I’ve been thinking of how I will say it, how I will turn someone’s life upside down as I move from patient room to patient room.  Room one holds a gentleman that is having trouble getting his diabetes under control and has diabetic kidney and eye disease as a consequence of his over indulgence.  My second patient, who has known coronary artery disease has been experiencing chest pain over the last week, awakening him every night with “an elephant on my chest” in a pool of sweat. “Luckily he is not currently having any chest discomfort,” my nurse tells me. I scan the list of my morning patients; hypertension, follow up labs, complete physical exam, back pain, trouble swallowing, shortness of breath, abdominal pain and weight loss. Then it’s lunch with a stack of lab results, adjusting blood thinners, pathology reports and back to seeing my patients at 1 o’clock. Then I see Allen on my schedule!  There it is at 1:30 pm.  FOLLOW UP RESULTS.  The young man is in his late 20’s, is engaged and has the whole world in front of him.  Except I’m going to tell him in the most tactful, gentle, and compassionate way, that he likely will not be around in a year.  That all the planning he … [Read more...]