When a Physician Finds Himself the Patient

How One Doctor Is Dealing With His Diagnosis

Nathan Wei, MD

Disclosures

October 05, 2017

A Doctor's Diagnosis, His Daughter's Prescription

It began with 3 days of right upper quadrant pain. I called a surgeon friend of mine, who examined me in his office and ordered a gallbladder sonogram. It showed acute cholecystitis as well as a possible hemangioma in the liver.

Nathan Wei, MD

A laparoscopic cholecystectomy ensued, but afterwards the surgeon said that he saw something peculiar on my liver. He contacted a hepatic surgeon colleague at Johns Hopkins, who recommended an MRI scan (the second of innumerable imaging procedures to come.) A recommendation for other tests, including a liver biopsy, came next.

And so my odyssey began.

The liver biopsy at Johns Hopkins was uncomplicated, and I thought, "It'll be a hemangioma."

I still remember the call from the Hopkins surgeon. It was noon on the following Thursday, and I was ready to eat lunch. I picked up the phone, and the surgeon told me, "They found poorly differentiated squamous cell carcinoma," adding, "I need to schedule you for more tests." The only word I could murmur at the end of the conversation was a weak, "Okay."

After I hung up, I asked my staff to cancel my afternoon schedule. I was in no shape to see patients. The next thing I did was to call my wife with the news. When you receive the diagnosis of cancer, it hits you like a tsunami. All the neurons in your body shut down. You become a zombie.

Somehow, I drove home. My wife was at the back door to greet me. She was on the phone with our oldest child, and said, "Becky has a great idea and would like to talk with you."

I put the phone to my ear: "Dad, you should go out and get that Porsche you've always wanted." I thanked Becky for her suggestion and handed the phone back to my wife.

My legs felt really heavy all of a sudden, and I went in and sat on the couch. My wife said, "You should do what Becky said," adding, "Don't be cheap about it."

While still in my zombie-like state, I stood up and said, "Okay, I'll do it."

The two of us drove to the Porsche dealer. My wife stayed with me a bit but had some other errands and left me with the parting words, "Do it!"

Usually, my wife and I purchase preowned vehicles after doing a lot of research and entering into brutal negotiations. So it was completely out of character for me to walk in to this dealer with no negotiating weapons in my quiver. After minimal haggling and signing a bunch of papers, I got the keys to a Porsche 911 Carrera 4, my ultimate dream car.

I drove away in this cushy cocoon, this Teutonic work of art. Extravagant? Outrageous? Yes. Affordable? Probably not. But emotionally, I felt on top of the world.

Treatment Begins

The subsequent days were a combination of more imaging studies, lab tests, and two hospital admissions. The first was for a bleed into the liver. My hemoglobin dropped to 6 g/dL, and I spent the day in the ICU getting transfusions. After discharge, I was readmitted with fever and dyspnea. This hospitalization was longer because, frankly, the doctors were stumped. Finally, empiric antibiotics designed to hit intestinal pathogens seemed to do the trick. I was able to go home.

(Oh yeah, my diagnosis is carcinoma of the stomach with metastases to adjacent lymph nodes and liver.)

I stayed healthy enough to get a port placed the next day and started chemotherapy the day after that. One of the drugs, 5-fluorouracil, requires a 24-hour infusion through a portable pump you have to carry around. The next day, a home care nurse came out to show me how to remove the needle from the port.

Having some of our children travel home to be with us was a great help.

For the first 2 days after chemo, I felt fine. Then, the bottom dropped out. Ten to 15 bouts of watery diarrhea a day for the next 5 days, and oral hydration wasn't cutting it.

When my systolic blood pressure hit 78 and I could barely walk, I bit the bullet and went to the local emergency department to get my tank refilled. Talk about night and day! I felt terrific after the fluids were in.

Going back to work after missing almost 4 weeks was tough. Even a half-day schedule was fatiguing. It still is. I can barely go a half-day still.

Reflections

It's funny how some things become important. I never used to be bothered by being referred to as "Mr" in the hospital when I've been a patient in the past. However, I requested that I be referred to as "Dr." It was one of the few pieces of dignity I felt I had left.

Being poked a lot was not pleasant, and my ordinarily big-veined pipes turned into little pipes, along with ugly ecchymoses around them. My arms would be an entree into the Blue Man Group, for sure.

I also had so many CAT scans with contrast, I don't think I need any radiation therapy. A PET scan is an interesting test. They have you drink this sugary liquid a couple of times while they put you into a machine like an MRI scanner. The magnetic resonance cholangiopancreatograph I had was tough because you have to hold your breath, and with the fever and dyspnea it was not easy.

I've let my hair and beard grow because I'm expecting they will fall out soon, so what's the point of getting them cut?

While I'm not particularly religious, I've always believed in a force, a Supreme Being that is larger than us. So I have always prayed on a daily basis, every time beginning with a thank you for what I have: my health (I'm still on the green side of the grass!), my family, friends, work, and the many blessings I have had in my life. I am also grateful for the gift of another day. As my wife says, "One step at a time, one foot in front of the other."

As you can see, I don't pray for a cure.

The mantra of the Stoic philosophers is this: "Control what you can; cope with what you can't; concentrate on what counts." I have no control over what the cancer will do. What I do have control over is to meet the enemy with courage, a strong will, and conditioning; to give it my best shot.

I listen to my kind of motivational music to pump me up: "Gonna Fly Now" (Bill Conti from Rocky), "Hit Me with Your Best Shot" (Pat Benatar), "We Will Rock You" (Queen), "Eye of the Tiger" (Survivor), etc—things to keep my spirits up.

Prior to all of this, I was a fitness fanatic and earned my certification as a personal trainer through the American College of Sports Medicine. So it's been killing me not being able to work out like I did. I've started riding a recumbent bike slowly, and even that's an arduous undertaking.

Being on the other side is not where you want to be, but we'll all be there someday. Fortunately, my patients have been very understanding, and it's been gratifying to know I've made such a positive difference in their lives.

You would think that as a rheumatologist, I would be studying all of the effects of the chemotherapy drugs on my T cells, cytokines, and so forth. I couldn't care less. All I'm interested in is learning about side effects and how I can minimize them.

When it comes down to it, it's a primal struggle.

Some other things occur to me. I started unsubscribing to many of the emails I get. Many are no longer relevant. Reading the book The Daily Stoic: 366 Meditations on Wisdom, Perseverance, and the Art of Living has helped me gain more insight into myself. Finally, I have Nietzsche's quote hanging up in front of me at home: "What doesn't kill us makes us stronger."

I hope I get stronger.

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