My pager went off late one afternoon with a message from the oncology service at my hospital, asking me to see a 70-year-old man with metastatic cancer and trouble breathing. I wasn't hopeful. I had chosen to train in pulmonary and critical care medicine because I wanted to be someone who saved lives. But, it turned out, there was so much sickness I couldn't fix.
The patient had worked as a mechanic. Vague pain led to a diagnosis of colon cancer that had traveled to his liver and lungs. Now, he was short of breath and might have pneumonia. His team was asking me to arrange a procedure, called a bronchoscopy, in which we insert a small tube with a camera at the end down the throat in order to look inside the lungs and suck out a deep sample to help find out what's going wrong.
"We'll get him on the schedule for tomorrow," I sighed, suspecting that nothing I did would make him better. "No food or drink after midnight."
In the waiting area outside the procedure suite the next morning, I went through the usual consent forms. He would be asleep for the procedure, thanks to sedative drugs we would run through the intravenous line. We would make him feel pretty good, but he would remember none of it. "Just imagine a really good martini – or two or three," I joked.
It was the first time I had noticed my patient smile. "You know, I'm more of a Guinness man myself," he said.