Tuesday, October 25, 2016

Megalomaniac

Dr. Music: Yes, S.E.?

He calls me S.E. Cupp, ever since I got my blended bifocals in February for presbyopia. I don't have cable, had to google her.

Me: Help. Endobronchial lesion. Bland as hell. Ordered some stains, no hits. I'm stumped.

Three hours later. Most consults like to tell you what they think. This guy likes to play attending. I'm used to it. His expertise is almost worth it.

Dr. Music (barging in my office): So what do you think this is?

Me: Well not sure. Bland endobronchial lesion. Obviously ruled out carcinoid and low grade adeno, my best thoughts. What do you think?

Dr. Music: It's obviously prostate cancer, and he has a history.

Me: Um, well, I guess that fits histologically, but I've never seen it metastasize there. History? Oops I missed that. Had like 8 diagnostics this morning. I'll throw on a PSA and PAP. Surely you saw the history before you figured that out?

Dr. Music: No. I thought of prostate cancer right away. (Barges out the door).

5 minutes later phone rings.

Me: Hello?

Dr. Music: Didn't you have Dr. Ancient at the VA? If you paid attention you would have known what this is.

Me: Yes I had Dr. Ancient.

Dr. Music: Dr. Ancient taught us that there are three cancers that metastasize as endobronchial lesions. Melanoma. Renal cell carcinoma. Prostate adenocarcinoma.

Me: Well, but . . .

Dr. Music: You would have known what this was right away if you were paying any attention at all in residency.

With all due respect to the great Dr. Ancient, by the time I was his resident he was Dr. Over Ancient. For example, once he gave an unknown conference where every single unknown for the entire hour was small cell carcinoma. We residents vacillated between alarm, amusement, and pity. But Dr. Music didn't let me get a word in edgewise to tell him about that.

Me: I've never seen any of those cancers manifest as endobronchial lesions. And I doubt I'll see it again in the next 15 years. But don't worry, you are burning it into my brain today. I won't forget.

Dr. Music: Good! You'd better think of that next time. I've done my duty here.

Next morning PSA (prostate specific antigen) and PAP lit up like a Christmas tree. I didn't text Dr. Music to let him know he was right. He's already a megalomaniac, as evidenced by the nickname given to him by the secretaries.


2 comments:

Liana said...

There's no substitute for years of experience... the more I practice, the more I realize I don't know (and learn).

Gizabeth Shyder said...

Me too! But it makes it exciting. Career might be boring if nothing new popped up.