Sandy Brown, MD


December 19, 2006

Ernie looked at least 20 years older than his given age when he first appeared in my office. He had literally come out of the woods to find out why he had lost 30 pounds the previous year. He was alarmingly thin and had the cachectic look of a cancer or TB patient. Nonetheless, he had no pain or cough and, besides some fatigue, no major complaints. He was accompanied by his significant other, Wilma.

I asked him what he thought was wrong. "I think I have digestive problems," Ernie said. "That may be," I told him, "but I still think you're going to need a full workup." Although, observing his tattered clothes and unkempt appearance, I wondered if he could afford it. "We have some savings," Ernie replied. "We'll take care of it." But they didn't look as if they could afford a meal, much less a barrage of expensive medical tests. "Why don't you see if you're eligible for Medicaid," I suggested. "We'll see," Ernie said.

His complete blood count and chemistry panel had some nonspecific abnormalities, and, an H pylori antibody screen, done at his request, was inconclusive. His chest x-ray, however, taken at my insistence, showed a large right-sided pleural effusion. "Ernie, you're going to need a CT scan of your chest and abdomen and God knows what else to get diagnosed. Won't you look into getting on Medicaid?" I asked. "Doc," he said, "I can't do that and I'll tell you why, but it's confidential. I was supposed to do time for a pot bust years ago, but I ran out on it. If I apply for public assistance now, they're likely to find me and send me to prison. Let's just do the tests. We'll pay for them somehow."

The computed tomography (CT) of the chest showed only fluid, but the abdominal CT was more ominous. "Your patient has a big tumor in his pancreas," Cyndi, our radiologist, told me. "He has metastasis to his liver. I'd give him two months tops."

On hearing the bad news, Ernie declared he would try naturopathic treatments, in particular, digestive enzymes. A few days later, he called to find out whether I could contact a manufacturer to request some catalogues available only to physicians. "I don't think traditional medicine has anything to offer me at this point," Ernie said. Besides giving him a more definitive diagnosis, I heartily agreed. "Chemotherapy will just make you feel lousy, and the cure rate for pancreatic cancer is abysmal," I said. I referred him to the local cancer resource center and told him to contact me for a therapeutic tap if the effusion made him symptomatic. I waited with curiosity to follow his progress with alternative therapy.

Ernie passed away 2 months later, just as our radiologist predicted he would.


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