Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What is a serious diagnosis?

Farokh Jamalyaria, MD
Physician
February 5, 2015
Share
Tweet
Share

The serious diagnosis is a polite middle-aged woman with a hopeful smile sitting on the side of the bed, with her husband in the chair across from her, as you carefully tell them what it means to have ovarian cancer.

The serious diagnosis is the teenager who just found out he has lupus nephritis — without any other signs or symptoms of lupus — and that he might be on hemodialysis soon if high-dose steroids and chemotherapy don’t work.  He has a three-month-old infant.

The serious diagnosis is the young Japanese woman in her twenties who survived congenital biliary atresia in childhood by receiving the Kasai procedure.  Thin and small, with large, deep yellow eyes (her bilirubin is in the twenties), she’s constantly teetering on the edge of death.  She is the definition of gravity and patience.  She picks out a few English words each day to ask about the chance of having surgery, to ask about her need for blood, and to say that she’s hungry.  Almost a hundred days into her hospitalization and innumerable packs of red blood cells later, she passes away.  Death did not surprise her; she accepted it long ago.

The serious diagnosis is the twenty-four-year-old man whose roommate called him a “sissy” and whose girlfriend is annoyed with him for complaining of pain in the roof of his mouth for the past month.  He’s a little agitated as he tells you his story, as if he just witnessed a shooting and is reporting it to the press.  He learns that he has acute myeloid leukemia in blast crisis.  Tragically, he is already in irreversible DIC (disseminated intravascular coagulation) upon admission to the hospital.  He is soon intubated and sedated and transferred to the ICU.  He dies several days later, edematous with so many units of fresh frozen plasma.

The serious diagnosis is the young woman from Poland with pancreatic cancer who traveled across the Atlantic to get chemotherapy that may, if she’s lucky, extend her life by a few weeks.

The serious diagnosis is very disruptive, especially for young people with previously normal lives.

The serious diagnosis is the middle-aged writer whose left leg has been heavy for the past week.  She’s unable to move it on your exam.  Her CT shows brain tumors.  An eventual lymph node biopsy reveals metastatic melanoma.  She accepts hospice care.

The primary team discusses the serious diagnosis in hushed tones.  Silence hangs heavy as team members reorganize their personal perspectives on life.

The serious diagnosis was the five-year-old boy diagnosed with type I diabetes in the 1960s.  After college, he worked as a draftsman.  It didn’t feel right, so, one day, he put his pencil down, walked out of the company, and went into acting.  Even though he only had minor roles, he has no regrets about his acting career.  He was able to retire early.  It’s all about marketing, he tells you while standing in the examination room.  (He avoids sitting because of his severe neuropathic pain.)  He says that anyone can be an artist, but only the business-minded succeed.  He’s here to be evaluated for a pancreas transplant.

The serious diagnosis is the young man with head and neck cancer who was lost to follow-up when his otolaryngology clinic disbanded.  Months later, he is admitted to another hospital system.  His face looks like a balloon inflated on one side and deflated on the other.  The cancer is deemed inoperable.  Some days later, he suddenly exsanguinates in front of his family and a resident and an intern not much older than himself.  The only thing they can do is bring buckets to catch the blood.

The serious diagnosis is the VIP patient with irreversible lung disease that flared up, landing him in the ICU.  He has an upcoming speech in front of thousands of people, his wife keeps reminding you.  His son flies in from the Ivy League.  You’re greeted by frustration every time you walk into his room.  The patient, however, remains very calm and accepting of his situation.

The serious diagnosis is the brilliant mathematician and pianist who read every published paper about his refractory myeloma and deliberately chose a very toxic chemotherapy regimen.  You’re following him in the aftermath of his decision.  In the past week, you’ve seen him lucid only once, for a few minutes.  He said something very wise, but you no longer remember it.  He’s delirious, in renal failure, and anemic, skirting death closely, closely.  A year later, you’re walking out of the oncology clinic when you see a vaguely familiar man with a full head of hair walking in.  Several seconds later, you realize he survived.

Farokh Jamalyaria rheumatology fellow who blogs at Physician-Artist.

ADVERTISEMENT

Prev

Survival pearls for surgical interns

February 5, 2015 Kevin 2
…
Next

Prescribing off-label: It's gotten out of control

February 5, 2015 Kevin 22
…

Tagged as: Primary Care

Post navigation

< Previous Post
Survival pearls for surgical interns
Next Post >
Prescribing off-label: It's gotten out of control

ADVERTISEMENT

More by Farokh Jamalyaria, MD

  • A physician aces his USMLE and ABIM board exams. Here are his tips for success.

    Farokh Jamalyaria, MD
  • a desk with keyboard and ipad with the kevinmd logo

    The spookiness about sudden death

    Farokh Jamalyaria, MD
  • a desk with keyboard and ipad with the kevinmd logo

    We should all be anonymous Samaritans

    Farokh Jamalyaria, MD

More in Physician

  • a desk with keyboard and ipad with the kevinmd logo

    How to advance workforce development through research mentorship and evidence-based management

    Olumuyiwa Bamgbade, MD
  • The truth about perfection and identity in health care

    Ryan Nadelson, MD
  • Civil discourse as a leadership competency: the case for curiosity in medicine

    All Levels Leadership
  • When a medical office sublease turns into a legal nightmare

    Ralph Messo, DO
  • Why the heart of medicine is more than science

    Ryan Nadelson, MD
  • How Ukrainian doctors kept diabetes care alive during the war

    Dr. Daryna Bahriy
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why clinical research is a powerful path for unmatched IMGs

      Dr. Khutaija Noor | Education
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
    • How to advance workforce development through research mentorship and evidence-based management

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 8 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why clinical research is a powerful path for unmatched IMGs

      Dr. Khutaija Noor | Education
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
    • How to advance workforce development through research mentorship and evidence-based management

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What is a serious diagnosis?
8 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...