elephant in the exam room.

03/30/2009 at 5:03 AM Leave a comment

Today I remembered a unique interaction.  There was this gentle and somewhat disheveled man who was sitting down. While greeting him I assessed his demeanor. The most notable thing was that he had a huge bulk around his pelvic area. I presumed that he had a depends and that he had come to talk about incontinence. I had seen the man about a year before and he did not have a problem at that time.

He surprised me by complaining of something else altogether, an irritating cough. I dealt with that problem and patiently waited for him to move on to the real issue and was surprised when he was done. He was so dismissive that I almost did not mention it, but on questioning he took his pants right off without comment. He did not have depends, what he did have was the most massive tumor I have ever seen. His scrotum was as big around as his thigh. He allowed me to examine it and it was non tender with a variety of hard and soft masses. I asked him how long it had been there and all he would say was ‘a while’.

On my insistence only he went and got a sonogram ( he refused a cat scan). The radiologist called me as soon as he read the scan. He had at least three different types of tumors inside his scrotum. They were merging and hard to differentiate but clearly at least one of them was probably malignant.

It took a long time to convince him to get more testing. The cat scan confirmed that the had at several different masses at least one of which extended into the abdomen but no clear indications of spread.

He agreed to surgery, not because he wanted the tumor removed but because he could no longer walk. Of course we ran into obstacles. During the preop exam his heart showed problems which required extensive workup. then he became sick for a while, finally when they removed the tumor ( most of the scrotum really) it weighed over 18 pounds!

For you guys out there, can you imagine getting a regular bowling ball ( 16 pounds) and strapping that to your scrotum? ). He had several germ cell tumors ( tumors from the reproductive organs), all of which were problematic. None of which were readily treatable, considering his age and debility and disinclination.

Nevertheless for the next several months he was a very happy man. He was able to walk easily and comfortably and without embarrassment. He no longer had to try and hide it. HIs joy was easy to see.  He could go to the bathroom with ease. The issue that he had cancer never did seem to worry him much. I think he had already figured that out prior to my questioning him.

I wonder if he would have ever brought it up? Or was his cough complaint his plea for someone to notice?

It is not the only patient to hide an overwhelming problem, although he is the most remarkable.

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Entry filed under: true story. Tags: , .

Com’n Doc you can do it. The right to be stupid

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