Tuesday, August 21, 2007

Lesions of the Damned

First year in Med School you learn a lot of new words, and learn to redefine a few old ones. As an example, back in the playgrounds of the wild westcountry we used to use “acute” and “chronic” almost interchangeably to mean “really really bad” as in “I’ve got this acute pain in me side. It’s bin there for days an’ it kills” or, “that joke was chronic” *.

You learn that “infarction” means death of tissue deprived of oxygen and is not just a posh way of saying “infection”. And you learn to call anything from a pimple to a tumour a “lesion”, ( rhymes with legion, from Latin laesio “hurting”). It’s a useful word, lacking all precision as it does, thus allowing us to talk about any variation in appearance or texture of skin in erudite fashion without revealing to the punter whether they should be terrified or relieved about the particular “bit” under discussion. It stops callow juniors from blurting out the word “tumour” inappropriately when discussing minor blemishes, or too soon when discussing major ones.

So far this week I have seen one lesion from either end of the spectrum. First came Tony. Tony has been getting steadily worse over the past month or so. He has lost weight, had frequent bouts of diarrhoea and increasing problems with control of same. He looks and feels wretched. Examination sadly confirms a large “lesion” per rectum. It is a tumour, and I have to tell him so. He is expecting the news and takes it phlegmatically. After all he has already had one brush with malignant disease and seen it off. He has also lost one child to another form of malignancy, and, after the awfulness of this, nothing much even comes close. His principal concern is if any proposed investigation and treatment can be out of the way before next years holiday, planned to celebrate a significant anniversary. I do hope it will be.

After Tony came Jennifer, husband Brian in tow. Brian is a bit cross. It seems Dr Neighbour treated Jennifer last week for a “lesion” on her shin. The blemish in question was a small area of non-malignant sun damaged skin or a keratosis. Dr N zapped it with our favourite toy, the liquid nitrogen gun, last week. The thing, far from dropping off in four to five days as she had hoped, has blistered rather alarmingly (as they often do). It needs no further treatment since as the blister separates it will take the keratosis with it naturally. It is best left to do this on its own, but Brian is not at all happy. He wants it out of the way before their holiday in two weeks.

I toy briefly with the idea of introducing him to Tony.

*Paronomasia being after all an aquired taste, even in the playgrounds of the wild westcountry.


Z said...

That's the thing though. Unless I were to think I might actually die if *whatever* was left untreated, it seems churlish to bother the doctor. Which is why I've been lurching around like Quasimodo, but without the actual hump, for the last ten months. Because I'm too polite to see a doctor.

Also, because he'll tell me there's a vast waiting liist for *whatever* unless I happen to have my chequebook ready. But that's not the main reason.

orchidea said...

Brian's not happy? Poor poppet. Here I am, picturing him all irate while his wife sits mutely through the tirade, smiling nervously.

What a shame the liquid nitrogen gun can't help Tony. One day, you must tell us what it's like to be the harbinger of Bad News, and whether it's just one more unpleasant task a doctor becomes accustomed to (I'm assuming rectal exams aren't much fun).

Doctor Jest said...

z-- it's just as well I'm such a consummate professional or the paronomasiast in me would be honour bound to raise a query about you not having had a hump for ten months ;-)

orchidea-- you have it exactly right, poor Jennifer really didn't look at all at ease. And your other assumption is entirely correct.