“Are you comfortable talking to him about all this stuff?” my attending asked me casually.
“Yeah, of course—sure,” I replied, trying to mimic the same casual tone.
Hold on. What did I just agree to do?
More than a decade later, I still feel the nervous tension in my stomach as I think about that day.
It was my first day of internship, and I was in an urgent care clinic. I had just reviewed a patient chart before going in to see him and discovered that he had newly diagnosed hepatitis C and a liver lesion on ultrasound, which made us concerned about hepatocellular carcinoma (HCC). And “all this stuff” that I had just agreed to do involved talking to the second patient I had ever seen in my life as a “full-fledged” doctor about this diagnosis.
A number of thoughts were racing through my mind as I walked toward the room (Now, I’m not sure, isn’t HCC something serious? Does it metastasize? Could the lesion be something else?).
I knocked on the door and reached for the doorknob.
As I entered the room, I noticed his face more than anything else. His face looked tired. Not the type of tired that comes from a night of poor sleep, but the type that comes from a lifetime of having it rough. I sat across from him, trying to make some small talk to break the tension I was feeling.
I told him the news quickly, in a rather matter-of-fact way. As I mentioned the words “cancer of the liver,” I watched him turn a little pale, somewhat shocked. He had lots of questions, but all I could really tell him was that he needed additional work-up and that it was critical that he follow up with a gastroenterologist as soon as possible. What did I know? It was my first day of internship. I remember telling him multiple times, “It’s really, really important that you see your gastroenterologist soon.” The word “really” was the only therapeutic intervention I could offer.
He left the office, but I knew he was in bad shape. My attending didn’t even ask me how the conversation went.
I was absolutely devastated. What had I just done? I had told someone that he might have cancer and then sent him out. This felt wrong in so many ways that I could not articulate that day but felt in my heart.
As soon as I got home, I went online and read everything I could about hepatitis C and HCC. Its presentation, progression, and sequelae. I became an expert. I barely slept that night, thinking about how I had left him. My mind raced:
I should have asked him if he had family.
I should have asked him who his gastroenterologist was.
I should have called his gastroenterologist.
I should have put a hand on his shoulder and told him we would figure this out together.
I should have told him he wasn’t alone.
I couldn’t wait to rush into the urgent care clinic in the morning, look up his number, and call him to deliver on some of the shoulds from the day before.
I went in early and dialed his number. To my great disappointment, a recording notified me that the number had been disconnected. Disconnected? I had just given him life-changing news and sent him out into the world without any support. I picked up the white pages and started calling the numbers that matched his name. I searched the system for some connection. No luck. Every day for three weeks, I looked for him in the urgent care waiting room and on the roster of scheduled patients.