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Voices: Changing Red to Black

May 1, 2013

Changing Red to Black | B.J. Rimel, MD

Every day after clinic, I sit with my list of patients in front of the computer screen. I type in the login and the password that keeps changing every month. Entering each medical record number, I wait for the electronic medical record to load so I can view the results. In my deepest, most secret place in my heart I say a little prayer for black. Black numbers are good, inside the normal range. Red numbers are the computers way of alerting me that the value I’m expecting is outside of the normal range and something is not as I want it to be.

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For each patient on my list I make little checkboxes with the labs or scans that I’ve ordered. I methodically look at each result and check the box when I’ve reviewed it. Every normal result gives me a little relief from the anxious feeling I get as I open the records. Will it be ok? Will it be fixable if it’s not ok? Will I know what to do next? Does anyone know what to do next? These are the thoughts that go through my head as I mentally connect my patient’s history with their lab value or scan result.

Sometimes the results are great – biopsy benign, CA-125 normal, CT scan with no evidence of disease. If there is no one around, I might even jump up and down when I read these results. I immediately call my patient and tell her the news. It puts a smile on my face every time. Nothing, and I mean nothing, feels as good as relief.

Sometimes the numbers are red. CA-125 is up. Tumor seen on scan. Biopsy shows a cancer. I’m sad, heavy with uncomfortable knowledge. Before I call my patient, I think through those questions that were furiously flying through my mind before. I wait to make sure that I have a plan of action, answers that make sense. I wait to make sure I have considered all options, sometimes surgery, or chemo, or radiation, or hospice. I wait to make sure that my voice won’t crack as I deliver the news.

I can only theorize on what my patients go through as they wait for me to call. It’s all so unfair, this unpredictable cancer. It seems sometimes like a roulette wheel, where I am always praying for the ball to drop on black. Our training as gynecologic oncologists teaches us to handle the red. Some things are an easy fix, some are impossibly hard. But this is our job—we turn red to black.