dark spots in a ct, a liver filled with tumor “Tired” said the chief complaint, and little else.

“Mom’s real tired, she don’t want to eat, and she’s lost some weight”.

how much weight?

“About 45 pounds”.

since when?

“Over about the last 4 months, and she’s always been skinny. She says sometimes she don’t want to eat ’cause her stomach hurts.”

I know it’s cancer, I assume they don’t know, and I wonder how they’ll take it. The patient is beyond caring, a thin late-middle aged woman who’s only here because she was too weak to enforce her stubborn will on her daughters.

I order the tests. Chest Xray is unremarkable, labs show some anemia. The abdominal CT looks like a grave to me: a liver riddled with dark spots that can only mean one thing.

We need to talk about your mom’s tests. There’s no good way to say this: your mom has cancer, it’s pretty advanced, and I don’t think she has much time left.

“We figured that was it, but she wouldn’t come in to see no doctor”.

They knew, but had to know, and I understand that desire to have an answer, to be able to predict the future because the now is explained.

I think about this sometimes. Many people bring me their problems: some I can help, many I cannot, and occasionally I give terrible news. Life and medicine can be very painful, on both sides of the gown.

Also posted on LingualNerve


  1. Sigh. That’s sad. We’ve all seen those and they’re lousy. The problem is, these patients are afraid to go to the doctor because they’re afraid of getting bad news and it gets to be a self-fulfilling prophecy. If you don’t go to the doc for 10 or 15 years something is bound to go wrong with you.

  2. I lost both my brother and mother to cancers. While both received what treatment they could and both lasted far longer than original predictions, in the end there was nothing more to be done.

    I am amazed and thankful for the Doctors and Nurses who deal with this terrible part of life. I wonder at the strength of these people who daily deal with the some of the most hopeless of medical cases, yet continue to do their best for the patients and their families.

    So, just in case you haven?t heard it recently, or enough, Thank you.

  3. No, Michael, from all of us, thank you.