114. Three to Ten

Andrea came in for day surgery last week, a simple procedure to remove an asymptomatic ovarian cyst.  She had been adamant about its removal even though at 32 her risk for ovarian cancer is low. Most of us would recommend a follow-up ultrasound in 3-6 months, rather than surgery, but because it did not have the characteristics of a simple, benign cyst, it was, in the parlance of modern medicine, a "shared decision-making" decision.

Before surgery, I asked her for permission to have her father present for the routine immediate postop talk (though she might appear alert, her short-term memory will be impaired and her father could serve as a back-up memory).  She explained, however, that he probably wouldn't be in the waiting room, since he might be with her mother in the car.  Her mother, she further explained, had Alzheimer's and would be disruptive in public.

Several times a year I talk with patients who want to hold off on necessary but not urgent surgery because they are the primary caregiver for a spouse with Alzheimer's Disease.  Unspoken is the shared knowledge that such deferment may not be long.  The interval between diagnosis and death can be just 3-4 years for patients older than 80 at diagnosis, up to ten years for younger patients; I would assume that Andrea's mother fits in the latter category.

I wonder if there is any association between Andrea's insistence on surgery, and the burden that she and her father carry.

113. from the Latin

The computer screen that displays my schedule tries to stuff in a lot of information, including name, number, time, age, reason for the appointment, plus a few other details. Abbreviations are part of the deal.

So when I saw "cerv mass" on the schedule the other day, I should have thought about a growth on the lower part of the uterus, right?

But no, I thought, "why would someone wanting a neck massage make an appointment with me?"