the Art of Oncology: Incognito

Incognito

 Seated at the computed tomography console, I have just finished dictating a report and ready myself to review the next case. What does the requisition say? “Assessment of recently discovered liver metastases.” The requesting physician has attached a handwritten note adding the patient has no known medical problems.

I scroll through the images on the screen. Not only is the liver invaded, but small nodules are scattered throughout both lungs, there is diffuse lymphadenopathy, and many vertebrae have collapsed. From the base of the skull down to the pubis, not a single one of the 800 millimetric slices is normal.

The patient just got up from the examination table, the technician accompanies him to the changing room. I see him from the back, wearing the green paper hospital gown, and 5 minutes later, I hear him leave the room.

It is a morbid curiosity, even a kind of voyeurism. But I need to know: what does someone so close to death look like? If I walked past him on the street, would I notice something?

I turn toward him, and together with my colleagues, I say goodbye.

He is wearing a dark gray suit, a sky blue shirt, and a striped tie. His salt-and-pepper hair is tousled after the exam. Of his face I catch a glimpse of black circular glasses and acne scars on his cheeks. He is in his fifties, slightly overweight. He holds himself straight, a briefcase in his hand. He greets and thanks us with a polite smile.

It is downright scary. Search as I may, I see absolutely nothing.

He is just like you and me.