I have a patient who is a liar. He is telling me a story to get pain medications. I don't have any proof he is a liar. He has no incriminating evidence that I can find. There is no labwork that I can do to prove his pain one way or the other. Without evidence, I am inclined to give him the pain meds. I am willing to play this game. All he must do is play the game with me.

Instead, the staff catch him with secret pain meds not prescribed by me, and eating meals from the cafeteria when he swears that he can't keep anything down. All he has to do is play along, and even that, he can't do.

And that is the sad fact about addicts. He has me beat, and still, he cannot stop himself from ruining it.

Leukemia is an asshole

I am currently reading 'The Emperor of All Maladies' by S. Mukherjee, MD. It is a biography of cancer. I got 20 pages into the book before I had to put it down and walk away for a while. It is tough to read. Only last week I had a patient die from acute leukemia, so it hit close to home, but this book struck a nerve with leukemia. I hate leukemia.

I do not hate diabetes or hypertension. In fact, I love them. If you remember the movie 'Backdraft' there's a nice quote: "the only way to truly kill it is to love it a little." There is a certain love of the pathologic. When I see something going wrong, I know what it is. I know why it does the things it does. I do love it a little.

But acute leukemia I hate with a burning passion. If leukemia was a man, I would kick him in the crotch several times, and then let him get up, and kick him again in the crotch, and then pee on him. THAT is how much I hate leukemia. I hate leukemia because it is totally unfair. It picks on little kids. It strikes hard. It is relentlessly fast. It is cruel. It doesn't care if you've been a good person. It wants you to suffer, and it makes you suffer in all sorts of horrible ways. It is an asshole.

You would be right to say that this is not unique to leukemia. Certainly, sepsis is similar in its tenacity. But with sepsis, it only asks for a cure. If you can treat with the appropriate antibiotic, then the cure is delivered. All I must do is keep the patient alive long enough for the foreign pathogen to be removed.

Acute leukemia is entirely different. In order to kill it, you must also try to kill your patient. You must play a game of chicken: if you swerve, leukemia wins and your patient dies, but if you stay straight, you may kill leukemia but also kill your patient in the process. All the odds are already stacked against you, but instead of other cancers where you think and plan, you must act now. So you destroy what remains of the bone marrow. You pour toxic substances throughout the patient's system. You push the patient to the very edge of death, and sometimes over. And in the end, all that buys you is a 20% shot at being alive after 5 years?

Fuck you, leukemia.

(Of course, prognosis for acute leukemias vary by many, many factors)