Case Summary:
You are Elaine Stuart, a 55-year-old math teacher. You began experiencing rectal bleeding two months ago. You were in this doctor’s office two weeks ago for results of a colonoscopy and biopsy which had been performed. You were then told that you had colon cancer and were sent to a surgeon on 1/29/98. You had a bowel resection performed on 2/2/98. It is now 3 days after your surgery. During surgery, all visible cancer was removed, as well as some suspicious lymph nodes (the cancer had spread through the wall of the colon into the lymph nodes). At this point, there are no obvious signs that it has spread any further and is classified as a stage 3 carcinoma. Five-year survival rates range from 35% to 65%. After 5 years, you would be thought of as cured.

Why You Are Seeing The Doctor Today:
The resident is seeing you today in the hospital, before you are discharged (likely in 2-3 days). He is seeing you to discuss surgical findings (Stage III cancer) and to discuss referral to an oncologist for adjuvant chemotherapy.

Opening Statement:
In order to start all of the encounters in a similar manner, your opening statement should be about obtaining the results of the analysis which was performed following your surgery. It’s hard to predict what the resident will say when he/she comes in the room; your response should be appropriate to the resident’s statement or question. For example:

The resident may ask you, "How are you doing, Ms. Stuart?"

• You would respond: "I’m feeling OK, a bit uncomfortable. I’d like to talk to you about what they found during the surgery."

Physical Description:

• Looking a little pale, dressed in a hospital gown.

• You appear to be fairly calm.
• You look the resident in the eye.

If the resident agrees with the surgeon, saying, "Yes, all was removed," you will react favorably and happily, saying, "Wonderful! That’s great! What a big relief!"

If the resident contradicts the surgeon, perhaps saying, "All visible cancer was removed, but we can’t be sure that some microscopic cells haven’t traveled to and invaded other areas of your body." (Or something to this effect.) In this case you:

• Will become more anxious as the interview proceeds, once you’ve been told that the cancer may have spread to other areas and the resident talks about survival rates or other issues.
• As the resident explains the treatment that you will need, he/she should acknowledge or ask about your feelings or concerns.
• If he/she does not, you will become quiet, as if you are thinking about something or are worried. Hopefully, this will prompt the resident to ask about your concerns, which are:
  • the possibility that this could now lead to a colostomy (wearing a bag for waste) or the need for further surgery.
  • the possibility that this has already spread to other organs.
  • you wonder about the effectiveness of the adjuvant chemotherapy that you will be having.
  • you’re worried about side effects of the chemotherapy ("Will I be sick?, Lose my hair?", etc.).
  • you wonder if/when you will be able to return to work.
  • you are worried because it seems more likely now that you will die/not survive this.

• You have been generally in good health.
• No allergies.
• Hospitalization: tonsillectomy at age 9; bowel resection done this week.
• Immunizations up to date.

You have been feeling sore since the surgery; you are uncomfortable since you have not as yet moved your bowels. You are concerned about when this will occur. You are also very concerned about the results of the tissue analysis from your surgery.

• Your current symptoms began about 8 weeks ago when you began noticing blood in your stool.
• The amount of blood increased and you became quite concerned; this is when you first saw your doctor (4 weeks ago).
• Because of the blood, you were sent to a GI specialist, who did a colonoscopy and biopsy on 1/14/98.
• During the colonoscopy, a mass was found which was immediately biopsied. You were told that the biopsy revealed cancer of the colon and were sent for this surgery.
• You have not lost a significant amount of weight.
• You are experiencing the following symptoms: abdominal tenderness and gas pains. You have been feeling fatigued for the last few weeks and weaker since the surgery.

• Prescription Medication: You were given "shots" for the pain initially following your surgery; you are now taking pain pills (Percocet). This is what you will answer when asked, "Are you on any medication?"
• Over-the-Counter Medication: Over the counter vitamins. Aspirin for occasional joint pain. This is what you will answer when asked, "Do you take any over-the-counter medicine?"

Personal Habits:
Alcohol Use: A glass or two of wine on weekends.
Tobacco Use: None.
Caffeine Use: 2 cups of coffee a day.
Drugs (Illicit): No history of illicit drug use.
Vitamins: Take "One a Day," one tablet per day; occasional aspirin for joint aches.
Exercise: You don’t have time.
Health Insurance: You are covered under your school’s Independent Health Association Plan.

• You will respond the same to all interviewing styles.

• "Will they eventually need to do a colostomy or other further surgery?"
• "Could this really have already spread to other organs?"
• "How effective will the chemotherapy be in preventing further spreading throughout my body?"
• "Will I be able to go back to work?"
• "What are my chances of surviving this?"