The First Patient

Do you ever forget your first real patient as a Dr? I hope not, as he was so lovely and sweet and made my day.
It took me a while to get into the swing of things yesterday. I didn't save any lives, but I didn't kill anyone and I may have just relieved some pain and suffering.
I felt completely overwhelmed, anxious and out of my depth.  I was checking, double checking and triple checking everything I signed and my poor consultant must have thought I was crazy as I ran absolutely EVERYTHING I did past him first.....I was so terrified of making a mistake!
The day moved slowly and I eventually got my groove on. As I was discharging Mr Eric (not his real name of course) ...my first patient, he said to me "thank you so much for looking after me, you are the best Dr I have ever had".
I laughed as I thanked him and said "Eric, I'll let you in on a secret...today is my first day as a Dr and you were my very first patient".
He took my hand and said...."well Tracey, you are wonderful and will go far I'm sure."
A warm fuzzy feeling came over me....I had helped someone and they liked me!

It wasn't all cotton balls and baby ducklings though.

I also had a very difficult case that kept me awake last night and will play on my mind for a long time as I wonder what I could have done differently.
A very anxious patient who had come in for something simple. Something I could fix easily, but in the course of my investigation I found something wrong, completely unrelated as to why they had come in.
I found something hiding, lurking silently, not giving any physical signs or symptoms to the unsuspecting patient that it was there.....a spot.
A dense spot on the chest X-ray of a young, fit 40 year old....my age.
I sat and looked at it. Was I imagining it? I had been looking to rule out rib fractures not to find this.
I waited for the radiology report to come through and tell me I was crazy and I needed new glasses but it confirmed my fears.
How was I going to tell my patient? Oh it's all good no fractures.....just cancer! Have a great day!
I took a deep breath and went to talk to them. I talked about how I wanted to do a CT scan so I could check the spot out and make sure it was nothing sinister.
My patient refused. What? Why? They were too busy. I talked some more, about what it COULD be and how important it was to find out.
I asked questions, explored their history further looking for risk factors....they don't smoke, never have. I asked more questions and explored their fears...the patients mother died of lung cancer. Surely then they would want to have this further investigated? "No thank you, I don't think I will" my patient said to me calmly.
Well maybe I could write a letter to the patients GP and have them follow it up? But they don't have a GP....they never have been sick, they don't go to the doctor. Well what about their kids GP maybe they could go and see them? No.
In the end......they left. Left against medical advice. Refused follow up. I was deflated.
Patients have a right to refuse treatment, we can't force them.
What else could I have done? Was there a magic phrase, something I could have said to change my patients mind? How could I have handled this better?
These are the questions that keep me awake at night?
Maybe Mr Eric is wrong....maybe I'm not a wonderful Dr after all, surely if I was I would have been able to convince my patient to stay.
I hope that they woke up today and decided to take my advice.