The paper straw in my cup of iced latte started to collapse. I had placed my drink on top of numerous nurse stations, brought it inside patients’ rooms, lugged it around from one hospital wing to another. After the fifth patient coffee started to crawl up the straw, turning it into mush. Metal or bamboo straws were not an option. I started using these “innovations” when they were given to me as gifts a few years ago, and at one point I almost impaled my hard palate with aluminum while sipping and driving on a dirt road.
I had resolved to always finish my breakfast before going on hospital rounds, trying to convince myself that for thirty minutes cancer can wait. The cancer would still be there, whether I go on rounds at 8 or 8:30. But it was a particularly busy day, and the numerous text messages flooding in in the middle of the night were poor prognosticators. Realizing the sort of antibiotic-resistant bugs that might already be swimming in it I finally threw the cup of coffee-flavored water to the trash. Bringing your drink with an exposed straw around the hospital is a disgusting practice. By now I should be used to the idea that when I slap the mask on, the next time I would be removing it is when I drive home.
Patient Tony texted with joy that his low back pain has miraculously disappeared. For weeks we’ve been communicating virtually for pain management. Malignant melanoma has started eating at his vertebrae, causing an impending spinal cord compression. I’ve sent prescriptions for steroids, morphine, fentanyl, and all sorts of things to help with the pain while waiting for his radiation treatment, but his pain scale had been down to at best a 4/10. For more complication, he got infected with COVID. Thankfully he was asymptomatic, but it caused a two-week delay in the management of a case that on all counts should be treated as an emergency. The news that his low back pain had suddenly disappeared filled me with joy, for one second.
“Can you still move your legs?” I asked.
He couldn’t, not even side to side. He had lost all sensation, including bladder and bowel control. He was paralyzed. The spinal cord compression was complete.
This was my fourth spinal cord compression during the pandemic, the worst time to get a spinal cord compression, or any oncologic emergency for that matter. I couldn’t admit the patient for IV steroids or pain medications. Rehabilitation referral, brace fitting, physical therapy–all of these would need to take a back seat. The mandatory COVID testing for procedures further delays things, not to mention an actual COVID infection. After that one case of spinal cord compression back in residency training that got us audited for not moving fast enough I have always been hyper-vigilant about spinal cord compression. But now, hyper-vigilance gets me nowhere. These patients will inevitably die from their metastatic cancers, but the prospect of being paralyzed while waiting for death always drives me bonkers.
Tony’s COVID eventually cleared, we successfully got a hospital room for him, and he was finally able to start his radiation treatment. I told him it might be too late to regain the use of his legs, but we could still hope. He told me it’s ok, don’t be sad. It kills me whenever the patient tries to console me.
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