I was in the office seeing patients the other day and as I looked at my patient list for the day I saw one of my patients was listed as having a brain tumor. As a private practicing neurosurgeon most of what I do in the operating room is treating patients with either disc problems or bone spurs in the cervical and lumbar spine. I enjoy helping these people, but the reason I became a neurosurgeon was to operate on the brain.
So when I saw the David Albright had a brain tumor, I was actually excited. What David reminded me of however, was that I must always temper my surgical judgment with what is truly best for the patient.
In my eagerness to see David, I only glanced at his chart and failed to review the attached documents from his doctor. So, as I asked how long David had the symptoms of headache and dizziness, he began by telling me since shortly after he the IV port placed for his chemotherapy. Immediately I realized his problem was far more serious than I had initially thought.
As it turned out David was diagnosed with a cancer of his kidney, several years before. After surgery and chemotherapy, it appeared his cancer was in remission. Within the last year, however he was found to have metastatic disease or spread of his cancer to his bones and his lung, and the oncologist told him it probably wouldn't be long before it went to his liver and brain. So he was placed on another regimen of chemotherapy in the hopes it would shrink the tumors that had already spread and prevent the possibility of further metastasis. That was when he developed the headaches and dizziness which was causing him to stumble a bit to his left when he walked.
So, David had a brain MRI which revealed an abnormality in his brain on the right side. Initially looking at the scan the radiologist believed this represented a relatively benign, abnormal collection of blood vessels, but looking at it myself, I was not so sure. Given David's history and the fact that there was some swelling in the brain I believed this represented a tumor, and not a benign one, but one that spread from his original cancer.
So I sat down with David and his wife Christine to discuss options about what to do. Surgery, I told them would be risky given the tumor's location, which was close to the area of the brain that controlled the left side of his body. Also, I told them with the presence of some abnormal blood vessels in the area, the risk of a brain hemorrhage would be fairly high. That is when David interrupted me. He told me, 'Doc, at this point I am more interested in the quality of life I have left, not to see how many operations I can survive'. I could hardly agree with him more. So, I stopped talking and merely sat there, looking at he and Christine and listened as they recounted the events of the last several months. After they were done he looked at me and said, 'Doc what would you do if I were your father?' Immediately, and without hesitation I said, 'I wouldn't operate on you, Dad'.
As they got up to leave, I apologized, saying I was sorry there wasn't anything I could do, but then I said, 'if it is OK with you, I would like to keep you in my prayers'. David immediately turned around, looked me in the eyes, as he grasped my hand and said, 'Absolutely, thank you'.
What a great story Hal. You gave David and Christine much more than your medical expertise. So many physicians, as you well know, are so evidenced based that they forget about the "person" they are caring for. I can tell you made this couple feel at peace with their decision. You don't learn the art of listening in books, or medical school, but with years of experience helping patients through the good, the bad, and the ugly; feeling their pain and feeling their joy. Good Job! Terri
Posted by: Terri | 02/04/2010 at 07:31 PM