In the fields of observation chance favors only the prepared mind.
-Louis Pasteur
“Do you drink much alcohol, wine, or beer?” He was a patient with a newly diagnosed mouth cancer. I was working through my checklist while we became acquainted.
“I have a beer most nights before dinner. Maybe I’ll have a couple more on weekends.”
The questions continued. The patient’s teenage granddaughter was clearly taken by my young, handsome resident. “How long does it take to be a doctor?” she asked him. He went through the litany of four years each of college and medical school, followed by five years of otolaryngology residency. She counted the years up in her head. “You’ll be 30-years-old when you finish! Why does it take so long?” she exclaimed.
He smiled and shook his head. “It takes a long time to learn everything you need to know to be a safe surgeon.” he replied. “Dr. Campbell even added two more years onto his training after residency.”
She looked at me in disbelief. “Slow learner,” I explained.
The focus returned to her grandfather and we completed the other questions about his health. The examination and scans confirmed what we already knew. His cancer was treatable but he would need an operation. He appeared to be in good shape and, before he left the office, we arranged a surgical date.
A few days later, he was asleep on the operating table. I made the incision. As the resident and I lifted the skin off the underlying neck fat and lymph nodes, a familiar feeling washed over me. “Look at these tissues,” I said. “What do you notice?”
The resident examined the fat intently.
“Why, the tissues are too flimsy, too soft, too yellow, don’t you agree? They don’t handle the way you would expect. Why is that?”
“I have seen tissues look like this in alcoholic patients. He didn’t tell us about any problems, but we will have to watch him carefully after surgery.”
I have never found a textbook that describes the subtle phenomenon we identified that day during surgery — the boggy, yellow fat that some alcoholics hide in their neck tissues — but this rare, subjective finding is something that I have noticed several times during my career. I spend time pointing out and discussing the condition whenever I see it. On top of everything else that our residents are expected to learn, we spend a lot of time sharing the non-textbook lessons. It is a long process.
Indeed, two days later, we were ready when our patient started spiraling into the alcohol withdrawal his tissues had predicted. Later that week, his family discovered a stash of liquor bottles in the basement.
Happily, my patient made a full recovery. In the process, though, he had helped prepare one more resident for the next patient who thought he had something to hide.
The following is feedback received for this blog:
Dr Campbell,
You recently were involved with treatment for my brother who has tongue cancer. Now that I have seen your comments in this blog I feel he more than likely received some good, direct and caring advice from you. Myself and other of his siblings have been with him 24 hr's/day for the last 9 days. And he has finally agreed to Hospice care. But we allowed him to make all his own decisions, as hard as it was for himself and for us. After 46 young years, his death is coming soon. He too was an alcoholic and a smoker.. Some people refer to the previous bad habits he had as the reasons for this cancer. I prefer to look at what is occurring today and forgive and forget his past. Even a person who did not lead a good life in lifestyle and/or relationships does not deserve to suffer in the manner in which cancer imposes. I look forward to his death for peace for himself but will relish many memories. Previous family deaths have taught me that the intense pain does diminish but it never diminishes the love for your loved one. As time progresses, memories will come in stages as painful, then bittersweet, then as soothing and delightful. Thank you for all the caring and humanity given by yourself by all the staff at Froedtert.
- Lori C.
Dear Ms. C.,
Thank you for your comments. It has been an honor to be involved in your brother's medical care.
One of your statements struck me. I agree that people tend to "blame" patients for the things that happen. We know that people who smoke and drink are more likely to get these cancers, and that knowledge can be very difficult for both the patients and their family members.
Still, developing cancer was not his fault. In light of that, your understanding words are so important. I truly hope that your spirit that focuses forgiveness and love on him can bring healing both to your brother and to your entire family.
Thanks again for writing.
Sincerely,
Bruce H. Campbell, MD
