It's Friday afternoon. Another exhausting but exhilarating week is winding down. Seven brain tumour operations have been successfully performed and the patients have all sailed through without a problem.
But some of the seven, including a new mother, have brain cancer and don't have much of a chance of being alive five years from now. Just as I slow down my practice, some of these lovely people will have died of their malignant brain tumours. My efforts and those of my oncology colleagues will usefully extend their lives, but will be unlikely to cure them.
I have been doing this a long time, yet the helpless frustration of knowing a patient is likely to lose the battle – in spite of all our efforts – still has not taken the wind out of my sails. That's a good thing, or the half-life of people with tough jobs would be short indeed.
I examine the printed patient list for Monday's clinic, which will occur just on the other side of another beautiful autumn weekend. My assistant is almost as detail-oriented as I am, so the left column has the patients' names, the next their medical record number, the next their referring doctor, the next whether it's a spine or brain problem (most are brain), and the last column is empty for my written comments after I see each patient.
Forty-three names stare back pleading with me to help them. Fifteen are new patients, and the other 28 I am following and monitoring for one condition or another, mostly benign brain tumours.
I like to be prepared for the clinic so I check out the CT scans and MRIs for the patients whose recent imaging is on our computerized system. Many will be bringing CDs with their imaging from other Ontario cities such as Barrie, Newmarket, Brampton, Peterborough, Huntsville and Thunder Bay, as well as various sites from within Toronto.
I stare at one name and see she is a 34-year-old woman. Her long last name tells me she is likely one of the many who have come from faraway places to find a better life in Canada.
The faxed referral from her neurologist tells me the patient began to suffer from severe headaches and blurry vision a month ago and an MRI showed a tumour.
I look at the MRI and see her future. It is not as long or as rosy as she might have planned. I wonder about her parents, her husband, her children.
I look at my operating schedule and type in her name and book a three-hour operating slot for the following Thursday (six days from now and three days after I will meet her).
She doesn't even know it yet but in six days, she will come to the hospital at 6 a.m., get an MRI, then be brought to the operating room holding area at 7:45 a.m.
She will meet the nurses and the anesthetists before being rolled into OR 3. She will undergo an awake brain surgery for removal of as much of her tumour as we safely can. We can get 98 per cent of this one out, I think, unless there are any unpleasant surprises.
At around 11 a.m., one of my residents will be putting a head dressing on her to cover the long, stapled incision above her left ear. She will spend two hours in the recovery room and, at around 1 p.m., will go to the day-surgery unit.
At around 3 p.m., she will have a CT scan to make sure there is no bleeding or swelling in the brain. Later I will see her, chat with her and her family, and discharge her around 6 p.m. if she is okay. She'll be home 15 hours after she left in the morning of that day that changed her life forever.
I will review her two weeks after the operation to discuss the pathology of the tumour and refer her to my oncology colleagues for radiation and/or chemotherapy. Then we will see her every three months with an MRI.
I know all this and I have not even met her. I have plotted out her medical future and she has not even met me. It's a little creepy to know something so important about someone that they do not yet know about themselves.
We work to try to improve other people's misfortune. Our enemies are illness and loss of dignity and death. It's never another person we fight – just the renegade forces of nature that conspire within people's bodies to ravage them and take them before their time.
We try our best and that is comforting to most patients. To know that folks they barely know are ready to go to war for them must be reassuring, a most wonderful feature of living in a civilized country with a well-developed infrastructure. We don't always win our battles, but we try and that counts for a lot.
It's Monday at 10:37 a.m. when I walk into room 4 in our clinic area with a medical student and a resident in tow.
The patient has an entourage too – her husband, her two daughters and one son, a sister and her parents. They all stare at me and try to hear every word.
"Good morning Mrs. T, I'm Dr. B. So good to meet you, my dear."
Mark Bernstein lives in Toronto.