I got some bad news in my patient reports yesterday in clinic.

[Aristus]

One of my patients died in hospice last week.

She was one of my mainstream patients, not one of my homeless patients. And when I say 'my' patient, I really only visited with her once. She was a regular of my supervising physician. I visited with her at the beginning of August when she came in for a medication refill. She was on some pretty heavy narcotics, because she had been diagnosed with metastatic cholangiocarcinoma. I always refill narcotic med requests without hesitation for patients with terminal diseases.

She was very sweet; I liked her a lot. She looked hearty and healthy, too. Not like someone in her condition might be presumed to look. Very cheerful, too. At the end of our visit, she said she wanted to switch primary care over to me, instead of my supervising physician. She called me "down to Earth" I'm sure she was just being nice, but I appreciated it.

A couple of weeks ago, I received a notice that she had been admitted to hospice. I was surprised because she still seemed so strong. But it can happen quickly.

When my Dad was diagnosed with pancreatic cancer a number of years ago, he seemed as awesomely vital as he always had. My brother took him on a "farewell tour" to visit with family members out of state, and say goodbye. When he arrived home, he deteriorated very quickly, and was dead within a week.

I regret not being able to get to know this woman better...

And if that weren't enough, one of my heroin users is pregnant. As soon as she got the news, she decided to go into treatment. Good for her. But in the same pile of reports that informed me of the patient above, I received notice that my heroin abuser had left treatment against medical advice. So I don't know what's going to happen with her baby.

Rough day. Let's just say I'm glad to have a few days off for some continuing education. Clinic is burning me out a little...

[irisblue]

1. metastic anything sucks, big time, for always

always sucks

[Aristus]

2. I'm sure she wasn't in any pain at the end.

Hospice care workers are some of the best people on the planet.

They really made sure my Dad was comfortable when his time came. I remember sitting with my brother at the edge of Dad's bed. He wasn't conscious. He would never regain consciousness from that point. But we told him all the things we had to say and would have regretted not saying otherwise.

I could never work in hospice care. But I have a ton of respect for them...

[mainer]

3. You sound like a good doctor and human being.

And cholangiocarcinoma can lead to a rapid death, even though the patient looks healthy only weeks earlier.

Good for you, being liberal with narcotics for your terminal patients. All these patients should just get whatever pain meds they need, even if it's enough to kill them.

Being a doctor can suck the soul out of you. I admit that I had to leave the field because of it.

[Aristus]

4. I'm a Physician Assistant.

Thank you for your kind words.

Were you a doctor?

[FourScore]

5. I don't know how you do it.

I am in awe of people like you. Thank you.

[Aristus]

6. Aw, that's sweet. Thank you.

I do it because I love it. I wish I could claim the mantle of saintly sacrifice, but the truth is, I'm very selfish. I love the feeling I get helping out every day. Feeling like I've made a difference. It's a terrific feeling.

It's nice to see you. I don't think we've met before...

[FourScore]

14. I am not in the Lounge much.

But I have admired you here at DU for years.

I just don't post that often. I used to, but back then I was called whereismyparty. I switched my name to FourScore after Obama became President. Oddly enough, I sort of regretted changing my name after I did it, but it was time. I had found my party again, and besides, whereismyparty had a rather unfortunate acronym -- wimp.

[sheshe2]

7. Thank you for all that you do, Aristus.

So sorry for your loss of your patient.

You are a good man.

[Aristus]

8. SHESHE2!

Thank you...

[sheshe2]

9. You are welcome Aristus.

Stay strong.

[Aristus]

10. I will.

And it because of friends like you...

[a la izquierda]

11. Oy, good grief.

Echoing others' sentiments, not sure how you do it. But thanks for doing what you do!

[Aristus]

12. Thank you.

One way I cope: Listening to Beethoven. Right now, I'm listening to Concerto in C for piano, cello and violin. Music will save the human race...

[CaliforniaPeggy]

13. Oh, my dear Aristus...

Death is nearly always shocking; we have so much trouble letting go ...Of life, of the people we love and care for...

You are such a good man! You have a heart that's as big as can be, and so much expertise...

Blessings on you every day for the work you do.