Small Change

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It’s tragic when a life-threatening disease strikes a patient, especially someone in the ‘prime’ of their life. For health care professionals it causes intense introspection. Could we have predicted the occurrence? Was there something we could do but wasn’t? Tragedy struck this week when we had to deliver the diagnosis of cancer of the lung to a young woman.

She’s a smoker, had been for many years. Yes, she should have quit a longtime ago. But she started smoking in high school when it was the ‘cool’ thing to do. Trouble is when the cool factor faded she found she enjoyed the relaxation brought on by inhaling nicotine. It became her solace; when times were stressful she relied upon this physical pleasure for comfort. Even when the media pressure about the harmful effects of cigarette smoke could be found everywhere she could not, did not want to stop. She was young and time was on her side. Or so she thought.

We often talked that it was time for her to quit. She was always polite, listened intently and admitted she had tried to stop several times. She would quit for a few days, week at the most, then life and it’s stressors would intervene and she reached for her cylindrical comfort. She once commented that the first puff would bring tears to her eyes; tears of relief and frustration that she had succumbed to temptation once again.

She looked to us to keep her well. She wanted a chest x-ray; at first yearly, then at almost every four-month visit. We stressed that many, well-designed clinical studies looked at the effectiveness of yearly, or twice-yearly chest x-rays in detecting early (potentially treatable) lung cancer. No benefit was found to catch these cancers early. Even when researchers combined yearly chest x-rays with analysis of sputum for cancer cells they found no benefit (early diagnosis). It didn’t meet the ideal goal of saving lives. As the years progressed, she googled often and became knowledgable about medical advances. Her requests became more focused and intense—how about a yearly CT (computed tomography) scan of the lung? After all, this procedure captures images of the lung in excruciating detail, surely it could pick up early cancer.

Indeed, in early and ongoing clinical trials a CT scan did pick up early lesions. Unfortunately, not all of these lesions were cancer, but our enthusiasm to find and eradicate these ‘spots’ resulted in many unnecessary surgeries. We learned the risks of radiation exposure associated with frequent CT scanning. Again, we found that on balance (as of this writing) this highly sensitive test did not save lives. Even when we found lesions it was often to late to cut the risk of dying of lung cancer.

She would always take all this in and smilingly shake her head, acknowledging that her smoking habit was dangerous. We admitted medicine didn’t have the answers she sought. We asked, pleaded really, why not stop now and not take the risk? I thought of those many conversations when I entered her hospital room. All I could do now was hold her hand and listen to her tearful protestations that this shouldn’t have happened, that she had too much to live for. I looked up to see the tubes of medicines flowing into her veins and my eyes caught a glimpse of her open purse at the bedside. Nestled among the papers and pocketbook, a pack of cigarettes lay neatly ensconced in its cellophane wrapper.

I could only agree with her that this shouldn’t have happened and gripped her hand tightly. Kierkegaard once wrote that life may be learned backward, but can only be lived forward. It is my hope that someday we’ll learn while were young, alive with good health and change, when change can really count.

Related Articles

• Lung cancer – small cell – All Information (umm.edu)
• Causes, Symptoms, Diagnosis and Treatment of Non Small Cell Lung Cancer (brighthub.com)
• Facts About Lung Cancer (brighthub.com)
• Just a Cough, or Lung Cancer? (consults.blogs.nytimes.com)