What a Doctor Should Not Say to a Patient on a Friday Afternoon

You’ve heard the old joke, “I’ve got good news and I’ve got bad news,” right? Well, that actually happened to me.

Back in 2009, when I had my first vertigo attack, I complained to my doctor of fullness in my ears. I’d seen an internist in my doctor’s office, and sure enough, I did have full ears before the vertigo attack. After the attack, I didn’t see my doctor again, but since I still felt as if my ears were full, we thought I needed a myringotomy.

I had an appointment with my ENT (Ear, Nose & Throat) doctor on a Wednesday morning. I expected her to punch a hole in my eardrum and be done with it. When I sat down in the chair and she saw my ear, she immediately started to mutter and grumble. I no longer had fluid in my ears. Nuts. She sent me down the hall to the audiologist.

Well, I explained I couldn’t hear anything out of my right ear. The hearing test confirmed it. Perfect hearing in my left ear. Zero hearing in my right ear. We discussed this during my hearing test. I wasn’t worried. I figured it wasn’t permanent.

Except it was. When I spoke with the ENT, she explained that sudden sensorineural hearing loss (SSHL) is almost always permanent. Since it had been three weeks, I could try taking steroids in the form of prednisone. They had a maybe 10-20% chance of working. Did I want to try?

Of course I did. I know the side effects of prednisone. In the past, I’ve gained water weight, had some mania, and when I tapered off, had a little sadness when the euphoria wore off. I was willing to chance it.

When you have sudden hearing loss, SSHL, you’re supposed to get an MRI. That’s the standard of care. So Phyllis, my ENT’s assistant, moved heaven and earth, and got me an appointment for an MRI the next day, Thursday, at 3pm.

I’m on prednisone, so I’m happy and feeling no pain in my sprained ankle My ankle wasn’t going to get better, but I wasn’t feeling it! I’d been drinking water to manage my vertigo, but I tried to reduce in preparation for the MRI.

Everyone told me the MRI should take about 45 minutes. I was ready. I knew there would be two parts to the test, one before the dye, and one after. Total of 45 minutes? Piece of cake.

MRIs are supposed to be noisy and irritating. I find them mildly boring. I often fall asleep. Maybe because I only hear out of one ear?

I don’t remember if I fell asleep that day. I might have. I do remember wondering how long this MRI was going to take.

At one point, the MRI tech said, “I need to run a few more scans. Please stay still.” Okay, I can do that. “Just a few more scans, and then I’ll add the dye.” Okay. “Just a few more scans.” Okay, already.

Finally, she came in and gave me the intravenous dye. It was only supposed to be another five minutes after the dye. “I need to run more scans. Please stay still.” “Just a few more scans. Please stay still.”

I’ve heard this before. She had to run many more scans. My 45-minute MRI took 90 minutes. I suspect something is wrong.

I asked how it looked. The MRI techs are very well trained. She said, “You have big brains!” I laughed, and left.

A friend who knows about radiology, but is not a doctor, called that night. “How did the test go?”

“It went well,” I replied.

“So you were out in 45 minutes?” she asked.

See, this is when I really knew something was wrong. “Nope, it took me an hour and a half.”

Silence on her end. “Well, I’m sure everything is fine.” She had that tone in her voice that people use when they don’t know what to say. The tone where they would like to say, “Oh shoot. Now what do I say?” That tone.

There are signs all over the radiology department that say it takes 48 hours to read an MRI and not to expect any report from your scans before then. My MRI was 3pm on a Thursday afternoon. I figured I’d hear from my doctor on Monday.

My ENT called me at 4pm on Friday. This is less than 24 hours from the time I left after my MRI. “I’ve got good news and I’ve got bad news. Which one would you like to hear first?”

“The good news.”

“You don’t have brain cancer and you don’t have Parkinson’s disease.”

“Excellent.” I thought to myself,  ‘I will live through whatever this is.’

“Now for the bad news. You had an inner ear hemorrhage. That’s what is causing your vertigo. And, it’s what caused your hearing loss. And, now for the really bad news. You have a benign brain tumor.”

“Okay. Will this tumor make me smarter?”

There was a long pause.

“Um, no.” My ENT sounded puzzled. She didn’t know my sense of humor.

“Okay, then I don’t need it. Do I need a neurologist or a neurosurgeon?”

“A neurologist first. Then you decide what to do.”

