Monday, April 11, 2016

When You're a Medical Student and Your Husband Has Cancer

DH drinks "berry-flavored" oral contrast
for a CT scan the first day in the hospital.
I asked him to let me taste it, so I know
what to tell my future patients. It's less
"berry" than "fake-grape" flavored.
Editor's Note: For those of you whose spam boxes ate the email I sent--we are keeping the news off Facebook--Dear Husband has been diagnosed with a large mediastinal seminoma and was admitted to the hospital last week for a work-up and to start treatment. Cross-posted on Caring Bridge. 

Now that the chemotherapy is catching up with him, Dear Husband has been either nauseous or fatigued. Our oncologist has been very understanding about keeping him in the hospital, where he can get IV fluids and anti-nausea medication even while he sleeps. Until he feels well enough to write again, I thought I would tell you a little bit about what it is like to be a medical student whose significant other is being worked up and treated for cancer.

The first thing to note is that cancer was not on the long list of differential diagnoses I had developed for DH's progressive and months-long chronic cough. We had discussed whether he should see a doctor for weeks before he finally got fed up enough to go. Could be post-viral cough, I thought--we have symptomatic treatment for that. If it were bronchitis, then he needed antibiotics. He couldn't remember whether he'd even gotten a booster shot, so it could be pertussis, though I doubted that was treatable this late in the game. Could be allergies, I supposed--we had a freaky early spring here, and over-the-counter allergy medication seemed to help a little. Or, since he was coughing at night, his childhood asthma could be making a reappearance, although I didn't detect any wheezing with my stethoscope. A mediastinal mass compressing his trachea was not anywhere on my radar, so I was surprised when he sat me down after dinner one night to announce that he had gone to convenient care, had an abnormal chest xray, and the doctor thought it might be lymphoma.

Naturally the first thing I did was ask him more history questions (loss of weight or appetite, fatigue, night sweats?). Then I walked him through the print-out of laboratory values he had been given, explaining what each one measured and noting only a single, slightly elevated result, which might or might not mean anything. Lymphoma didn't seem to fit his clinical picture. So the second thing I did was consult the interwebs. Yes, medical students and doctors research things on the internet! I skipped Wikipedia and went straight for my favorite online medical encyclopedia, Medscape, where I researched the causes of antero(superior) mediastinal masses. A mnemonic holds that there are 5 Ts: thoracic aortic aneurysm, cancer of the thymus, cancer of the thyroid, teratoma, and "terrible" lymphoma. Given his symptoms (mostly just cough and inability to run anymore) and the CT scan results the next week, I decided it sounded like a thymoma and started reaching out to medical colleagues for recommendations for a chest surgeon.

Meanwhile DH was scheduled for a CT-guided biopsy at one of the hospitals at which I have rotated. We arrived early on the morning of the procedure, and since there was no volunteer at the info desk, we proceeded upstairs to the OR, where we were told we needed to register downstairs. What? I had no idea what office the woman was talking about. Medical students never see patients that early in the process. So we went back downstairs and figured out how to register for a same-day procedure with interventional radiology. They don't teach us these things in medical school.

After the biopsy came the waiting. And the speculating. And the wondering how much this was going to throw off my clinical schedule. Thankfully my attending physicians have been eminently understanding, encouraging me to focus on DH first and school second. Because I have already Matched, and class ranks and honors have already been decided, the rest is just formality. There is nothing to keep me from graduating, although we are anxious that DH feel and be well enough to attend the ceremony. As Doctor of Musical Arts and Loyal Spouse, he has the long-awaited honor of bestowing upon me my green velvet hood as Doctor of Medicine.

Once the diagnosis came, the research and anticipation changed, of course, to chemotherapy, which is better and worse than surgery to open his chest and scoop out the tumor from among so many important structures: heart, lungs, the nerves that let him breathe. Chemotherapy means months of nursing and running him back and forth across town for appointments. Thank goodness we have so many willing friends in town! I also realized is that T for "teratoma" is really shorthand for "germ-cell tumor," which includes seminomas (what DH has) and non-seminomas (which have a worse prognosis).

Being a medical student means that the doctors and nurses have talked to me with a little more medical jargon. They have let me manipulate the scans on the computer. One even let me scrub up to access the port in his chest for the first time. Dear Husband delights in the ways in which he has contributed to my medical education over the years. When I was learning how to do a physical exam as a second-year student, and my student-partner came down with mononucleosis, he graciously let me listen to his lungs, tap his reflexes, and feel the pulses in his feet, over and over again, until the routine seemed a little less foreign to me. He joked that he must have been the healthiest guy, since he'd just had ten physicals. Now I've done my first port access, and it wasn't terrible for either of us.

Although I understand the vocabulary and am familiar with many of the drugs DH is getting, I do not have any experience with oncology treatment, so this is a learning experience for both of us. Particularly with this first round of chemotherapy, we wonder what each day will be like. Today's nurse assures us that succeeding rounds will be less physically demanding, as his body accommodates to the rigors of the chemotherapy. So that's all we know for now. We will keep you updated.

Here is a follow-up post about being a resident in a new city with a husband with a cancer diagnosis.

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