Rural Rounds

Last month I was on the hematology service at the University Hospital. It is a service primarily composed of patients with leukemias, lymphomas, or a disease called multiple myeloma (a rather unique cancer of the blood). Very busy service, routinely with 18-20 patients to see each day and manage outside of new admissions and coordination of discharges. It's easy to let yourself get automated in such an environment: are the labs normal? Ok. Any fevers? Yes? Draw blood cultures and start antibiotics, lets move to the next patient. Medicine is perhaps easiest when you know the problem and know the solution, and you see that the solution works. A great example would be a patient with an ear infection; I simply prescribe antibiotics in the clinic and they go home, 5 days later their ear is better. Medicine is far more difficult when death comes into play, or you have a therapy that doesn't work. Such is life on a cancer ward. I have seen a number of my or my colleages' patie