Today was a crazy day at the clinic. We had 1 practitioner sick, the other on leave, the other took off mid day, which left just Dr. Buffaloe and me to cover 3 pages of appointments and all the walk-ins. On top of the physicals, pile of ear aches, casts for busted ankles, and old ladies needing their feet checked, I found myself giving my first "you've got cancer" talk. It shook me far more than I realized. I was talking to the patient, a young Navajo in his 20's, when a number of red flags came up. Weight loss...fatigue...strange unremitting abdominal pain radiating to his back. I wasn't sure though, after all, he's so young, right? I spoke with him for awhile about his studies, he's in his first year at a liberal arts school but had to withdraw b/c of the abdominal pain. He's gone to multiple hospitals for help with abdominal pain, each time they dismiss him as a case of irritable bowel, run a series of screens for infection and send him home with ulcer meds. Each time he comes back, the meds never help the pain. He noticed a lump on his collar bone in february..they told him it was a lipoma, a fat deposit. In june a abdomen CT was done but he never heard back from the hospital about the results. Finally he comes to our little clinic b/c his pain has become worse in his back. I took a break from seeing hte other patients and dug through his chart and go through his labs with him. Noone's told him anything about all the tests they've run on him the last 9 months or what they thing is going on with his health. I tried to go through what the values meant, etc...then I got to thte CT and had to go to Dr. Buffaloe to find out the results. We call the center and get a faxed copy...."extensive retroperitoneal lymphadenopathy...differential includes lymphoma or metastic testicular cancer." So, I went back to the room to tell this poor boy. I've never seen such fear in someone's eyes. He was terrified and near tears, even though I tried to explain that nothing would be conclusive until biopsies were done. I wonder if he could tell that I was as scared as he was. Then he asked me about a lump he noticed on his neck. Wasn't like any lipoma I've ever seen, they were swollen Supraclavicular nodes...they were huge. Anyways, we got him in for a biopsy this coming monday, we'll see what happens, I told him to call the clinic or email me if he doesn't hear back about the path results within the week, I hope he doesn't fall through the cracks again. So all in all, an eventful day...lots of happy healthy patients, and some sick ones. ¶ 19:53