A Tale of Two Sisters

Jane Barker and Judy Swift didn’t look like sisters, and from what I understand, they didn’t spend much time in each other’s company. They had both been my patients for years by the time I learned that they were sisters.

The one thing they had in common was their smoking history. Jane was discreet about it, but Judy’s struggles to quit were obvious. She had tried every available smoking cessation drug. She had COPD and saw a pulmonologist regularly to help manage her chronic cough and shortness of breath.

Jane’s most pressing medical problem was always her touchy digestive symptom, and Judy came in a couple of times last fall for fatigue. Then just before Christmas, Jane developed a severe cough. Her chest x-ray was negative and the cough was non-productive. I told her it was probably viral, and prescribed inhalers for her. She called back asking for antibiotics and cough suppressants. I tested her for influenza and prescribed empiric antibiotics for mycoplasma, but she continued to be plagued by her dry cough. A repeat x-ray suggested a lesion in her right lung, and it looked malignant on CT scanning. I referred her to a pulmonologist and a thoracic surgeon.

Jane’s cough made the thoracic surgeon nervous, and her surgery was delayed several times because of the severity of her cough. Finally, in mid-February, she had her surgery. I saw her for a couple of postoperative visits, and although she felt terrible and continued to cough, her surgery seemed to have been a success. We spoke of her stubborn cough and how it probably saved her life.

In late February I saw her sister Judy again. She looked terrible, and she had lost weight. I had done all kinds of tests on her just before Christmas when she came in for fatigue. She had seen her pulmonologist not that long ago, but I sent her for a CT scan of her chest, even though her x-ray didn’t show anything new. The scan showed a plum-sized irregularly shaped tumor deep inside her right lung. She also had several enlarged lymph nodes.

I called Barry Wolf, her pulmonologist. I could hear him sigh when I told him what I had found.

“I’ll get her right in,” Barry said.

I received a couple of courtesy copies of her test results in the mail that told the rest of the story. Her pulmonary function tests were very poor, and she wasn’t a surgical candidate. There was a consultation note from a radiation oncologist, then nothing more.

Her obituary was printed in Saturday’s paper.

2 Responses to “A Tale of Two Sisters”

  1. 1 NPs Save Lives May 31, 2009 at 2:16 am

    Genetics is a harsh taskmaster isn’t it doc? Too often we try to modify our risk factors, but sometimes we can’t escape what may come anyway. I tell my patients over and over again to quit smoking but most don’t care to. It’s sad to watch someone waste away. I’m really sorry to hear about those nice women.

  2. 2 Dr. Grumpy June 7, 2009 at 11:16 pm

    We do our best. But at the end of the day, we can’t follow them home to enforce healthy behavior.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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