GETTING IT RIGHT: LESSONS LEARNED
MY METAMORPHOSIS FROM
“PERSON” to “PATIENT” By Dennis R. Laffer, MD, FACG, Tampa, FL
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Top: Dr. Laffer with his wife and children. Right: Dr. Laffer. Photos courtesy of Dr. Laffer.
20 | GI.ORG/ACGMAGAZINE
t all began with a persistent cough from an upper respiratory infection. After this went on for several weeks, my wife suggested that I see a physician. I hate going to doctors. At the time, I had been a a solo GI practitioner for approximately 20 years, so I paid a visit to an internist on my floor. I simply wanted him to listen to my lungs for any sign of pneumonia. The chest was clear, but a complete blood count demonstrated a microcytic anemia; a subsequent ferritin was 23 ng. My medical history was unremarkable with the exception of well-controlled irritable bowel syndrome. There were not any alarm symptoms. A Hemoccult was negative. The clinician region of my brain concluded that I had colon cancer. I was 53 years old, a husband, father of 15- and 13-year-old daughters, and a physician. The clinical plan was obvious: colonoscopy followed by surgery. Now I was faced with a major dilemma: did I tell my spouse of 18 years that I knew I had a malignancy? I decided to wait until the completion of the endoscopy, so en route to the hospital I simply said I hoped that they would not find anything that required surgery. After all my years as a physician, this was my first real experience on the other side of the proverbial bed. My transition from individual to patient to object began slowly but quickly accelerated as my individuality was lost in the progression of paperwork, finger printing, photograph, and name band with date of birth, allergies, and medical record number. The colonoscopy demonstrated nine tubular and tubulovillous adenomas of varying sizes distributed along the length of the colon. However, a two-cm, moderately differentiated adenocarcinoma was also detected. When the effect of the sedation resolved, I was informed of the findings but was not surprised or overly alarmed. I anticipated imaging followed by laparoscopic surgery and a six-week recovery time. However, a preoperative CT scan, confirmed by a PET exam, demonstrated a fourcm left hepatic lobe metastasis. Stage IV disease—not an uplifting finding. At this point, the game changed dramatically. I realized that the situation had become more serious and complicated, but I never doubted my survival. Surgery was going to be more extensive, followed by six months of chemotherapy. The hardest thing to face at that time was telling my daughters of the results in a manner that allayed any fears. I also wondered whether I was going to return to my practice—my alter ego—following surgery, and during and after chemotherapy. As it turned out, I did not return. A permanent peripheral motor-sensory neuropathy from oxaliplatin forced my involuntary retirement. The years of building up a practice from the ground up seemingly vanished overnight. My professional identity was
