Posted by: medicblog999 | June 4, 2009

Keeping a secret

breast%20cancer%20cell

Its been a bit of a tough time since I got back from my hols,but at least im home again now and I think its overdue that things get back to normality again.

Being a typical man, Im feeling a bit sorry for myself, so I thought I would share this story with you which sort of puts my own problems well into perspective. The saying is always true..

“There is always someone worse off than you”

I was working on the rapid response car a couple of years back when I was called to a 76 year old lady who was suffering from chest pain. It obviously came though as a Category A call due to it being chest pain, so off I went on lights and sirens to the address which was about 5 minutes away. As it was an A, I knew there would be a crew automatically backing me up from somewhere, so as I arrived I did a very quick assessment of things to see if I needed the crew or if I would be able to deal with it myself.

Sure enough, after a quick once over, the ladies pain (lets call her Joyce) seemed to be respiratory in nature, sharp, stabbing, situated along her left lateral diaphragm area, and much worse on coughing and inspiration. her son, who was on scene, informed me that she had been seen by two GPs over the last two days, the first one stating that it was a muscular pain, the second that it was a chest infection, who had started her on antibiotics.

Joyce was a good colour, had oxygen saturations of 96% on air, no cardiac signs or symptoms and was in good spirits. She stated her pain wasnt too bad and that she had been coping with it for the last 3 weeks before she contacted anyone. I decided that I could deal with this one and contacted control to stand the back up crew down, so that they could be available for another emergency.

Since Joyce had already been seen by two GPs in the last two days,I felt that I wouldn’t be doing her a great service just by referring her back to the GP again. Its obvious that something is bothering her sufficiently to call 999, and in all likeliness, a further GP would just send her to the hospital anyway. I told her that I would run her up to the hospital myself, in the car, to get her checked out further.

I went out to the car to return my bag, oxygen and monitor, so that I could help her out to the car. As I walked back in I overheard her son saying

“youve got to show he mum, he needs to see it”

“Whats that then?” I said as I walked in.

Joyce looked down at her feet whilst holding her hand against her left breast, she slowly took her hand away and pulled up her top to show me a large fungating breast tumour occupying the majority of her left chest wall. I was dumbstruck to say the least, but it very quickly changed the whole outlook on the job.

For those who dont know what a fungating mass looks like, just click here for a selection of images, but be warned that they are graphic in nature and may not be for everyone.

M999 “Joyce, how long has that been like that?”

Joyce “About 2 years”

2 YEARS!!!!!!!

M999 ” Have you not shown anybody in that time, or had any tests or investigations?”

Joyce ” No, I didnt want anybody to know about it”

M999 ” Do you understand what it actually is?”

Joyce ” Yes, I know its cancer”

M999 ” What about the 2 last GPs you saw, did they not see it when they examined your chest?”

Joyce: “No, they didn’t ask to look, so I didnt show them”

Amazing!

There are a number of things that shock me about this one. It is very rare to see advanced fungating tumours like this these days as people generally seek help at an early stage and have surgery before getting to this point. I have only seen this once before, when I was a cancer nurse in 1996.

Fungating masses can usually have a very unpleasant smell as they are essentially composed of decaying tissue and infection. Joyce had obviously been caring for her mass very well as it was clean, odourless and had no signs of infection. The reasons for her not telling anyone are only known to her. Maybe she was afraid of the diagnosis, maybe she didn’t want any treatment anyway or maybe she just never “got round to doing something about it”.

Whatever the reason, it is obvious that there isnt a great deal anyone can do for her now, other than try to keep her comfortable. At least her family are now aware of things and they can come together to support her through the difficult times ahead.

I contacted control to request a crew again for transfer, this was no longer a simple chest infection and now that Joyce was being honest with me, she tole me that she had pain in her back and hips also. She scored her pain at 6 out of 10, so I inserted a cannula and titrated some morphine to effect so that she was more comfortable. It is highly likely that her pain is due to metastatic spread of her cancer to her bones, the least we can do as a service is try to make her short trip to hospital as comfortable as possible

I saw her in A&E a couple of hours later as I was dropping off another patient, she had been seen by the medics and was about to be transferred down to the wards to start her battery of tests.

Its going to be a tough time for her and her family.

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Responses

  1. Old ladies are tough as nails. Most of them would put a big strapping man to shame.
    Had an old lady several years ago involved in a MVA
    who had an open laceration from her eyebrow to her hairline….open,gaping, skull visible !!!!
    She didn’t want to be any trouble and could she go home and bandage it up. Finally had to get a cop to “tell” her she had to go to the hospital.
    I’d have been crying like a wee girl !


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