“Have a Seat…” — Worst Words to Hear

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A great way to tell people bad news.
A great way to tell people bad news.

“Hey..I think you should take a seat” — these are the words no one wants to hear from their doctor.

I heard them — and as life would have it the timing was perfect, just when I started studying for the MCAT.

He went on to explain, “Your liver enzymes are elevated about 4-5x the normal amount. At first we ignored it because you’re otherwise healthy, so then, we re-tested it after another visit –and it was still elevated. This is unusual, as you’re otherwise healthy, and you exercise.”

We, the doctor and I, then went down a list of ways to insult your liver. Given my age, there were only a few ways to have bloated liver enzymes levels:

  • Hepatitis A-C: I have no prior IV drug use (nor current if you’re wondering), no prostitution (besides intellectual), and I’ve never had a tattoo. Though, I have volunteered in prison, so I had to leave this possibility open. We tested for Hepatitis, the great news was a diagnosis was knocked off the list: clear of Hepatitis.
  • Cirrhosis of the liver: we ruled this out rather quickly, though I drink, my habits weren’t enough to scar the liver. Though, there was also a chance for “out of the blue” idiopathic Cirrhosis, but the rest of my liver enzymes didn’t fit this diagnosis.
  • Nonalcoholic fatty liver: this was ruled out pretty fast.
  • Several other system inflammations: all of them were ruled out, as I had no indicators for inflammation.

As my physician and I whittled down the list, it soon became apparent to me he had already completed the check-list by himself, perhaps even several times. The real reason why I was asked to sit down soon became pretty obvious:

  • Neoplastic growth (cancer) that happens to be secreting enzymes on its own: it was a remote possibility he admitted. A possibility that my doctor had hoped to jettison once I came in to give a better history. He asserted this wasn’t very likely, but we had to rule it out given that everything else was negative. Besides, I had been a asthma drug test subject for over a decade, perhaps I would add a new symptom to their speedy commercial disclaimer once the drug was released.

So, that was my first several months of the MCAT studying, trying to figure out if 1) I had cancer 2) if I were diagnosed with cancer would I continue to apply to medical school and 3) if I should tell anyone. The wasn’t much I could do about the first point, after a little mopping around. It wasn’t a particularly fun period of time as I was still recovering from the suicide of a friend and the death of a family member. But, eventually I mustered my MCAT motivation, I realized I either ‘sick’ or I wasn’t — so I decided to move along with applying to medical school as planned. And since, all of this was unsure, I decided to keep it to myself. And so, I didn’t tell my friends or family.

I’ve been close to death several times in my life with asthma, I’ve even slipped into death, only to be revived (a story for another day). But, this was different for me, because with asthma it was always an immediate emergency, this time it was like an invisible timer. I thought about my life, my friends, and how much they meant to me. As the weeks went on, and we couldn’t find a reason for my liver enzymes still, I decided to use the best of my apparent dwindling time: spending time with friends, calling people I haven’t seen in years, and trying to be a better son and brother. I’m not used to expressing my emotions openly, so I told them good bye in my own way, in the guise that in the future I’ll be moving away to medical school if admitted. I went to eat with my research mentor, told him how much he meant to me. All along, I kept studying for the MCAT — no, it’s better to say I can’t myself occupied by studying for the MCAT.

Fortunately, one day, I remembered that I have a degree in Exercise Physiology (i.e. physiology under extreme conditions) and a minor in Physiology, so I decided to go out on a limb and do some research using Pubmed about liver insults — this time focusing purely on the exercise physiology. I recalled learning that the liver most process the products of muscle break down, and recycling various energy (potential) molecules. Supporting my hypothesis, I found one paper that explicitly expressed that research investigators should be wary of recruiting subjects who are exercising vigorously because their liver enzymes will be much higher than normal (4-5x more, like mine).

I then decided to put a mental bet on my self diagnosis, it was either I was right or I’m in a heap of trouble. I then emailed the paper, and my reasoning by email to the physician — I even thought of a way to test for my diagnosis: stop exercising and watch my liver enzymes. If they dropped I was right and I’m going to live (for now), if they still elevated I’d best get my last will and testament in plus life insurance. He emailed me back almost immediately, he liked my idea and decided to try it. Good news: I didn’t have cancer.

And let me tell you, I’m pretty happy I was right — but, you never really know when life will just “happen”, so expect a lot of curve balls. I went onto take the MCAT, and did well enough to get in, though I never expected to lose so much time from studying with trying to study my own case.

Reach me at twitter @doctororbust




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