this dying business, part two

Next to me is Mr Beswick, a retired plumber. He is a 78 year old man with lung cancer who’s been on the ward for four days. He presented with worsening shortness of breath and weight-loss of twenty kilograms over seven months. The GP did a chest X-ray, which showed a pretty big pleural effusion around his left lung. So he sent Mr Beswick into hospital straight away to have the fluid drained. One smart intern thought about sending it for cytology and it came back positive for malignant cells. Score one for the team! They did a CT and found the primary cancer in the left upper lobe (of the lung) with enlarged mediastinal lymph nodes, but no metastases in the usual places. So now he’s waiting for a biopsy to obtain some tissue for histology, and a pulmonary function test to see if he has enough pulmonary reserve for the surgeons to remove one lung.

Of course, getting all this information hasn’t been entirely straightforward. Mr Beswick himself isn’t quite sure why he still has the chest tube in place or why he’s having the pulmonary function test. I don’t think they’ve even broached the subject of surgery yet. All he knows is he has cancer and the doctors are “running some tests”. The story had unfolded over a few hours on Sunday afternoon, in dribs and drabs, between visitors coming and going, and a lot of guess work and piecing the pieces together. It’s very frustrating that I can no longer just go behind the nursing station and read his file.

I myself have been here for two days. I felt a bit crook on Friday, coughing and sputtering and a bit sinusy, and woke up hot and sweaty on Saturday. I measured my temperature and it was 38, so I had to come into emergency. Luckily my mate Baz was doing a shift, so I didn’t have to hang around for that long. They really do need to rebuild the whole department – its tiny cubicles and narrow corridors and the cramped fishbowl area really makes it an awfully uncomfortable place for both patients and doctors alike. Anyway, they took some bloods and my neutrophils (which help the body fight infections) were a bit low. So Baz made some calls and worked the system and I made it up to the ward by mid-afternoon, admitted for observation. Just my luck – stupid neutrophils!

I was donating more blood to the nurse (her badge said Silvia) when a dude with a stethoscope marched in. The fact he is a doctor is a no-brainer, and I guessed he was the resident by his brisk walk. Registrars walk a bit slower, and they dress nicer, too. Medical consultants walk even slower. Besides, they never round this early. And they wear suit jackets. You used to be able to tell them apart by their age, but with all the postgraduate students around these days, you just can’t tell any more.

‘Good morning Mr Li. I’m Mohammed, one of the doctors on the team who will be looking after you. How’re you feeling today?’

‘Yeah, good thanks. How was your weekend?’

Mumble-mumble. He is flipping through my file and obs chart.

‘I see you have come in over the weekend with a temperature. Have you had any more fevers or chills?’

‘Not since yesterday, no.’

‘Well, your X-rays came back negative. We’ll see what your blood test shows this morning and if they’re good we can probably send you home today.’

He looks up and grins. He thinks he’s saved my life. Wonderful. I decide to really make his day.

‘Mr Beswick next door is a bit worried about what’s going on though. He’s not sure about this lung biopsy thing so maybe you should have a chat to him. And he wants to know if he needs to have surgery. I don’t think anyone has told him.’

Mohammed looks at me quizzically, and then at Mr Beswick, who is struggling to wake up for Silvia, and then back at me again.

‘Ah right.’