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Our sickest patients that we see as oncologists are in the hospital. As time has gone on & with the changes that have been made as to who can be hospitalized and who can’t be hospitalized, the number of patients in the hospital who are truly very ill has risen. Patients tend to come and go much quicker out of the hospital, and those patients’ left behind tend to be most sick & most seriously ill. In the hospital currently, we have a patient who is under going treatment for acute myelogenous leukemia. Working with leukemia patients’ is extremely challenging as a physician, a lot of hospitals don’t have the man power, the nursing expertise or the referral doctors to allow us to treat patient’s with leukemia. A typical stay for a patient newly diagnosed with leukemia is somewhere between six and eight weeks. They tend to get very sick as they go through chemotherapy, and then there is a long period of time when their blood counts are low & they are susceptible to infection. They tend to have significant nausea & vomiting and tend to get sores in their mouths. These things usually lead to a patient not being able to eat well & they wind up usually on some form of I.V. nutrition, which is “steak & eggs” through the veins. They almost all have some kind of infection when they first present because of the severe immunosuppression that leukemia cause.They require innumerable number of blood transfusions and platelet transfusions. It’s a sobering fact that out of all the patients that we start on treatment for leukemia probably as many as 20% of them die before they leave the hospital, just from the toxicity of the chemotherapy or the resulting low blood counts & their inability of the immune system to fight off infections.
The other types of patients that we now have in the hospital are those patient’s with advanced disease and having a significant amount of problems related to the disease. This includes bowel obstructions, pleural effusions, and significant pain. Trying to somehow relieve their symptoms or in many cases help them with tough choices regarding end of life issues and palliative care is a challenge. Although being in the hospital and seeing hospitalized patients is a nice contrast to working in the office, the week that we are on call is among the most taxing that we go through. I think a lot of the reason why it is so exhausting is trying to figure out what is best for a particular patient, and whether some particular complication or symptom can be controlled.
The other type of patient that we see in the hospital is newly diagnosed patients. Patient’s who come in to the hospital and are diagnosed with cancer are usually ill and are struggling with the new diagnosis. It’s sometimes difficult to come in and establish a relationship in a very short period of time with these newly diagnosed patient’s and set up a treatment course, get a patient to understand their treatment and then in some cases to proceed with treatment. To top it off, it’s raining today.
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