Not exactly a "clinical case" but just a "JFC, can my people get a break around here" kind of venting post. I've been out of the office for a week (was supposed to be on vacation in Florida but instead I've been home nursing a dog dying of sarcoma...but that's a different issue). I have 2 days in clinic this week. They're not even all that busy. But in them I have:
- 81M with b/l hydronephrosis, one kidney that doesn't even appear to work anymore, diffuse FDG uptake throughout the chest and a bronch scheduled in 3 weeks...he came in with 5 family members all rarin' to go about what I'm gonna do about all of this (situation defused, should get a bronch next week but still exhausting)
- 49F has had 2 IIIC melanomas resected and treated with adjuvant IO in the past 5 years. CT yesterday shows new liver mets. Oh...and her kid works in my clinic
- 59M with GERD like sxs for ~6 mos finally gets a CT scan and has numerous retroperitoneal and splenic masses. Fortunately, it's just garden variety DLBCL...he'll be OK
- Two different 70 year old guys with Stage II-III esophageal cancer who got FLOT x4 per ESOPEC (sailed through chemo). One developed bony mets (biopsy proven) on treatment. The other was found to have aortic invasion at the time of (aborted) surgery.
- 69M who got a directed/living donor kidney transplant last month, found to have widely metastatic pancreatic cancer on a CT scan done POD10 for a wound dehiscence. And just for fun, his graft hasn't picked up function so he's back on dialysis and his creatinine and bilirubin are vying for "worst prognostic factor" (both >3 on Monday).