THE HEARTACHE OF A FAILED FOLLOW-UP

A physician once shared with me the following story.  A very attractive, soon-to-be-married, 29 year old woman came in seeking relief from the typical symptoms of a bladder infection: pain with urination and mild low abdominal pain.  She had no fever, back pain or for that matter any other symptoms.  Didn’t even feel bad.  Just painful urination.

The routine analysis of the urine, which involves both a dipstick and microscopic examination of the urine sediment, revealed the typically large number of white blood cells, or “pus cells” or “infection cells” as they’re frequently called.  But it also revealed a fair number of red blood cells but not in a sufficient number to be seen with the naked eye in the urine cup or commode water.  The doctor prescribed an antibiotic with instructions for her to
follow back up with a urinalysis several days after she completed the antibiotic course to make sure the microscopic blood had cleared.

She was an event coordinator, very busy, and didn’t have time to do much of anything between her work and planning for the upcoming wedding.  She was totally without symptoms, voiding well, and since she felt her recent sexual activity had really been responsible for the infection, she put off the follow-up.

Until two months later when her symptoms returned.  Same song and dance.  She went to her doctor, he and she both suspecting a bladder infection, with the perfunctory urine examination again revealing the infection cells – and the microscopic red cells.  He prescribed an antibiotic and gently scolded her about following up so the urine could be rechecked and confirmed to be clear of microscopic blood.

Once again she went about her business with even more to do than before since the wedding was just around the corner.  Again, she failed to follow up with a recheck of the urine as she was totally devoid of symptoms, having no pain with voiding or with sex or with anything else for that matter.

Another three months passed when her symptoms revisited.  On this occasion she attempted to treat the almost certain recurrent bladder infection with over-the-counter preparations, and diluted baking soda which she had heard was an old remedy.  But this failed so she called her doctor and asked to have an antibiotic called in since she was having the same symptoms and problems as the previous two times.  

After reviewing the notes from her last two visits, her physician refused to call in the antibiotic and told the nurse to urge her to come in for another urine analysis.  Another week passed until, exasperated, she marched into the doctor’s office inconvenienced over this distraction what with so much left to do.  But on this occasion she shared with the doctor that she had felt she was in a “funk,” that she now had mid-back pain and was feeling clammy and weak.  She had passed these feelings off to just all the running around and being very active and busy.

But also on this occasion her urine was loaded with microscopic red blood cells and the white cells were now misshapen and in greater numbers.  An IVP, a dye test that images the kidneys, revealed a strange shadow on her right kidney.  A CT scan revealed it to be a solid mass.  A follow up biopsy of the kidney
under fluoroscopy revealed a malignancy.  And follow-up surgery the next day confirmed the diagnosis and the diseased kidney was removed – along with 14 surrounding lymph nodes – six of which proved to contain malignant cells from this newly diagnosed renal cell carcinoma.

Her physician explained the prognosis, which wasn’t good, but promised along with the cancer specialist, an aggressive treatment to the extent that her small physical frame would allow.  

Since they had known each other since college, she and her fiancé were married the following month, in spite of the 10-15% chance of survival. 

Six months later her well attended funeral took place on a rainy day in December, at a cemetery located at the outskirts of town.