My memories of a life-changing event

In the spring before I entered medical school in 1982, I had an experience that had a profound affect on me as a doctor. I was finishing college in New Haven, CT and felt a sharp pain under my left ribcage radiating to my shoulder. While lying down, I saw a large asymmetrical fullness in my upper belly. A noticeable bulge in my left abdomen extended deep into my pelvis. The right side was flat. Every breath I took gave me a crampy pain in my left shoulder.

I had been the picture of health, an active twenty-five-year-old with nothing to fear. I had been accepted to medical school and was trying to bone up on premed subjects during an otherwise idle last semester.

When I went to the emergency room, I was referred to the college health service. I was told that I might have cancer. My spleen was enlarged causing pain and irritation on my diaphragm. The usual causes of an enlarged spleen are cancers of the blood and bone marrow. I read up on my condition and was expecting the worst. I was hoping for one of the more manageable blood diseases and started to imagine taking a semester off before medical school to undergo chemotherapy.

The anticipation was excruciating, worse by far than the pain in my shoulder. I couldn't get an appointment with a doctor for several weeks. I had a friend whose father is a doctor in New York City. He had me see a renowned hematologist (specialist in blood disorders) named Dr. Edward Amorosi, who admitted me to the New York University Hospital with a diagnosis of probable blood cancer.

Eventually I had a CT scan. This device was relatively new at the time. I met Dr. Alec Megibow, who was the CT specialist at NYU. While I was still on the CT table, he came into the room smiling and told me that the mass was in my spleen and was almost certainly benign because a large tumor had the consistency of water.

I had an operation to remove my huge water-filled spleen by a surgeon whose reputation is still known today, even though he died many years ago (coincidentally of a blood cancer). Dr. John Ranson (the author of the Ranson criteria for pancreatitis) did my splenectomy. I still cherish the intraoperative photographs he took.

So, what did I learn?

  • Pain is a terrible enemy. Shoulder pain can be due to an enlarged spleen or "referred" from some other problem within the abdomen.
  • Uncertainty and anxiety increase the terrible stress of waiting. Waiting for tests, appointments, and procedures should be reduced to a minimum for all patients.
  • Special attention from providers is important. Medical people are wonderful (with a few exceptions). They deserve a great deal of respect for the work they do.
  • A midline incision hurts, but gets better with time.
  • A nasogastric tube is awful.
  • You can live a normal full life without a spleen. After a stressful health situation like this, you wonder whether you will ever be the same. I know now, almost 30 years later, that the answer is no, you will never be the same. But like most memories, this one has faded and rarely penetrates my consciousness.