From the start, I had a feeling this one would be different.
“What brought you into the emergency room this
evening, ma’am?” I asked Mrs. Jones (I’ve
changed her name), a woman in her early 50s who had
been rolled back in a wheelchair to ER bed 15. She apparently
was too weak to walk.
|By Dan Munoz,
School of Medicine, '04
With a pleasant smile but a tired voice, she responded,
“My potassium is low and I have pneumonia.”
Unclear as to how exactly she could have self-diagnosed
with such oddly specific precision, I asked her a few
more questions. Her son helped fill in the details.
Soon, a more complicated picture began to emerge. Relatively
healthy until four or five months prior, Mrs. Jones
began feeling inexplicably fatigued. Each day she felt
progressively weaker, less able to do the things she
liked. Stairs became more difficult to climb and falls
became more frequent. Her weight went into a downward
spiral. Something was not right. After several doctor
visits, and a battery of tests and procedures, a frightening
answer surfaced. She had cancer. And it had already
spread to her liver.
Then, earlier today, Mrs. Jones had gotten a call
at home from her doctor. A CT scan from the day before,
done as part of the routine staging process for her
cancer, showed possible pneumonia. In addition, blood
work from earlier in the week had reportedly shown her
potassium levels to be low. Her low potassium, likely
a result of her particular type of cancer, was not new.
And according to Mrs. Jones, it was the clear reason
for her fatigue.
Rather than go to their local emergency room, the
Joneses had decided to travel across the state to Hopkins.
With an appointment to see a Hopkins oncologist in a
few days, they did not want to risk missing it. Her
son handed me a copy of his mother’s CT scan from
the day before. I told them we would run a few tests.
Forty-five minutes later, my resident and I had some
encouraging results. “Your potassium is fine and
your CT scan doesn’t show any obvious evidence
of pneumonia,” we reported, after reviewing the
films with the radiologist on call and performing some
initial blood tests.
“So I can go home?” Mrs. Jones exclaimed.
It sounded more like a victory declaration than a question
Before we could respond, her son interjected, “Do
you mind if we talk outside?” His eyes telegraphed
that this discussion was not yet complete. He walked
out into the hallway with us and in a soft but firm
tone began to share his worries. “She’s
in denial,” he explained. “She latches onto
other issues and focuses exclusively on them. She focuses
on her potassium and attributes her fatigue simply to
that. Anything but her cancer. She doesn’t get
how sick she is. She doesn’t get how difficult
it has gotten to take care of her.”
He paused. “We’re overwhelmed. My father
is not capable of taking care of her. He’s dealing
with his own medical problems. And he has to work. Without
his health insurance, we’d have no way to get
her the care she is going to need. And I can’t
be there all the time either. If I hadn’t stopped
by the house this morning and found her in the bathtub,
unable to get up, she would have spent the whole day
There, on vivid display before us, was the stunning
maturity of a 28-year-old. In the absence of anyone
else—a spouse, a parent, someone older in the
family capable of taking on a leadership role—he
took on his parents’ denial to face the undeniable
facts. After he’d spent almost three decades looking
to his mother and father for guidance and advice, for
protection and for shelter, his role reversal was powerfully
evident. He was now involved in dealing with an enormously
difficult decision, a more torturous choice than most
people his age commonly face.
We stepped back into the room. With a loving calmness
and candor, in front of two virtual strangers, he presented
the reality to his mother. He explained how difficult
it had become to care for her, and how increasingly
ill-equipped he and his father were to accomplish that
task. He told her that he loved her and would respect
her wishes, namely to go home. But he shared with her
his pain of seeing her like this and his admission that
he felt overwhelmed by the home care she required. He
paused, and then with a hint of unsteadiness whispered,
“Mom, I think you should stay here.”
It was one of the gutsiest displays I had ever seen.
Rising above his sadness and the generational impulse
to defer to his parents, Mrs. Jones’ son looked
his mother in the eye and told her the hard yet inescapable
truth. He was respectful but direct. And despite our
presence, he did it on his own. I could not avoid wondering
whether I would have the same courage were it my mother.
In that moment, Mrs. Jones’ son became a parent
sooner than he had ever planned, and in a setting devoid
of joy or promise for the days ahead. And that, along
with the sadness I felt for a family facing a devastating
diagnosis, was both inspiring and humbling.