Anxiety in the scanning age

Direct access diagnostics can be a double-edged sword

What IS a lesion?” she said, leaning towards me, arms folded across her lower chest as if trying to hold herself together. “You know me, I tend to worry.”

In other words, she was asking me to say it’s nothing at all.

“Well, it doesn’t mean cancer, if that’s what you’re worried about,” I said. “The x-ray just said lesion. A lesion could be nothing at all. It doesn’t mean cancer.” I wrapped my arms around myself and leaned forward, mirroring her pose. “You know, it could be nothing at all.”

“What if it is cancer?” she said, her arms tightening around her, leaning further forward. “You know me, I’m a worrier.”

“The report just said lesion,” I said. “A lesion doesn’t mean cancer.”

“What if it is?” she said.

“But I’m almost certain it isn’t.”

“What is a lesion anyway?” she said. “And what about this pain?”

“I haven’t forgotten the pain,” I said.  “The pain is the reason we’re doing the tests.”

“Oh, of course. It’s just, it’s still there, around my belly button, worse over here.” She dug her fingers into her right side and moved them around. “Can I have something for it?”

“Well, yes, I can give you something to try. But I’m still not sure what it is.”

“Oh, of course. It might be the lesion.”

“Probably not….”

“Oh, then why are we doing another scan?”

“Because you had a pain, we did a scan. The report says there is a lesion on one of the adrenal glands and….”

“What glands? I didn’t know there were glands in the stomach.”

“I’ll explain that in a minute. First let me tell you why you are having another scan.”

I turned to the computer where the scan report was open and began. Maybe I should read her the report.

“All these tests have me really worried,” she said. “I didn’t sleep a wink last night after getting the message to come in. Why didn’t they just do the scan when I was there? How long will I have to wait? What was the name of those glands?”

What, if any, question should I answer?

“I still have the pain,” she said, perhaps deciding that she didn’t need answers. Perhaps she was asking questions she didn’t want answered and not asking those that she did. Perhaps she wanted to distract me so that I wouldn’t give her bad news. The news I had wasn’t bad. It should have been a very straightforward consultation. An ultrasound scan showed a likely benign lesion on her left adrenal gland. The radiologist suggested a CT scan to confirm that this was of no consequence. I just needed to tell her this, send the referral, and she could leave.

She placed her hand on her stomach. “It’s all around here. All around the belly button,” she said. “Is that where the lesion is?”

“Yes and no,” I said. Was it any wonder that she was confused?

“What is a lesion anyway?” she said.

I gave her a very short explanation of the glands and their location. I realised that I had never had to explain a “lesion”. I wasn’t very eloquent. “It looks like one little area in one of your glands is different to the rest of the gland,” I said.  “It’s not a growth or a tumour. It’s just different. It’s very unlikely to be causing your pain. A CT scan will tell us for sure that it is nothing to worry about.”

“But I do worry, doctor. You know me. I’m a worrier.”

The explanation had fallen on deaf ears. The wait for the CT scan would be trying.

“Look,” I said, “the CT scan will check out all the organs that could be causing that pain. And if it doesn’t find anything, then I will have a better idea how to treat it. In the meantime, if you don’t mind, I’m just going to put a hand on your tummy to make sure there is nothing new there and then I’ll give you something to see if it helps. How does that sound?”

I got up and tore off the used couch roll, threw it in the bin, and covered the couch with a fresh piece of roll. Her face brightened as she opened the top button of her trousers and moved over to the couch. She lay down, the ritual familiar to her. A moment of quiet, I thought as I laid my hand on the places where she had indicated the pain.

“And my neck is killing me doctor,” she said. “Could you have a look at it for me, please? And maybe I could get a scan on that at the same time.”