Bad Things Can Happen to Healthy People

I recently took care of a young patient who was diagnosed with a large neck mass that was compressing his windpipe and carotid and jugular vessels. He was diagnosed with tongue cancer years ago with a recurrence in 2008. He underwent surgery, radiation, and chemotherapy but unfortunately the neck mass developed. He fought hard. His family provided extraordinary support. However, there was nothing medically that could be performed to cure his cancer.

Reviewing his case, I expected to find the cause of the tongue cancer. I expected to see a tobacco history but he never smoked. He had no significant history of alcohol, drug, or tobacco use including chew tobacco. We looked at environmental and work exposures but found no association. He worked in HVAC. Bad things can happen to healthy people.

In medicine, we assess risk factors, find causes, and prevent potential severe medical conditions. We advise people to stop smoking to reduce the chance of heart disease. We encourage exercise and healthy diets to reduce the obesity epidemic. We vaccinate children to prevent Polio, Measles, Mumps, etc...We advise colonoscopies, pap smears, mammograms to prevent cancer. However, as in life, the unexplainable does occur in medicine.

One of the most frustrating aspects in medicine is when bad things happen to healthy people. This young man had no risk factors for tongue cancer yet he was diagnosed at around thirty years of age. The median age for tongue cancer is sixty. Risk factors include tobacco use, alcohol, HPV, and age. The incidence is about three per 100,000 per year (rare). We can only blame a faulty gene. The thought is always what could we have done to prevent this but unfortunately the answer is nothing.

Does this case reduce the importance of preventative medicine and risk factor stratification? No. It makes me appreciate how delicate and precious human life is and to be more cognizant about medical "zebras" and rarities. It makes preventative medicine more important so people can live life to its fullest. Therefore, eat healthy, drink in moderation, avoid drugs, do not smoke, exercise, and laugh. And if something bad does happen, understand that there is always a silver lining somewhere in the clouds, whether it be improving a physician's skill, bringing a family together, or making people appreciate their own lives.

Also, pray for the citizens of Haiti. It is a devastating situation and I wish to all my colleagues who are going to Haiti a safe journey.

Thank you.