Like a Freight Train

Sometimes, you can see cancer coming.  What I mean is that when we sign up for that mammogram, or that PSA blood test, there has to be some tiny little part of us that says, “Ok, this time it’s my turn.  This time I’m the one who’s going to get the call.”  Sometimes the cancer sneaks up on us—that nagging little cough that makes us want to—suddenly and belatedly—quit smoking.  Or that little bit of blood in the stool that we’d rather think is a hemorrhoid, or that lump in the neck that doesn’t go away even when our doctor treats us for the strep throat that we know we don’t have.  But sometimes, as it happened to my patients yesterday, that cancer hits us like a freight train.  Just flattens us and leaves us in fragments, speechless in surprise and terror.  And when that train hits, we know in an instant that life will never be the same again.

I had two of the freight train kind of patients yesterday.  The first was a man in his 70’s, previously healthy, an avid stamp collector.  One day in August, he suddenly had difficulty finding his words.  A CT scan done without contrast dye showed no stroke or bleed in his brain, and he was sent home from the emergency room.  His wife persisted with the primary care doctor—“My husband is just not right!” she said, and last month an MRI was ordered which revealed a  large ugly looking brain tumor, and the patient was taken to surgery.  The pathology returned as glioblastoma multiforme, the most aggressive type of brain cancer.  He was seen in outpatient oncology clinic by a young neuro-oncologist, just out of his training. By the time the patient came to me, every shred of hope was gone.  The man, still having difficulty with his speech, told me that the doctor said that at most, he would live a year, if he chose treatment, a few months if he did not.  He said that the doctor told him that the tumor would spread like a spider web over his brain, and that he would lose all function.  The patient cried when he told me this.

The second patient was a very fit man in his early sixties, a retired school teacher who had surfed and been a life guard all his life.  In July, he had a surfing accident (his wife said, “Can you believe it?  He surfed some of the greatest waves in the world and he wiped out in two feet of water here at home.”)  He broke his collarbone in three places, which required surgery to repair.  His pain got worse however, and he started to have back pain.  Spine films showed a compression fracture, also thought to be related to the accident.  As this tan, fit, athletic man began to seek more and more narcotics for his pain, an MRI of the spine was obtained, which showed the bones to be brittle and riddled with tumors.  Yesterday the biopsy of his sacroiliac area came back positive for multiple myeloma, a disease of plasma cells in the bone marrow which destroys the bones that cultivate it.  In an instant, this nice couple’s dreams of a happy retirement were shattered.

When we first moved to the West Coast, I was offered two very different jobs.  In one practice, I was to be the person that rotated through six different outpatient facilities, covering the regular doctor’s vacations.  I would see the patients for consultation, and perhaps treatment planning, but would never see them through their treatment or in follow up.  The other job was a hospital based practice where I would be the director of the department and have longitudinal care of the patients.  I chose the second, of course, because being the linear task oriented person that I am, I could not conceive of not seeing each patient through from start to finish to follow up.

I see things differently now, twenty years later.  I have a calling in life.  I want to be there when that freight train hits.  I know I can put the pieces back together, and I know that when that shattered patient leaves my office, for the first time in hours, or days, he will be able to notice the sun shining in our Southern California sky, and taste a faint flavor of salt on the warm breeze flowing from the Pacific. In turn, I will have the deep satisfaction of knowing that I did something good that particular day.  And that, actually, is quite enough.


  1. I had a very good friend who, at age 38 died from Multiple Myeloma, leaving behind a 6 and 8 year old. Her 756 day struggle was heartbreaking and her kids will never be the same. Thank goodness for Doctors like you who have no trouble standing on the railway tracks.

  2. Yes, it is a powerful boost when we can use all of our skills to give a client a sense that, tho things are not what we want them to be, this is not the time to give up or call it quits. Let’s make the most of what is around us.

  3. You do have a gift. The gift of being a good person and dedicated to your cause. If I were inclined to medicine, I might have taken that other job. I really don’t know how you do it! I am thankful for all my doctors and sorry for the bad rap they often get. Certainly thankful for friends.

  4. Diagnosis of Glioblastoma certainly hit us like a freight train . . . . about a month ago my husband, age 74, said to me “I’ve been having a little problem with short term memory recently” and my reply was “well, you’re finally catching up with how I’ve always been!” I have always had to keep notes and lists for everything and for the 51 years we’ve been married he has had a mind like a steel trap. A week or so later he woke me up one morning absolutely in a frenzy – he said “I think I’ve had a stroke or something . . . I can’t remember my password to get on the computer!” He’s used the same password for several years so this was very strange, and I didn’t know his password because I use a different computer. More surprising was that he knew that his password was a name and that it had 5 letters – that it was “letter, letter, two letters just alike, and one more letter. My first name is Patti so I suggested maybe that was it. We tried that and it was not correct but a hint question came up (“wife’s maiden name?”). My maiden name is made up of five letters in the same sequence. But then he looked at me in disbelief and said he couldn’t remember what my maiden name is. We went to the emergency room. They did a scan and an MRI and found a tumor on his brain – inoperable. Over the next 10 days, waiting to have a surgical biopsy more symptoms arrived: He couldn’t remember what vehicle he drives – he said, ” it’s long, it has 2 doors in front, side doors, and double back doors” and he was correct, but he had no idea the model, make, or color. He began to lose peripheral vision in his right eye, he had headaches, he could not find words he was searching for while speaking, he became off balance while walking, At one point he couldn’t remember our little dog’s name. One day he thought he was 84 instead of 74. He put a muffin in the toaster and turned on the microwave. The biopsy report came back – Glioblastoma. They can’t remove it, but he is to begin radiation treatments and pill chemotherapy five days from now (the day after Christmas), but his prognosis is not very promising. One day it’s like maybe he’ll be helped and the next day it’s like nothing is going to help him. OMG this is one of those times in life you say to yourself “what on earth did I spend my time thinking about before this happened?” It is all consuming, and devastating. I suppose we will adjust and accept, but right now this is like a terrible bad dream for both of us. Sorry to go on and on . . . just needed to share these feelings. Others out there in the same situation? I’m so sorry . . . and I know exactly how you feel.

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