Wednesday, November 24, 2010

Part 20: The Substitute

The woman felt out of place amidst the sea of predominantly white hair. Not quite pregnant, not quite suffering from cancer—it was a queer state. It had been two weeks since her last visit. She had just come from her bi-weekly blood draw and now sat in oncology waiting to be the lucky one called over the intercom. Across from her sat an aged couple. They were both asleep.

Not very promising, she thought, hoping she'd have enough patience to make it through the wait.

A glance through a magazine and many daydreams later, she finally heard her name. The clinical assistant brought her back to a room where she took the woman's vitals and then promptly left, leaving her with the promise, "The doctor will be in shortly."

Either the assistant had made a good faith estimate on the time frame or she had lied through her teeth. The woman decided to take the silent advice from the elderly couple in the waiting room and pass the time by napping. She positioned herself in such a way as to be decently reclined, her feet hanging just off the edge of the bench cushion, but not so much that she wouldn't be able to quickly resume a somewhat normal seated position, were she caught off guard.

At last, the woman heard a knock. In walked a pot-bellied man in his sixties, the substitute doctor while her gynecologic oncologist was out of town. Generally pleasant, he seemed a tolerable replacement. It was obvious he didn't know much about her case. For the first five minutes he barely said a word to her and skimmed her patient notes. Great. I have some guy treating me that has no idea who I am or what's going on, she thought. He then proceeded to review her lab results. Blood counts and liver function looked good, but the HCG value, the one she cared the most about, had yet to post.

"Normally, if the initial run falls above the upper limit of detection, they will need to dilute the sample and re-run it," he said. "I'll just get started ordering up your next chemo dose while we wait."

"But don't you need to know what the actual value is before you go ahead and prescribe another round?" she asked. "What if the value is already at zero?"

"The likelihood of that is pretty slim. And even if it were at zero, we would still prescribe another round."

The answer slightly annoyed the woman. Then why am I even here in the first place? A call asking if I was okay would have sufficed, she grumbled to herself, the dollar signs multiplying in her head.

She glanced over toward the computer screen and noticed an error message pop-up. He had been sitting at the computer for at least ten minutes and was making comments to himself. Apparently the ordering system was not the most user-friendly. The longer it took him to place the chemo order, the more confidence she lost in his competence. Considering the personal impact this drug would have on her body, she was markedly concerned. Her mind raced to the close call at the hospital a few weeks back. She tried not to worry.

The doctor finally figured it out and had the woman get up on the exam table where he listened to her heart and pushed on her belly. She began to ask him all the questions that had been collecting in her mind over the last two weeks and she was disappointed by his answer. "You're getting out of my level of expertise," he said. "I'm not in gynecology, I'm in oncology."

Dejected, she decided to keep her mouth shut from there on out. Why do they have some guy who can't even answer my questions treating me? she wondered in frustration. He freed the woman to head to her next appointmenther first injection of chemo round two. "The girls will get you your schedule," he said and oddly ended with a question, "Do you have any kids?"

You've got to be kidding me. "Nope. This was my first," she said and walked away.

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