I’m Feeling 32

My alarm went off at 4:30 am. My dogs were already at the door awaiting their morning walk. I grabbed their leases, and we headed out. Feeling older than my 31 years, I noted tightness in my low back and a dull ache in my right hip as I walked down the stairs.

A few hours later, I was at the hospital. My first patient was a 32-year-old man with no prior medical history who had ongoing back pain after sustaining an injury at work. Despite several weeks, a previous ER visit, and taking ibuprofen around the clock, the pain had only worsened. He was pale, his heart raced, and he was tender over the length of his spine. The ED physician ordered labs and a CT scan. The results were devastating. His blood counts were extremely low, and he had pathologically enlarged lymph nodes.

I explained these test results and their meaning: he almost certainly had cancer. We talked about the possible diagnoses, and I answered his questions about staging and prognosis.

“So I’m hoping for lymphoma?” he asked me with a slight smile but sad eyes.

I arranged for a lymph node biopsy the following day. The pathology results returned not with lymphoma but with adenocarcinoma, which had a much worse prognosis. I met with him again to explain that he had stage 4 cancer and was incurable. He was shocked but remained stoic as he asked what would happen next. He was interested in trying any possible treatments.

I rotated off service before he began his first cycle of chemotherapy. I woke up on my day off and, as always, headed to the front door to take my dogs out. As I bent down to pick up the leashes, that stiffness in my low back remained. I thought of my patient. My 32nd birthday was two days away.