Thursday, December 17, 2009

It's always nice to have grateful patients. Even if in some cases it's undeserved.
I saw Mr. S previously for consultation of an adrenal mass. He was a jolly old man, though he did look a bit more frail than his 72 years. This was picked up as he went through staging for his cancer. The CT showed a 3.8 cm left adrenal mass that lit up pretty intensely with some good ole' contrast. When I ran him through the usual tests, I was somewhat surprised that his urine metanephrines were elevated, though honestly I didn't think much of it, thinking it was probably just some false positive. After all, he was pretty asymptomatic (teaching point for the medstudents out there: pheos are often asymptomatic and you should never defer screening in an adrenal mass because of the absence of symptoms) , and you sometimes see borderline screening tests for pheo especially if the patient was hypertensive. Nonetheless, I told him he needed surgery; I was much more concerned that this represented a metastasis of his cancer, rather than a pheochromocytoma. Either way, this needed to come out, and given the equivocal labs, you had to block him pre-op, just in case. And boy, was I glad I did: the path did confirm a pheo.
He did well post-op, and saw me in follow up 2 months later this week. His repeat 24-hour urine tests were normal this time. Biochemically he seems cured. And really, the surgeon did most of the work; I just pointed him in the right direction. Apparently that's not how they saw it.
His very peppy wife announced, loudly, and repetitively from the moment they checked in at the reception to the time they brought him to my exam room,
"Dr. V saved my dear husband's life! He did, he did!!".
I had to remind them that I wasn't the one who did the laparoscopic adrenalectomy, and while I was concerned about the mass, I was betting against this being a pheo but a focus of cancer. But they would have none of that. Apparently to them I might as well have been the one who operated on him. And so, on and on they went. And it probably didn't help my ego that we had a bunch of medstudents in the hallway that day, who seemed to be in awe for the next few hours and didn't nod off when I taught them as usual.
Ahh. Gratitude, even if undeserved, is nice. ashamed smileys