CASE VIGNETTE – APRIL 2019

An Evening At The Broncos

Try to imagine a winter’s afternoon, a Friday, at about 5:30pm. I was sitting in my consulting rooms on Wickham Terrace with my back to the window. The window gave a splendid view of the city lights. Seated opposite the desk was a young couple, probably in their late thirties or early forties. They had two children, both boys, aged 11 and 8.

The wife was the patient. She gave a six weeks history of lower back pain which was almost constant, definitely disturbing her sleep and without any particular radiation into the lower limbs suggestive of a sciatica. She had been reviewed by her general practitioner on numerous occasions, had undergone a month of physiotherapy and had also attended a chiropractor.

Clinical examination revealed some tenderness in the lower part of her lumbar spine and in particular, lateral to the sacroiliac joint. This joint is made up of the sacrum (which is part of the vertebral column) and the hemi-pelvic wing on that side.

I looked at the radiographs. Those of the lumbar spine were unremarkable. The CT scan examination that had been arranged was also within normal limits. There was no sign of any disc narrowing, disc bulging or neural compromise.

What I did see however caused considerable alarm. It was on the left side, medial to the SI joint, and involving the sacrum proper. The lesion was approximately 5cm across and it looked as though a small shark had taken a bite. This was her first presentation with breast cancer. This was a secondary deposit in the pelvis, destroying bone and heralding a premature end to her life.

The cause for this problem was clearly outside my purview. I broke the news as gently as I could, I made several telephone calls while they sat in my office and I made arrangements for her to be seen by both a breast surgeon and an oncologist the following morning, the Saturday. It was obvious that they were grateful but more importantly, they were overwhelmed with grief.

The level of grief, its intensity and its sudden onset were all understandable. There was however a dimension that I had not expected.

The four of them (the husband and wife with the two boys) were en route to a home match of the Broncos. They were trickling down the hill towards Lang Park. They were going to stop for a bite to eat at a hamburger joint on the way. The family was very excited.

Amongst the myriad of thoughts passing through the minds of this young couple was how they would go out into the waiting room and break the news to the boys. Would they hold the news until tomorrow so that the boys could enjoy the Broncos match, would they tell the boys but still go to the match anyhow and try to enjoy themselves, or would they tell the boys and simply abort the evening and go home?

To this day, I cannot quite remember what decision they made. I do remember though feeling the grief for them. I suppose there is half a dozen memories I have like this after 40 years in practice. You will understand that these memories just never fade.