18. The Other End Of The Spectrum
“Had an elderly man who was in his early 70s (long term smoker) who came in with shortness of breath, trouble breathing, and a little bit of a cough and occasional production of blood tinged sputum. <— that last one is a bad sign
He also complained of a little bit of back pain he’d been having that started about a month ago after he was helping his son move. When asked to rate his pain he said 2/10 (‘not too bad’).
He has no other history, always had good blood pressure, no cholesterol issues, no diabetes… has a little bit of anxiety/depression, unmedicated.
So we check him out. Reduced breath sounds all across, more so on the left lower side. Tenderness to palpation in the lower back, he jumped when we touched it, said it was about a 3/10 when we touched it.
Check vitals, his blood pressure is 180/85 (this happens with severe pain), he has no fever, and his heart rate is in the 120s (also happens with pain).
Get scans and labs. He has three broken vertebrae, probably pathological (caused by cancer) a pleural effusion (it was malignant, as in, caused by cancer), and a few masses in his left lung. Guy had stage 4 lung cancer that spread to his back, caused his back to break, and he said he had 2-3/10 back pain.
Either he was set on fire in his childhood and then beaten with 2x4s filled with nails then rolled in broken glass… or he was faking not having pain. This is someone who we would describe as a ‘minimizer’.
Not the typical story you expected, I guess.
He got his surgery, and the next day wanted to leave the hospital cuz he had to do some paperwork and pay his bills, didn’t take any of the pain meds offered to him, except at night to help him sleep.
I hope he’s still alive, was a really nice guy.”
