Started out in triage that day.
First patient, 20-something female with complaint of "generalized abdominal pain"
Joke to the nurse, "well, this could be just about anything. Let's bring her in and get clocked in for the day"
Patient strides in. Overall she looks well-enough. She's young. Healthy. Physically fit. She smiles at us.
She was two weeks postpartum and was convinced the pain and vomiting were just part of recovering from pregnancy. It had been a remarkable year. She had gotten married, moved here for work, and delivered her first child—a son.
Vitals are stable. Exam is reassuring. No focal tenderness, distension, or rigidity. Nothing appears apparently off.
Then I noticed her eyes
They’re big and impossibly bright.
The kind of eyes that smile at you before the rest of her face did. They were really quite striking.
But then... something isn't quite right about them... are they… just the faintest wash of yellow? Only slightly, one could've believed you were imagining it.
We start the workup. Labs look mostly good but sure enough the bili and LFTs are a little bumped. So we order the CT scan.
As the images become available I scroll through it.
Base of the lungs...hm well, that’s odd...
keep scrolling...
"oh no"
The words leave my mouth involuntarily. My stomach drops
I'm no radiologist. I didn’t need to be.
Read comes back, sure enough metastatic … liver, lungs, lymph nodes... and finding of singular focus, there's a mass in the gallbladder
Those big beautiful eyes stare right through me as I begin to talk. There's disbelief. Surely we're wrong. She's just sick from the pregnancy recovery, right? Her gaze slowly becomes hollow.
As we talk it sets in. We're progressing through stages of grief minute by minute.
There are conversations in medicine that no amount of training ever truly prepares you for. My responsibility was to tell her the truth. My hope was that I could do it without taking away every ounce of hope she still had.
I used every shred of tenderness, kindness, and strength I could muster while trying not to betray my duty to be honest with her. I talk to GI and our oncology diagnostic team to arrange the follow up and go over every detail
---
A few weeks go by and a young patient checks in for fever. Sure enough its her.
She comes in a wheel chair this time. Her obvious physical fitness has become more liken to a skeleton. This time, she does not appear "well-enough". Her eyes are a bit sunken in but still striking even now as she stares, trying to smile through them. HR 135, fever 102. Septic workup starts, she gets admitted.
I add her chart to my list of patients. I look back and she's had a bunch of office visits. She was diagnosed with metastatic cholangiocarcinoma. She's undergoing treatment.
I follow her chart, she ultimately gets discharged in about 8 days.
---
A few months later I'm getting ready to go to the hospital with my wife. We're expecting our son and it's time to go in for induction.
I'm not sure what inspired me while I'm sitting on the spouse's bench/bed in the delivery suite, but it jogs my memory.
So I check back on that patient’s chart. There were a stream of follow ups and treatments after her discharge. There were also a few additional ER visits and some admits.
Then... the office visits, treatments, ER visits and all other notes just... stop.
I'm holding my son now. He's just barely older than her's was when I met her. Sometimes it's hard to fathom how easy it is to take health for granted... and how cruelly that can change.
I’ve forgotten innumerable patients, labs, and CT scans. But I have never forgotten those eyes.