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It's like the doctor spoke Klingon

It's like the doctor spoke Klingon Downloaded from https://pdfs.journals.lww.com/jaapa by BhDMf5ePHKZxZb3ruX4b9cKfbT5h3bp+v9gTtSlrchDWvVTxyN8Hif2P/rPZfAxb8td684/2m6Qj/1S0ZObgiiKJ9vD64yNdY1wI1G/v4gN3ti1fujtTJsg5898WZFuC on 02/23/2019 THE ART OF MEDICINE Cameron Young Sweeney, MMS, PA-C e fell out of touch after I moved 100 miles pleural sacs of the lungs that contains all the viscera of the away, and months had passed since our last chest except the lungs and pleurae. (\ lim- fad- n-'äp- -the\) ' ' Wconversation. Suzanne’s text out of the blue Abnormal enlargement of the lymph nodes got straight to the point. “My sister has stage IV lung The urgent care chest radiograph identifi ed a right upper cancer.” I picked up the phone and called. lobe mass. The follow-up CT revealed mediastinal ade- Suzanne had little information. She and her sister under- nopathy. Bronchoscopy provided the tissue diagnosis. stood even less. “What did the doctor tell you?” Non–small cell lung cancer. Negative molecular markers. “He was very nice. He used really long words. He wrote NSCLC. EGFR- ALK- ROS1- PDL1-. “Why would they some things down, but I don’t even know how to pronounce name something based on what it isn’t?” anything. It’s like he spoke Klingon... It’s bad, isn’t it?” Metastasis (\m -'tas-t -s s\): the spread of a disease- Dyspnea (\'dis(p)-ne- \): diffi cult or labored respiration producing agency (such as cancer cells) from the initial or Suzanne’s sister was a longtime smoker. Her usual “morn- primary site of disease to another part of the body ing cough” didn’t seem much worse but she found herself Her balance was wobbly, and she fell a few times. The increasingly winded and had to pause midway up the stairs staging scans confi rmed multiple lesions in her brain. to catch her breath. She blamed getting old and getting fat. Dexamethasone reduced the brain swelling but she com- Hemoptysis (\hi-'mäp-t -s s\): expectoration of blood plained that it kept her awake and caused her face and from some part of the respiratory tract belly to look puffy. She attributed the tickle in her throat to allergies or sinus Prognosis (\präg-'no-s s\): the prospect of recovery as drainage. She was treated for bronchitis. She didn’t think anticipated from the usual course of disease or peculiarities to mention that her morning phlegm was occasionally of the case smeared with pink, other times speckled rusty brown. She I cautioned that I could explain lung cancer treatment crumpled the tissue or rinsed the sputum down the drain only in general terms, because I was not privy to the specif- without close inspection. At a subsequent urgent care visit, ics of her sister’s case. I shared that stage IV cancer was she was given a nebulizer treatment, then sent home with incurable but could be treated for a while. “Can she take an inhaler and prednisone for a chronic obstructive pul- one of those medicines on TV commercials? They say you monary disease exacerbation. After a few more months live longer.” without improvement, they prescribed antibiotics, which Hospice (\'hä-sp s\): a program designed to provide didn’t help. palliative care and emotional support to the terminally Cachexia (\k -'kek-se- \): general physical wasting and ill in a home or homelike setting so that quality of life is malnutrition usually associated with chronic disease maintained and family members may be active participants She was delighted when she lost the fi rst 10 lb. It had in care always been such a struggle to lose weight before. When She responded to treatment briefl y but before too long 40 lb disappeared, her family began to notice and expressed the disease progressed. When Suzanne called to ask my worry. Her appetite was good, but her cheeks, once smooth opinion, I recommended that they follow the advice of her and apple-round, drew in like the fragile skin of an over- care team. I emphasized comfort care that would allow ripe tomato left in the sun too long. the family time together. Her sister died almost 6 months - - Mediastinal lymphadenopathy (\ me-de- -'sti-n l\) Of, to the day after her diagnosis. relating to, or affecting the space in the chest between the 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 lan- Cameron Young Sweeney practices in oncology guage of medicine, with polysyllabic words rooted in the at Novant Health Oncology Specialists in Winston- ancient tongues of the Greeks and Romans, can be unintel- Salem, N.C. The author has disclosed no potential ligible to the uninitiated, even when they speak English. confl icts of interest, fi nancial or otherwise. We disguise uncomfortable truth in jargon or cloak it in Tanya Gregory, PhD, department editor euphemisms, determined not to steal hope from those who DOI:10.1097/01.JAA.0000546486.89098.33 may be dying or denying. We think we are preserving hope, Copyright © 2018 American Academy of Physician Assistants but we may as well be speaking Klingon. JAAPA 58 www.JAAPA.com Volume 31 � Number 11 � November 2018 Copyright © 2018 American Academy of Physician Assistants Downloaded from https://pdfs.journals.lww.com/jaapa by BhDMf5ePHKZxZb3ruX4b9cKfbT5h3bp+v9gTtSlrchDWvVTxyN8Hif2P/rPZfAxb8td684/2m6Qj/1S0ZObgiiKJ9vD64yNdY1wI1G/v4gN3ti1fujtTJsg5898WZFuC on 02/23/2019 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the American Academy of PAs Wolters Kluwer Health

