“There’s something in your lung”: five years ago today

This is a re-post with new URL – for some reason the original of this post failed.

Precisely at 9:00 a.m., five years ago today, the phone rang and my life changed.

There were two calls, actually, from two physicians. I don’t recall which was first, but one was Dr. Danny Sands (my primary), and the other was orthopedist Dr. Jeffrey Zilberfarb.  Five days earlier I’d seen Dr. Sands for a physical; in my pre-visit agenda email (PDF at right), I’d noted “Shoulder: range of motion complaint,” and that as we’d discussed earlier, I had made an appointment to see Dr. Z on January 2. That visit had been cordial, unremarkable; he’d x-rayed my shoulder.

But in the x-ray Dr. Zilberfarb saw something unexpected, and he’d contacted Dr. Sands. Dr. Sands called me and said, “… I pulled up the x-ray on my screen. Your shoulder will be fine – it’s just a rotator cuff problem. But Dave – there’s something in your lung.” (See lower image.)

He said we didn’t know what it was – could be a fungal thing, could be a scar left over from some old infection – but “we need to find out.” I said, “So, you need me to get back in there?” He said yes.

Imagine hearing “There’s something in your lung” when you don’t feel sick – something significant enough that your doctor calls you at 9 a.m. You immediately start thinking about that spot, looking for any sensation, any sign of trouble. You start wondering, “Do I have a time bomb inside me??” And that’s not a nice feeling to have, when your doctor’s on the phone.

He said he’d called radiology and ordered a CT. In parting I asked, “In the meantime, is there anything I can do?” And Dr. Sands replied: “…Just go home and have a glass of wine with your wife.”

And that is a sobering thing to hear from your physician.
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A couple of things about my interaction with Dr. Sands.

• The personal relationship between physician and patient is pivotal – knowing each other as individuals. He’s since said he wouldn’t give every patient news like this by phone, but he knew me well enough to handle it appropriately.
• Note also the subtlety of his advice to have a glass of wine with my wife. He’d never said anything like that to me, so it conveyed, artfully, that this was different. It prepared me for what we’d soon find out, causing what I’d now call appropriate concern without unnecessary alarm.

Please note the importance of the relationship in this crisis. This is impossible if all a patient ever sees is docs in the emergency department.
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p.s. Our relationship has always included humor. By July 23 of that year my treatment had completed, and the next CT confirmed that my lesions continued to shrink. So I posted this to Dr. Sands on the PatientSite portal:

—–Original Message—–
Message Date: 8/27/2007 9:46:30 PM
Subject: Now, about this shoulder….

I’d like to write to Dr. Zilberfarb and see if we can pick up where we left off <8 months ago. (What a wild ride THAT was – jeepers.)

Indeed: what a five years this has been. Here’s to great medicine, here’s to great doctors and nurses, and here’s to participatory medicine.