Question of the Day - Now with Answer!
The cherubic face of the medical student before me showed a crease of anxiety as I patiently waited for him to answer my question. We were huddled in the doctor’s lounge staring down at a couple of plastic cafeteria trays loaded with delicacies from around the globe, ostensibly there to eat a hasty lunch and then skedaddle back to the office for more of that “duty and humanity” stuff. Those students who have come within earshot of my sonorous voice, however, know that I love to teach using the Socratic method, known in the olden days of medical school as “pimping the student.” I therefore had decided to use this intermezzo to quiz my apprentice. The question I had just asked, which I surmised was strangling every neuron in his brain as he wriggled into the same posture as that of Michaelangelo’s statue of Moses, was the following:
“Suppose every scanner and x-ray machine in town breaks, and you need to find out if the cancer treatment you have given your patient is working. What is the most important piece of information you can obtain in order to make an accurate conclusion?”
Remembering that college kids don’t get into medical school without a quiver full of cleverness, I wasn’t surprised by his answering my question with a question. He asked, “Can I interview and examine the patient?”
“No,” I said. “You don’t have to because you’ll know the answer before you even walk into the exam room.”
“What about lab tests?”
“Not necessary. Here’s a clue - think about what it means when you have cancer and it begins to die. How does your life change?”
His eyes began to petrify which I suspect would have caused the casual observer to remark vigorously “how much that young man over there reminds me of Degas’ absinthe drinker.” I found the resemblance uncanny to say the least and decided I had better either take the bottle away from him or give him the answer, when suddenly he brightened.
“Your life changes for the better - which means….” He was so close to the truth yet still it eluded him as if he was trying to catch minnows with his hands. As I revealed the solution to the puzzle he cried out “Of course!”, startling an elderly physician sitting next to him who reminded the whole room of that certain dinner painting by Caravaggio. We both laughed and made our way past the crowded tables back to the office.
If you think you have an answer to this puzzler feel free to leave it in the comment section. The Cheerful Oncologist will provide his own answer shortly, as soon as he can remember it…
UPDATE: I botched the name of the artist of “L’Absinthe” - it was Edgar Degas (since corrected)…to Maria from intueri: No, the patient didn’t code!… to Ali: of course he’s in the room - what do you think this is, a Twilight Zone episode? HINT: The patient hadn’t been seen for a month…the information I needed was already in the chart as I entered the room.
AND NOW THE ANSWER: kudos to Barbara C, who correctly guessed that I had glanced at the patient’s weight before opening the door. The comment by Dreamer is not inaccurate - patients do lose weight on chemotherapy, especially patients with incurable cancer who can shed a tremendous amount in an impossibly short time. Where I come from this is called dying, which makes it all the more rewarding to see a patient start to put on the pounds again. Why all of a sudden do they gain weight?
Because they’re going into remission. Yep, after years of observing this phenomenom I am ready to reveal it to the world, and as my old professor would say after listening to this brilliant deduction:
“Thanks for stating the obvious, Craig.”
“You don’t have to because you’ll know the answer before you even walk into the exam room.” - leads me to believe there will be no patient in the exam room.
Comment by Ali — November 16, 2005 @ 5:47 am
Oh, Cheerful Oncologist, it is truly unfortunate that when I read “when you have cancer and it begins to die”, my mind immediately alighted upon tumor lysis syndrome and I began to worry, “Potassium… oh no… the patient is gonna code!”
The antipsychotic medication should kick in soon, I hope.
Comment by Maria — November 16, 2005 @ 6:02 am
(I should mention my decision was influenced by your previous post.)
Comment by Ali (again) — November 16, 2005 @ 7:00 am
How long since the last office visit?
Comment by Barbara C — November 16, 2005 @ 3:47 pm
The patient is still alive?
Comment by Wiz — November 16, 2005 @ 8:28 pm
Change in weight status.
Comment by Barbara C — November 16, 2005 @ 9:40 pm
Can’t be weight. Most patients lose weight while on chemotherapy, even though the tumor is shrinking. Particularly patients on curative type chemotherapy. I’d be glad to hear about this professional secret.
Comment by dreamer — November 17, 2005 @ 1:40 am
cool. so the 20# I have gained since being diagnosed is a good thing…as I have suspected
Comment by Feisty — November 17, 2005 @ 5:09 am
shoot! I disagree. I gained almost forty pounds during my first five years of chemo experience. Now, I am losing weight. Back to my pre cancer days.
Comment by cheryl — November 19, 2005 @ 12:10 pm
i gained lots of weight too. i have heard the onc nurses say that it is the type of cancer, the stage, but also the treatment. the breast cancer patients get loaded with steroid, so that causes the weight gain.
Comment by Aimee — November 19, 2005 @ 10:55 pm
no steroids, probably more sedantary during treatment, but my point was, having stable weight or a slight gain is better than anorexia
Comment by Feisty — November 21, 2005 @ 5:11 pm
A Registered Dietitian (RD) would have picked up the weight change right away. Can’t help adding that nutrition support and advice from an RD would decrease the risk of weight loss and cachexia in these patients to begin with
Comment by Nancy — November 23, 2005 @ 4:32 am