BLOG: My patients, my heroes: ‘Doug, get your thyroid checked’
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In an afternoon Middle Clinical Experience teaching session, in the fall of 2018, I was sitting in the corner of the exam room watching the two students interviewing the simulated patient.
Middle Clinical Experience refers to second-year medical students at Michigan State University College of Human Medicine; first-year medical students are referred to as Early Clinical Experience.
These terminologies were introduced in 2016 in MSU’s new curriculum, referred to as the Shared Discovery Curriculum, which is an innovative curriculum based on simulation and housed in the Learning and Assessment Center. As stated in the center’s website, this new curriculum utilizes “... simulation of ‘real life’ events to prepare future and practicing physicians, nurses, veterinary technicians and other health professionals for contemporary health care. The combination of simulation, teaching/learning and assessment promotes skill acquisition that is intended to readily transfer to clinical practice.”
Simulated patients are hired people from the community who play roles of patients with various medical conditions, and students play the roles of “medical students in real life.” Our role as preceptors is to supervise the student-simulated patient encounters. Having been teaching at MSU for over 15 years, teaching both the prior curriculum and the new curriculum, I am very impressed with the simulation teaching model.
As I was watching the two students take a history, I noticed a lump in the neck of one of the students, Doug.
After finishing the teaching session, and as the two students were about to exit the room, I looked at Doug and said:
“Doug, get your thyroid checked.”
“Why?” Doug asked with surprise.
“You have a lump.”
It was a large lump, roughly 2 cm to 3 cm by eyeballing. Doug said he had never noticed the lump or had any related symptoms.
A week later, while I was doing afternoon hospital rounds, I was paged by a senior colleague in the college’s admission office who told me that Doug had had an ultrasound done, and a large suspicious thyroid mass was found. A fine-needle aspiration was planned at a radiology facility, but it was scheduled 3 weeks later. Doug was in his office and concerned about waiting.
I responded, “Please ask him to meet me in my clinic in half an hour.” Then I called our sonographer, Shannon Habermann, RDMS, RVT, and asked her to prepare the ultrasound machine.
When I arrived at the clinic, Doug had already been checked in and was sitting on the exam table while his father looked at his neck.
“Doug, is that your son?” I asked.
“Dr. Aldasouqi, yes, this is my son, Doug.” Father and son had the same name.
Doug Sr. then said, “Remember, I was telling you that I have a son in the medical school, and you might want to say hello. I was saying he is a good kid, and you will be proud of him.”
I then recalled that when Doug Sr. mentioned his son during his prior clinic visit, I asked how I would know him.
He said, “He has the same first and last name, Doug Jr.”
I may have taught Doug Jr. prior to this encounter, but I could not remember.
Doug Sr. was, coincidentally, my patient, for about 2 years. He had hypercalcemia, and we diagnosed primary hyperparathyroidism. He underwent resection of a parathyroid adenoma. He also had a thyroid nodule that we biopsied, and it was benign.
I asked Doug Sr. how they could have avoided noticing the lump in Doug Jr.’s neck since it was visible.
He said, “You know, Doc, he is a very busy man, between his apartment and his school, always studying, and we just did not notice the lump.”
There was no family history of thyroid cancer or radiation exposure.
The real-time ultrasound I did with the sonographer confirmed a large suspicious-looking nodule larger than 4 cm, with multiple suspicious lymph nodes.
FNA was done within few days. Papillary thyroid cancer was suspected. Within 2 to 3 weeks, a total thyroidectomy was done, confirming the diagnosis, with numerous metastatic lymph nodes. The first surgery was extensive and very lengthy. It was followed by another extensive surgery during which more metastatic lymph nodes were removed, one of which was outside the thyroid region, to the side (the supraclavicular region). Doug Jr. then received radioactive iodine ablation.
Doug Jr. had a smooth recovery. He is a strong and resilient kid. Remarkably, he is very polite, and very professional. He also has a great appreciation for his parents.
And he has a sense of humor, for sure! When he came out of the first surgery, which took several hours, I went to see him in the recovery room. I said, jokingly, “You made it, how are you doing?”
He looked at me with a smile and acting as if he just has finished a light sports game, he said: “I am doing great, Dr. Aldasouqi, but I wish they had longer stretchers.”
He is tall and his feet extended beyond the stretcher!
Doug Jr. graduated from medical school and is now doing an internal medicine residency at a prestigious program.
Now, about 4 years later, Doug Jr. remains in remission, in good health and in great spirits. Indeed, he is a good kid. After this encounter, Doug Sr. and I became friends. We started going to the gym together. I wrote about my (new) friendship with Doug Sr. in a post on this blog at the time. I titled the post, “Ping-Pong, MD,” but I did not mention Doug Sr. by name.
What reminded me of this Ping-Pong issue is a recent friendship. My new friend has convinced me to be more regular in going to the gym, as he is athletic, and despite his busy job schedule, he manages to find time for the gym. We happened to be members of the same gym in town. At my age of 59 years, this is perhaps way past due. I have always found excuses to avoid exercising, including a very busy schedule as a clinician.
Doug Sr. and I also meet up every now and then for lunch or dinner. We always talk about Doug Jr. and what a great kid he is. He is now aspiring to specialize in oncology. He wishes to share his personal experiences to increase awareness about thyroid cancer.
September is the thyroid cancer awareness month, and I hope Doug Jr.’s story will help spread awareness about thyroid cancer.
While the majority of patients with thyroid cancer have favorable outcomes, thyroid cancer is amongst the very few cancers that have increased, rather than decreased, in incidence notwithstanding the debate about the drivers or the implications of this observed increase in incidence.
The National Foundation of Cancer Research states on its website that thyroid cancer will likely kill 2,000 U.S. residents this year, and about 54,000 will receive a new thyroid cancer diagnosis.
The unique location of the thyroid in the neck provides an opportunity for good observers, especially endocrinologists, whether in person or virtually, to identify thyroid lumps for people who often don’t notice their own lumps. Over the years, as an endocrinologist, I have observed several thyroid lumps in people whom I knew or I did not know, and I would share the observation with them.
One such encounter several years ago was a cashier at a fun place in Canada. I was traveling with my family on a summer vacation. When I noticed the lump in the thyroid region of the woman’s neck, I was not sure what to do. I didn’t want the lump to be missed, but was it appropriate to notify the woman of its presence?
So, I asked my wife and my daughter for advice. They both advised that I should mention it to the woman. She smiled and thanked me, and then she said that she was aware, and that her doctor was in the process of evaluating the lump.” I was so relieved.
But I considered the detection of Doug Jr.’s thyroid lump one of the best blessings that happened to me in my career. His cancer was very aggressive, but thankfully it was effectively treated.
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