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The Art of Medicine

It's like the doctor spoke Klingon

Sweeney, Cameron Young MMS, PA-C

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Journal of the American Academy of Physician Assistants: November 2018 - Volume 31 - Issue 11 - p 58
doi: 10.1097/01.JAA.0000546486.89098.33
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We fell out of touch after I moved 100 miles away, and months had passed since our last conversation. Suzanne's text out of the blue got straight to the point. “My sister has stage IV lung cancer.” I picked up the phone and called.

Suzanne had little information. She and her sister understood even less. “What did the doctor tell you?”

“He was very nice. He used really long words. He wrote some things down, but I don't even know how to pronounce anything. It's like he spoke Klingon... It's bad, isn't it?”

Dyspnea (\′dis(p)-nēə\):difficult or labored respiration

Suzanne's sister was a longtime smoker. Her usual “morning cough” didn't seem much worse but she found herself increasingly winded and had to pause midway up the stairs to catch her breath. She blamed getting old and getting fat.

Hemoptysis (\hi-'mäp-tə-səs\):expectoration of blood from some part of the respiratory tract

She attributed the tickle in her throat to allergies or sinus drainage. She was treated for bronchitis. She didn't think to mention that her morning phlegm was occasionally smeared with pink, other times speckled rusty brown. She crumpled the tissue or rinsed the sputum down the drain without close inspection. At a subsequent urgent care visit, she was given a nebulizer treatment, then sent home with an inhaler and prednisone for a chronic obstructive pulmonary disease exacerbation. After a few more months without improvement, they prescribed antibiotics, which didn't help.

Cachexia (\kə-'kek-sē-ə\):general physical wasting and malnutrition usually associated with chronic disease

She was delighted when she lost the first 10 lb. It had always been such a struggle to lose weight before. When 40 lb disappeared, her family began to notice and expressed worry. Her appetite was good, but her cheeks, once smooth and apple-round, drew in like the fragile skin of an overripe tomato left in the sun too long.

Mediastinal lymphadenopathy (\'mē-dē-ə-'stī-nəl\) Of, relating to, or affecting the space in the chest between the pleural sacs of the lungs that contains all the viscera of the chest except the lungs and pleurae. (\'lim-'fad-ən-'äp-ə-thē\) Abnormal enlargement of the lymph nodes

The urgent care chest radiograph identified a right upper lobe mass. The follow-up CT revealed mediastinal adenopathy. Bronchoscopy provided the tissue diagnosis. Non–small cell lung cancer. Negative molecular markers. NSCLC. EGFR- ALK- ROS1- PDL1-. “Why would they name something based on what it isn't?”

Metastasis (\mə-'tas-tə-səs\):the spread of a disease-producing agency (such as cancer cells) from the initial or primary site of disease to another part of the body

Her balance was wobbly, and she fell a few times. The staging scans confirmed multiple lesions in her brain. Dexamethasone reduced the brain swelling but she complained that it kept her awake and caused her face and belly to look puffy.

Prognosis (\präg-'nō-səs\):the prospect of recovery as anticipated from the usual course of disease or peculiarities of the case

I cautioned that I could explain lung cancer treatment only in general terms, because I was not privy to the specifics of her sister's case. I shared that stage IV cancer was incurable but could be treated for a while. “Can she take one of those medicines on TV commercials? They say you live longer.”

Hospice (\'hä-spəs\):a program designed to provide palliative care and emotional support to the terminally ill in a home or homelike setting so that quality of life is maintained and family members may be active participants in care

She responded to treatment briefly but before too long the disease progressed. When Suzanne called to ask my opinion, I recommended that they follow the advice of her care team. I emphasized comfort care that would allow the family time together. Her sister died almost 6 months to the day after her diagnosis.

Hospitals provide interpreters for non-English speaking patients to make communication more effective and to help those we serve make better-informed choices. But the language of medicine, with polysyllabic words rooted in the ancient tongues of the Greeks and Romans, can be unintelligible to the uninitiated, even when they speak English. We disguise uncomfortable truth in jargon or cloak it in euphemisms, determined not to steal hope from those who may be dying or denying. We think we are preserving hope, but we may as well be speaking Klingon.

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