The problem is not that I have a brain tumor. Well, it’s kind of a problem. The real problem is that I don’t have enough information, namely the proper name. The proper name is meningioma. If you search on meningioma on a Friday afternoon, you can learn enough to not be freaked. But, if you search on “benign brain tumor” on a Friday afternoon, all you learn is scary stuff. Extremely scary stuff.

This is what doctors should not say to patients ever, never mind on a Friday afternoon. Doctors should never use euphemisms. Doctors must use correct terminology.

If you are a patient, make sure you ask for the proper names of things. When I searched for “inner ear hemorrhage”, I found intralabyrinthine hemorrhage right away, so I knew what the proper name was. But, when I searched for benign brain tumor, there are too many kinds of brain tumors.

I have a meningioma on my right frontal lobe. It’s about an inch in diameter, on my dura, about in the middle of my right forehead. It’s not growing, so I’m not even considering surgery. I mean, really–who needs a hole in her head?

It means I need more MRIs. It also means that every time I fall down and need an MRI or a CT scan, especially somewhere where I’m a stranger and I forget to tell them I have a brain tumor, they don’t know how to break the news to me. “Oh, I forgot to tell you, I have a meningioma, right here,” and I point to my forehead. They are quite relieved that I know.

The byword with this brain tumor is “watch and wait.” Get MRIs, see if the darn thing grows, and as long as it doesn’t, do nothing. I get no airline points for my MRI visits.

Because it was a Friday afternoon, I could not discover what kind of a brain tumor I had until Monday. I would not wish that kind of a weekend on anyone.

When I made an appointment with a neurologist, I asked for one with a sense of humor. I figure if I’m going to have him for a while, I want one who has a shot of understanding my sense of humor. He does.

Every time I have a strange symptom–and, I have plenty–we blame it on the brain tumor. “Well, what do you expect of a woman with a brain tumor?” Or, we blame it on the vertigo. Every so often, we blame it on me, just being dumb, “Operator error.” But I like to blame it on the brain tumor.

If you have a condition, make sure you get the proper name. With the proper name, you can do the research. Without the proper name, you flail.

Oh, and now that my ENT knows me, she enjoys my sense of humor and she shows me that she has one, too!

5 thoughts on “What a Doctor Should Not Say to a Patient on a Friday Afternoon

  1. Debi Z

    On a completely different line, but another “what … shouldn’t say on Friday” – a few years ago, we received a registered letter (delivered by motorbike) late on Friday afternoon. It said that my husband owed 1 million shekels (>$250,000) to the tax authorities, and that they would be coming over on monday to reclaim all the contents of our house!! Needless to say, we did not have a very relaxing weekend…..
    In the end, it wasn’t for my husband, it was the wrong name, the wrong address, the wrong business, and the wrong city. But the woman at the tax office was still mad at my husband for making her go to the archives to fetch the original order ….

  2. M.L. Browne

    JR, are you SURE the “J” doesn’t stand for “Job” (or “Jobina”)?

    I totally agree with you about a) no “good news/bad news” comic delivery from doctors on Friday afternoons, and would extend it to EVER; b) patients are not incapable of hearing multi-syllabic diagnosis and dealing with it, so proper terminology ought to be a requirement (as in, first word out of the doc’s mouth after “benign brain tumor” should have been “meningioma”); and c) a sense of wit helps defuse ANY potentially awful situation, and provides a smidge of optimism, too.

    That all said, the MRI tech who said you have “big brains” was absolutely correct.

    I hope the tumor stays benign, and I hope you continue to update us through these posts as to how you’re doing.

    Best,
    Marsha

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  4. Michael Tardiff

    “Okay. Will this tumor make me smarter?”

    I love your sense of humor, and your fantastic laugh. I pray I have your presence of mind – and sense of humor – the next time I need to laugh at life’s surprises.

    Cheers.

    + Michael

    1. johanna Post author

      Michael, remember, I was already warned in some sense that the MRI news was not going to be good. It took 90 minutes for a 45-minute MRI. I knew there was a problem. And, the fact that my ENT called me less than 24 hours after the MRI was done? I knew there was a problem as soon as I heard her voice.

      This is when learning to breathe, to remember to wind your watch, whatever you do to get past the “oh no” or whatever you say when you first encounter a really bad problem is critical. Remember that part from PSL? I live it, I don’t just teach it. I’m human too, so I don’t always succeed. I have to admit, I get a lot more practice these days.

      Thanks for your compliment on my laughing. We don’t laugh enough in this world, as far as I’m concerned. I’m working on changing that. One laugh at a time.

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