cancer anywhere from a year to 15 years ago. There was nothing particularly striking except for the fact that for a number of reasons we were running at least an hour late the entire day--since we only had 1-2 exam rooms available as the medical and radiation oncologists were hogging the rest for consults the patient flow was very slow and there was a lot of sitting around twiddling thumbs on my part. I did get several questions I had answered by the surgeon though, so altogether it was an educational day.

Tuesday I returned to radiology. Looked at a bunch more mammograms. I was supposed to watch a mammogram being performed so as to understand the different positioning methods, but the techs never came to get me (likely because they had much more important things to do than baby-sit the med student) and I have to admit I didn't use a lot of initiative to make it happen as I could have. I figure there will be plenty of times in my career I'll have to interpret mammograms, and not many times that I'll be responsible for setting up the machine. One amusing point was when I went with the radiologist to ultrasound a potential tumor--the tech was convinced that the patient was hispanic, but knew that the translator who was scheduled to come by had just been interpreting for a Russian patient earlier in the day--she came to the conclusion that the translator must be fluently trilingual, and we were all duly impressed. Until we went into the patient's room and found her to definitely be speaking Russian. The tech was quite embarrassed.

Wednesday was OR day--another lumpectomy. This patient ended up having to spend two nights in the hospital, mostly for pain control, but she was also somewhat complicated in that she had a very rare genetic neurodegenerative disorder. I saw her this morning as she was getting ready to go home, and she was very happy to be leaving.

Thursdays the nurse practitioner usually has clinic, but she is currently on vacation, and the radiation oncologist was taking an administrative day, so I thought that I might get the day off. However, the surgeon had two patients to see in clinic--one at 0830 and one at 1300. The first patient (who naturally wasn't roomed until about 0900) was a woman in her early 30s who had just been diagnosed with breast cancer and was here to discuss treatment options. She and her husband were handling it quite well. Cancer had already spread to at least one of the lymph nodes in her armpit, and she will likely have to have chemo for several months before having surgery. Fortunately, her prognosis is quite good. She is also one of the first patients I have seen who will need an MRI as her breasts are too dense to see anything on the mammorgram. She will also need a full PET-CT to make sure the cancer hasn't spread anywhere else in her body.

The later patient was also a rather sad case, a woman in her 80s who had had a left mastectomy in the 1970s. She was unfortunately somewhat demented and lived in a nursing home. Her attendants had discovered a mass in her right breast a couple months ago. She herself was not even aware why she was at the doctor's, and the daughter who came with her was not the power of attorney, thus I was not able to get a good history. At this point, she had already had a biopsy which showed cancer. In her condition she was clearly not a candidate for either chemotherapy or radiation. When I did the exam, however, it was immediately apparent that something needed to be done soon. She had a huge lobulated mass that filled the lower half of her breast, and the skin on the underside was a dusky blue, indicating that the mass was well on its way toward ulcerating through the skin. She also had readily palpable nodes in her armpit. She will need to be scheduled for a mastectomy and axillary node biopsy within the next couple weeks. Odds are that the cancer has already spread, but it is possible that the surgery may catch it early enough.

Today I was in pathology. I went through several slides with the pathologist, then watched a tumor being processed by one of the techs. Now I need to work on my list of residencies I will apply to.


Post a Comment

<< Home