We’re all familiar with those epidemiology pie charts that preface most of our pathology lectures. They’re the slides that everyone tunes out and gleefully skip over when reviewing for the exam, minus the few pertinent buzzwords: risk factors, mean age, gender and common symptoms. After all, “think horses, not zebras” is one of the most famous adages in medicine and rightfully so, because biology operates on efficient systems in very logical patterns. Do the body harm, suffer the consequences. Eat an apple a day, live long and prosper. Every now and then, however, we are taught the ever-elusive “idiopathic” cases. Here are two such cases:
Case #1: A previously healthy 27-year-old white male presents with recent harsh back pains. He works as a radio journalist and hasn’t had any recent trauma. Examination shows a mass growing on his spine.
Case #2: A 25-year-old white female about to start graduate school at University of California, Los Angeles presents with nausea and general gastrointestinal discomfort for the last two to three months. A CT scan shows masses growing in her pancreas and liver.
Okay, you got me. Case #1 is from a movie, but to be fair, it is part autobiographical. Warning: some spoilers ahead.
“50/50” is a 2011 film written by Will Reiser based loosely on his personal experience with cancer. The movie stars Joseph Gordon-Levitt who plays a normal 27-year-old suddenly diagnosed with schwannoma neurofibrosarcoma, a malignant cancer on his spine, with a fifty-fifty chance of survival. The movie was written in a raw comedic style that was ironically appropriate for the subject at hand. The insight into Adam’s friend, played by Seth Rogan, as an “adult-child” who grew up fast coming to terms with his friend’s cancer, only the brushed the surface of what friends and family go through in similar cases, but nevertheless added another dimension to the plot.
Case #2 is the story of Lindsey Miller, who happens to be the older sister of one of my best friends from high school. She was diagnosed with a neuroendocrine tumor almost three years ago, with lesions in her pancreas and liver (the same cancer that Steve Jobs had). Since then, she has had several different chemotherapies and, thanks to generous donations, recently flew to Germany for a new treatment.
What do these two cases have in common? For those of us going into the medical field, I would say they create a sense of helplessness. Both patients are too young to spend hours in the hospital and didn’t make any questionable life choices that compromised their health. In medicine, we learn that certain pathologies are consequences of poor life decisions, genetic predispositions or unforeseen environmental exposures. Things make so much more sense when there’s a clear cause and effect.
There was a scene in “50/50” when the doctor informs Adam that he has a tumor on his spine. Adam, in a moment of shock, says: “How is that possible? … I don’t smoke. I don’t smoke. I don’t drink. I eat healthy … I even recycle.” No matter how many years of experience one may have as a physician, there is nothing one can say to that (at least with our current technologies) except that it is what it is. It was very hard to wrap my head around Lindsey’s diagnosis. Granted, I mostly dealt with it through my friend’s eyes, but that probably contributed more to the feeling of helplessness. There I was, a hopeful future doctor who couldn’t contribute more to the conversation besides asking very specific scientific questions. It was the only way that I could objectify the situation.
A professor once facetiously said that these “idiopathic” cases are labeled as such because we’re idiots and we can’t figure them out. I would agree with that, but I imagine it’s in bad form to admit to patients that they can’t be cured because the doctors are idiots. Worse than admitting to a patient that we’re idiots who can’t cure their cancer is actually feeling like helpless idiots.
The 2013 Medscape Physician Compensation Report revealed that only 51% of doctors would choose medicine as a career if they had a chance to do it all over again. Perhaps the remaining 49% feel more like helpless idiots than hands that cure. Perhaps they had overbearing parents or realized they spent the majority of their prime in the library. Perhaps they have just simply seen too much. For me, a dose of desperation calls forth a sense of responsibility for my knowledge that no pathology lecture can ever do. When I hear about cases like Adam and Lindsey, it’s more empowering to say, “Oh yeah, I learned about that,” than rely solely on morbid statistics that I find on Google Search. Perhaps that’s just my way of coping.
Editor’s note: the in-Training Editorial Board obtained permission from Lindsey to publish her story. To read more about Lindsey’s journey, visit her blog, i am a liver.
Many of us go into med school with big visions for bettering modern medicine, but as we go through this journey, we realize that there is still a long way to go, and we can’t do it all alone. This column is not meant to be extremely profound or didactic but simply a reflection on the what it means to stay human in midst of society’s expectations and our own expectations.