Happiness in this World

When I was a third-year medical student rotating for the first time on a general medicine service inpatient ward, my team admitted a thirty-year-old woman in acute congestive heart failure. That a thirty-year-old was in congestive heart failure was unusual enough. Even more shocking was the cause: an echocardiogram revealed a tumor sitting on top of her mitral valve preventing the normal flow of blood out of her lungs to the left side of her heart. No one on my team, including the attending physician, had ever seen anything like it. A CT scan revealed widely metastatic cancer throughout her entire body—it looked as if every square inch of her had been splattered with buckshot—with no obvious dominant lesion to suggest its point of origin. Continue reading…