I felt cancer for the first time

I enter the examining room and see 2 women sitting waiting (elderly and mid-late 30's). Assumption is the daughter brought her mom in for the appointment. I do a quick glance at the charts, listen in to the doctor chat and quickly realize the silver-haired elderly woman brought her daughter for her regular weekly checkup for palliative care. Mom is carrying a clipboard that carefully documents the medication schedule and her daughter's daily treatment routine. Her frail daughter, first diagnosed at 29, has chondrosarcoma. The tumor is cartilage and has grown throughout her entire abdomen. Barely even able to walk comfortably, the daughter says to me with a genuine smile, "Yes, of course you can feel my stomach. It'll help with your learning."


I'd learned about it in my classes - the investigations, staging, treatment, services available etc. for cancer. It took nearly 2 year, however for me to actually feel it. I felt it in my hands as I palpated her stomach. I felt it in the room as we chatted.

The experience definitely left an impression on me. Sure, it tugged on my heart strings, but I'm not talking about the "must hide!!! man tears about to roll out" kind of impression. It hit me how easily a perfectly normal person can suddenly fall rock bottom because of something completely out of her control. This young woman was diagnosed at an age just a few years from where I'm bound, and the dead-end to her path is more or less already determined. Now I'm even more irritated by fat-asses that sit on their couch and don't exercise - at least diabetes and heart disease is preventable. But that's a rant for another time.

My patient also reminded me of how often I will be seeing this in the near future. This was my first "oh crap, this woman is going to die...soon" situation. It was no doubt a Mickey Mouse experience compared to what the few years will throw in my face, but you always remember your first time with everything, right?

"did you want to give this pap smear, RF?" "err. I've never seen a pap smear."

When a man looks back on his life, images of milestone moments will come up...

Surviving the beerbongs of college

First girlfriend

First paycheque

Losing his virginity

AND.....

and, of course, giving his first pap!


Setting the scene:
Early morning and doc asks me - "RF, you saw me give one last time. You ready?".

*Digging back to memory of the process...right - KY jelly the hell outta the speculum, swippity swab, in-out, dunzos*

"Yeah, I think I'm ready."

"Alright, I'm going to be 'down there' with you to keep the patient at ease."

*The 2 of us being "down there" while whispering things like "is that it?", "don't pinch the walls", "more light!" will keep her at ease?"

"Sure sounds good."

So I'm gearing up, wondering what my first pap patient will be like. Thoughts streaming back to another blog I'd read:

"...enter the room and note the inevitable inaudible groan from the hapless female. There are a number of variations on this groan, depending on the patient’s age:

The young teenager: "Aghh!! A boy!?!?!" followed by immediately looking at the ground. In the meantime, you thank God that she doesn’t need a Pap smear.

The old teenager: "Omigod. I, like, totally can’t believe that this, like, totally random dude is going to see my vajayjay! I’ve got to text [best friend]. Wait ... he’s kind of cute."

The 20- to 30-year-old woman: "AWKWARD."

The 30- to 45-year-old woman: "Ugh, a student ... and a male student! Just my luck, he probably hasn’t even found a vagina yet."

The > 45-year-old woman: "Hahaha, oh, a young buck!""

Now my doc usually sees older patients, so I figure I'd get someone roughly in the last aforementioned category. As awkward as the situation would be, at least she'd be happy to see me. After all, I had worn my special clinic pants that make my butt look nice.

Door opens - (cute) 25-ish y/o female. Talk about being thrown off! If YOU were in that situation (guess this only works for males), what would have been going through your head? Hopefully not what went through mine 'cause that's the stuff medical lawsuits are made of.

Anyway, I keep my cool. I get under the gown with my doc and go at it. I do my thang fairly smoothly (except for clipping the vag wall and getting smooshed in the face with a lamp smeared with KY). DONE!

I give my doc the high 5 glance and we exit the room.

"RF, that was great. But please - don't ever do that last part again."

"What last part?"

"The part where you asked 'So was it good for you?'!"

Scalpel!

There are few things in life that you remember for the rest of your life. You can't deny still remembering the first time you stole a kiss, drove a car, or was attacked in the back alleys of Guatemala (maybe that last one is just me). Or perhaps the time you made a life-altering decision to get to where you are today.

I added another item to my list today. Friday afternoon, they ushered us into the - wait for it - yup, you got it - cadaver lab. As my lab group of 8 surrounded the body bag, I was certain everyone, despite his/her best efforts to remain calm, had a heart racing 200km/hour.

As the body bag opened up, we saw the tiny embalmed body. I should say, actually, we smelled the body prior to actually seeing her. No, this wasn't a group activity. It's just nearly impossible to escape the rush of formaldehyde seeping out of the cadaver and into every nook and cranny of the students' clothing.

She was face down and most of the body was still wrapped up in yet another towel. Since we were only looking at the back, we just proceeded to unwrapping the back. I was taken aback that the skin was looking mighty preserved. I don't know why I was expecting flesh like a live person. Perhaps too much Hollywood morgue scenes. Anyway, imagine a class of 306 students and roughly 40 cadavers with skin that resembled much like the fetal pigs that you dissect in biology class.

Next step - incision. This actually turned out to the easiest part of the lab. Once the initial shock was over, removing the skin off was only 10% disgusting, 30% awkward, another 10% Texas-chainsaw-esque and the remaining 50% was awesomeness. We removed the fat and observed all the muscles of the back. Layer by layer, we checked out the structures that help us do everything from giving a high-5 to sitting up. Think about that the next time you're moving around.

It's pretty cool to have gone through all of that in the first week of medical school. It's pretty hard to not have a new appreciation for the human body. Yes, even with all the formaldehyde and sticky fat tissues.