The man went to the emergency room thinking he had a cold, but was told it was much worse



Jason came to the ER complaining of six weeks of intermittent fevers, chills and a cough. When her first symptoms started, several members of her family were suffering from similar symptoms. They tested themselves for COVID several times and it was always negative. He said he usually catches a cold every fall as the seasons change and he thinks it’s completely normal.

Jason started to worry when his loved ones were all better and he kept coughing. Tired, he took naps several days a week – which was very unlike him – but he was still able to continue working. He started eating better and taking vitamins. After feeling like he was finally kicking him, he would feel lousy again a few days later.

I went over Jason’s medical history and he told me he was healthy as far as he knew. He usually didn’t need to see a doctor because he wasn’t taking any prescription drugs. He admitted that his only weakness was smoking. He had smoked since he was a teenager. He briefly switched to vaping, but the stress of the pandemic got to him and he started smoking again last year. He said he had come down considerably over the past month because he had terrible coughing fits every time he smoked. He hoped he just needed antibiotics to finally recover from this illness.

Dr. Erika Kube

Listening to his heart and lungs with my stethoscope, I could smell cigarette smoke on his clothes, even while wearing my face mask. I placed orders for a chest x-ray and lab work and asked the nurse to do a COVID test as it had been a few weeks since he last tested himself.

Her COVID swab came back negative soon after and her lab work was not revealing. I looked at her chest X-ray when it appeared in the computer and was immediately concerned. Shortly after, the radiologist confirmed that Jason had a large mass in his right lung and several smaller masses in both lungs.

There were a lot of people in the emergency department that morning and I wanted to make sure I had uninterrupted time to talk with Jason about his results. I explained to his nurse what was happening and asked her to interrupt me only in case of an emergency. I sat for a while thinking about how much I hate having to break such news to patients. I took a deep breath, took a sip of my coffee, and went to Jason’s room.

For a while I felt relieved to have a mask because I hoped it would cover some of the emotion on my face. I tried to be positive when I walked in, but Jason must have sensed my concern. He sat up in bed and immediately asked for his results. I sat down, pulled out the chair next to his bed, and logged on to the computer to show him his x-ray. I carefully and slowly explained what the abnormalities were and what the radiologist’s concerns were regarding these results. I told Jason that although we were very suspicious, we couldn’t definitively diagnose him with cancer because he would need further tests like a biopsy.

He was silent for a minute or two. I let him process what we talked about and sat down with him. He took a deep breath and let out a big sigh. He said he knew something was wrong several weeks ago when he hadn’t bounced back like he usually did when sick. He also said smoking was bad for him and said he tried to quit many times but just couldn’t give up completely. He said he really thought he could quit a few years ago, but the pandemic hit and he smoked to cope.

He stopped for a moment, then looked at me and told me that his father had died of lung cancer. He started to cry and said he was afraid of what would happen to him after seeing what his father had been through. He asked me if I was sure he didn’t need antibiotics to get better. I told him that I wish that was the solution.

I handed him a box of tissues and tried to console him. We talked about the next steps for his admission to hospital so he can undergo further evaluation to make a definitive diagnosis and develop his treatment plan. I asked if he had someone he trusted to be with him and he said he would call his brother.

While he had been waiting in the emergency room for several hours for his bed in the hospital, his brother and his best friend came to see him. I went back to Jason and he told me he was fine and assured me he was fine. He said the support of his family and friends was exactly what he needed. His brother held his hand and promised he would be with him every step of the way.

Dr. Erika Kube is an emergency physician who works for Mid-Ohio Emergency Services and OhioHealth.[email protected]

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