She was so pleasant when I met her. She laughed politely in bed and stated that she, “Didn’t want to come to the ER, but the vomiting and dizziness had become so bad over the last two months that I had to come here.” I asked her a few more questions. Her vomiting was worse when she moved from sitting to standing positions and with any kind of motion…maybe she just had vertigo? She was also dizzy, which further pointed me in the direction of this benign diagnosis. Her bowel movements were regular. However, her history also included profuse right quadrant tenderness and night sweats. She had lost over 40 lbs over the last three months. She attributed the weight loss to her inability to keep food down and was actually pleased with the results. Aside from confirming the existence of profuse upper right quadrant tenderness she had already reported, the patient’s complete physical exam revealed no clues to her condition.
I hoped her condition would be benign. However, her symptoms affected almost every system. Over the course of the evening, my preceptor ordered labs, an ultrasound of the patient’s abdomen, and a CT scan of her abdomen. Things happen quickly in the emergency room, but they also happen slowly. The process of ordering and interpreting all her blood work and resulting imaging took 4-6 hours. She was quite sick, so I needed to check on her several times through my shift. She was always positive and became a vibrant presence for most of my shift. She was 60, with a daughter who was 27 who had just graduated from nursing school.
Her CT scan came back showing masses consistent with cancer that had metastasized to her liver, lungs, spine, and bones. When my preceptor saw the CT scan, he asked me, “Was she nice?” I responded, “yes.” “It’s always the nice ones,” he replied. I’ll never forget his question or his response. He did not express disappointment that such a bad thing could happen to someone so good. He said, “It’s always the nice ones.” He continued, “I swear anytime someone nice comes in, they have cancer.”
After receiving her diagnosis, my patient asked for some chap stick and a blanket. As a student I had the time to bring them to her. When I brought them to her, she smiled sadly and told me her 27 year old daughter would be devastated by the news. Then, she started describing her cross necklace that she wore daily. She talked about how it encouraged her to be kind to other people and reminded her of the importance of God in her life. She said that she forgot to wear it today, but that when she heard my name, “Christian,” she felt immediately comforted. She laughed and wished me luck in my future. She thanked me for caring for her that night. How could she be grateful? She had just discovered that she had cancer.
Bad things happen to good people. Life is not fair, but that night this patient reminded me that we have a choice to react joyfully to even those dark moments of our lives with kindness, joy, and laughter.