I have a 64-year-old male patient with severe osteoporosis and a few other health issues like anemia of unknown origin. His main complaint has been pain which we eventually chose to treat short-term with Percocet, upping the ante to long-acting morphine when the Percocet couldn't touch it. A few weeks ago, he sat under a tree outside of his apartment building and said that he wouldn't take the morphine any more and he only wanted Percocet. This type of behavior often speaks of addiction (or at least dependence) but we gave in, at least for the meantime. Meanwhile, after grasping at straws regarding his anemia, we sent him to a gastroenterologist to see if perhaps he was bleeding internally, and also to treat his esophageal reflux disease.
Yesterday I received a call from the gastro provider that they needed to send him for an emergency abdominal CT-scan which later revealed the fact that his abdomen is riddled with cancer that has metastasized from his liver to his stomach, adrenal glands, and lymph nodes. Now his pain makes sense, although his symptoms were always vague (and we were worried about Percocet dependence!). My, how things turn on a dime.
Now the game-plan has changed and I will accompany him to an emergency visit with an oncologist tomorrow. I don't look forward to the look on my patient's face when we hear what I expect to hear: that the cancer is already profoundly spread throughout his abdomen, and the chance of curing him is almost nil at this juncture. I can see that we will be stepping gingerly onto a new path of palliative care as he begins what may be a very rapid decline. His stalwart friend and advocate will be there with us tomorrow morning, and it will be up to me to translate all of this new information---literally and figuratively---into something that my patient can grasp.
The language of illness and death can be harsh and forbidding. My job is to distill it into digestible syllables and be there to pick up the pieces of grief. All in a day's work, I guess.