Yin and Yang

I spent yet another week at the Thyroid clinic. And amongst other things, saw and diagnosed several patients with thyroid cancer.

I caught myself thinking this one day. It seems ironic that the thyroid harbors both (one of) the slowest growing cancer (papillary thyroid cancer), and the most aggressive as well known to man (anaplastic thyroid cancer).

It's such a contrast. I knew the man I saw with PTC is very likely going to do well. Yes, it's possible that he may be left with miniscule amounts of remnant disease in the nodes after surgery, but it will likely not impair his longterm survival. I felt pretty good reassuring him of his prognosis, and telling him he'll see his daughter grow up. That his smoking probably has a higher chance of killing him than the cancer and so he should think about quitting.

But later the same morning, when I walked in the door to see the lady with anaplastic cancer, it was different. She already had an inkling this was to come. Her surgeon had already pre-emptively put in a tracheostomy. And just a few weeks out of surgery, she was already noticing a new mass in the neck. We both knew she would not live to see 2009. I suspect she would not be alive by the time I graduate. She knew what was coming, and got to the point:

"What's going to kill me, doctor?"

She wanted to know how she was going to die.

Probably loss of her airway, I told her. Despite the trach.

I reassured her as best I could. That we probably won't be able to change the outcome, but we've advanced far in the field of palliative medicine.

Such a contrast, these cases.