A life vs a grade

In the brief time that I have been a third year medical student, I have seen things that shock, amuse, excite, infuriate and amaze me- just some of a myriad of emotions. 

At times the situations that a third year medical student is put in are extremely frustrating. While I can gladly suffer the indignities of being ignored or treated as a dullard, knowing full well that everything is temporary and this is one step of many toward my goal, I can’t abide seeing patients get substandard care.

Earlier last week, a woman came in for oncologic surgery, having had multiple forms of cancer in her life. Reading through her chart, I realized this had to be a genetic syndrome, because it was simply too many cancers at too young an age to be mere coincidence. In fact, this seemed to me to be a textbook case of Li-Fraumeni Syndrome, a mutation in the p53 tumor suppressor gene that leads to multiple cancers. I suggested this to my residents, who had never heard of this syndrome, but after some explaining on my part, agreed that it was a likely conclusion.

That night, I went home and read up on the syndrome and found the patient fit the diagnostic criteria to a T. The next morning, I came back with the article and information and presented it to my residents, as well as the attending. They all agreed that this was a good observation on my part and that the patient had Li-Fraumeni Syndrome. However, when we rounded on the patients that day, no one said a word to her about her condition. Not a single word. Confused, I brought it up with the residents after we left her room. “Aren’t you going to tell her?” I asked. “Eh,” said the resident. I was stunned. But let me explain: Li-Fraumeni Syndrome is autosomal dominant; it was likely that one, if not both of her sons had inherited it.  In fact, one of her sons had already had leukemia, one of the cancers included in this syndrome. Li-Fraumeni Syndrome makes its sufferers extremely susceptible to DNA damage by radiation and it’s very important for these patients not to have or to have very few X-rays or CT-scans, not to mention they should not receive radiation treatment for their multiple cancers. This woman needed to know her condition. She needed genetic counseling, she and her sons needed to understand what was happening to them to prevent further damage and lastly, she deserved some answers to the mysteries of her health. To take it even further, she should be offered some time with a social worker, since the syndrome would be a very heavy psychological burden, and this woman had been through a lot of trying times in her life.

After struggling with shock and disappointment, I raised the issue two more times with the resident. Seeing that he was getting annoyed, I dropped the issue. I desperately wanted to tell her myself but was reluctant, knowing the consequences would be a verbal evisceration and a bad evaluation. So I didn’t. And as time went on and she was discharged, it seemed too late to do anything.

Each time I think back on this, I realize I should have told her anyway. This patient needed better care than these residents were willing to give her. The bare minimum of medicine that they were providing was simply not enough. Even as a third year doing the first week of rotations I could see that. And what is a lousy evaluation in the face of a person’s life?