It's like the doctor spoke Klingon

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Wolters Kluwer Health
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1547-1896
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0893-7400
DOI
10.1097/01.JAA.0000546486.89098.33
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Abstract

Downloaded from https://pdfs.journals.lww.com/jaapa by BhDMf5ePHKZxZb3ruX4b9cKfbT5h3bp+v9gTtSlrchDWvVTxyN8Hif2P/rPZfAxb8td684/2m6Qj/1S0ZObgiiKJ9vD64yNdY1wI1G/v4gN3ti1fujtTJsg5898WZFuC on 02/23/2019 THE ART OF MEDICINE Cameron Young Sweeney, MMS, PA-C e fell out of touch after I moved 100 miles pleural sacs of the lungs that contains all the viscera of the away, and months had passed since our last chest except the lungs and pleurae. (\ lim- fad- n-'äp- -the\) ' ' Wconversation. Suzanne’s text out of the blue Abnormal enlargement of the lymph nodes got straight to the point. “My sister has stage IV lung The urgent care chest radiograph identifi ed a right upper cancer.” I picked up the phone and called. lobe mass. The follow-up CT revealed mediastinal ade- Suzanne had little information. She and her sister under- nopathy. Bronchoscopy provided the tissue diagnosis. stood even less. “What did the doctor tell you?” Non–small cell lung cancer. Negative molecular markers. “He was very nice. He used really long words. He wrote NSCLC. EGFR- ALK- ROS1- PDL1-. “Why would they some things down, but I don’t even know how to pronounce name something based on what it isn’t?” anything. It’s like he spoke Klingon... It’s bad, isn’t it?” Metastasis (\m -'tas-t -s s\): the spread of a disease- Dyspnea (\'dis(p)-ne- \): diffi cult or labored respiration producing agency (such as cancer cells) from the initial or Suzanne’s sister was a longtime smoker. Her usual “morn- primary site of disease to another part of the body ing cough” didn’t seem much worse but she found herself Her balance was wobbly, and she fell a few times. The increasingly winded and had to pause midway up the stairs staging scans confi rmed multiple lesions in her brain. to catch her breath. She blamed getting old and getting fat. Dexamethasone reduced the brain swelling but she com- Hemoptysis (\hi-'mäp-t -s s\): expectoration of blood plained that it kept her awake and caused her face and from some part of the respiratory tract belly to look puffy. She attributed the tickle in her throat to allergies or sinus Prognosis (\präg-'no-s s\): the prospect of recovery as drainage. She was treated for bronchitis. She didn’t think anticipated from the usual course of disease or peculiarities to mention that her morning phlegm was occasionally of the case smeared with pink, other times speckled rusty brown. She I cautioned that I could explain lung cancer treatment crumpled the tissue or rinsed the sputum down the drain only in general terms, because I was not privy to the specif- without close inspection. At a subsequent urgent care visit, ics of her sister’s case. I shared that stage IV cancer was she was given a nebulizer treatment, then sent home with incurable but could be treated for a while. “Can she take an inhaler and prednisone for a chronic obstructive pul- one of those medicines on TV commercials? They say you monary disease exacerbation. After a few more months live longer.” without improvement, they prescribed antibiotics, which Hospice (\'hä-sp s\): a program designed to provide didn’t help. palliative care and emotional support to the terminally Cachexia (\k -'kek-se- \): general physical wasting and ill in a home or homelike setting so that quality of life is malnutrition usually associated with chronic disease maintained and family members may be active participants She was delighted when she lost the fi rst 10 lb. It had in care always been such a struggle to lose weight before. When She responded to treatment briefl y but before too long 40 lb disappeared, her family began to notice and expressed the disease progressed. When Suzanne called to ask my worry. Her appetite was good, but her cheeks, once smooth opinion, I recommended that they follow the advice of her and apple-round, drew in like the fragile skin of an over- care team. I emphasized comfort care that would allow ripe tomato left in the sun too long. the family time together. Her sister died almost 6 months - - Mediastinal lymphadenopathy (\ me-de- -'sti-n l\) Of, to the day after her diagnosis. relating to, or affecting the space in the chest between the 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 lan- Cameron Young Sweeney practices in oncology guage of medicine, with polysyllabic words rooted in the at Novant Health Oncology Specialists in Winston- ancient tongues of the Greeks and Romans, can be unintel- Salem, N.C. The author has disclosed no potential ligible to the uninitiated, even when they speak English. confl icts of interest, fi nancial or otherwise. We disguise uncomfortable truth in jargon or cloak it in Tanya Gregory, PhD, department editor euphemisms, determined not to steal hope from those who DOI:10.1097/01.JAA.0000546486.89098.33 may be dying or denying. We think we are preserving hope, Copyright © 2018 American Academy of Physician Assistants but we may as well be speaking Klingon. JAAPA 58 www.JAAPA.com Volume 31 � Number 11 � November 2018 Copyright © 2018 American Academy of Physician Assistants Downloaded from https://pdfs.journals.lww.com/jaapa by BhDMf5ePHKZxZb3ruX4b9cKfbT5h3bp+v9gTtSlrchDWvVTxyN8Hif2P/rPZfAxb8td684/2m6Qj/1S0ZObgiiKJ9vD64yNdY1wI1G/v4gN3ti1fujtTJsg5898WZFuC on 02/23/2019

Journal

Journal of the American Academy of PAsWolters Kluwer Health

Published: Nov 1, 2018

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