10. An emergency diagnosis
T. came to the emergency room of our hospital because of a sudden onset of headaches, blurred vision, and uncontrolled twitching of one of his arms. A neurologist evaluated him, diagnosed him as having a seizure, and ordered an MRI of his brain. The MRI showed numerous tumors growing in his brain that were characteristic of cancer that had spread from another location in the body.
T. was admitted to the hospital for further evaluation. Because he was a smoker, a CT scan of his chest was performed, which revealed a tumor in one of his lungs. Biopsy of the tumor revealed lung cancer, and he was diagnosed with stage IV lung cancer because of distant metastases to the brain.
T. received antiseizure medicines, steroids (medicines related to cortisone) that reduce brain swelling caused by tumors, and brain radiation. After his condition improved, he was discharged from the hospital with plans to treat the rest of his cancer as an outpatient. T. story illustrates how cancer can sometimes strike suddenly and dramatically, causing a person to seek urgent medical attention.
Like heart attacks and stroke, cancer emergencies require immediate treatment. Because the possibility of cancer is usually not foremost in the mind of a patient who seeks emergency care, a cancer diagnosis under these circumstances often creates tremendous stress.
M. was a forty-nine-year-old man who had been in excellent physical condition until sudden severe shortness of breath and dizziness led him to be rushed by ambulance to our hospital. A chest X-ray and CT scan showed that a large mass in the middle of his chest (in a region called the mediastinum) was impeding the flow of blood to his lungs and brain. M. rapidly underwent biopsy of the mass, and it disclosed an aggressive lymphoma. His condition was worsening by the hour, and he needed treatment urgently. Yet he and his wife, A. , were very analytical, highly intelligent people who wanted to know all about lymphoma and the different treatment options before they would consider treatment. Their friends also told them to get a second opinion before commencing treatment.
They were not sure what to do. For M. welfare, I needed to put a halt to his and A. indecisiveness. I told them firmly that they needed to make a leap of faith and do something extremely important: trust me. Ordinarily, I explained, I would never dissuade a cancer patient from seeking a second opinion.
But in this situation, there was no time to get one at another center. It was not even safe to transfer M. to a larger hospital, for this would unacceptably delay his treatment. Our hospital had the expertise to make him better, I said, and they needed to let us try. A second opinion could certainly be obtained once M. was out of danger and discharged from the hospital in better condition.
This meeting was one of several between us in just two days, so M. and A. were ready to put their trust in me and commence treatment for his cancer. Fortunately, his lymphoma responded beautifully to chemotherapy and immune treatments, and within days of his first treatment he was feeling better. On discharge, he had a second opinion consultation that agreed with our strategy. It is now more than four years since his diagnosis, and he has been back to normal health for some time; M. lymphoma is, we hope, cured.
