Blast from the past

Another blast from the past. This was 11 years ago.

The irony of life...

There are some patients that it is impossible to every forget. I had such a patient die today-- a vibrant, spunky, life-loving 13 y/o female victimized, ravished and finally murdered by Hodgkin's lymphoma.

I diagnosed her approximately 6 weeks ago--completely incidentally. She came in for an unrelated complaint and I obtained a routine, baseline chest x-ray prior to discharge. It was at the request of an outside consultant, who she was to see as an outpatient.

She had only been in the hospital overnight, admitted for a rheumatoid arthritis flare-up. She had all the classic symptoms and all the classic labs. Already, after only 12 hours of naproxen, she was feeling "back to normal" and anxious to go back home to her friends and family. I remember her eyes dancing when I told her she could leave. She was packed and dressed within minutes!

I had called the pharmacy with her discharge prescriptions and had opened the browser (we have an electronic medical record system) to sign her discharge home order. I pulled up her chest x-ray just to make sure everything was all right. Her mother had already seen it. The tech showed it to her.

"My daughter has a BEAUTIFUL CHEST X-RAY" she had exclaimed to me!

Having never seen a chest x-ray before and was fascinated by the wispy white ribs and perfectly aligned spine. She only saw beauty and perfection--I saw a large mediastinal mass.

I wanted it to be a mistake, not real, a hoax. It wasn't. Fourty-five minutes later a STAT chest CT confirmed the worst: large anterior mediastinal mass with necrotic center concerning for hematologic process (aka CANCER).

I couldn't tell the family. Feeling so much better, all packed up and ready to leave, the child and her family couldn't seem to grasp the seriousness of it all. They were literally walking out the door. She was transferred to heme-onc service. Chemo was started over the weekend. She never got to go back home. She suffered severe complications and died within 1 month of diagnosis.