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A Piece of My Mind
May 22/29, 2018

Filling in the Gaps

Author Affiliations
  • 1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
JAMA. 2018;319(20):2079-2080. doi:10.1001/jama.2018.5837

On a fall morning in 2016, I was looking at an abdominal ultrasound scan together with the technician who had just performed it. Her face was ashen, and my own unease grew steadily as I contemplated the prominent findings: a grossly enlarged spleen, with massive lesions that encased the splenic and renal arteries and extended widely into the abdominal cavity. The scan was mine. As a medical oncologist with decades of experience interpreting such images, I knew my life was about to change even more dramatically. I was just finishing my first year of bladder cancer treatment, but clearly my ordeal was about to intensify. This was either metastatic urothelial cancer, an infectious complication from the bacille-Calmette-Guérin (BCG) immunotherapy, or more likely, a lymphoma.

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