A 3 a.m. ER visit I still think about

Years ago, on a night shift, a man came into the ER around 3 a.m. He apologized before he even sat down. He was sorry to bother us, sorry it was the middle of the night, and sure it was probably nothing.

His shoulder had been hurting for weeks. It had gotten steadily worse, and now it hurt most at night, enough that he couldn't sleep. He'd tried ibuprofen, ice, and sleeping in a recliner. He figured he'd strained something.

The X-ray of his shoulder didn't show a strain. The bone had a "moth-eaten" look, the pattern we see when cancer has spread to bone. A chest X-ray found where it had started: his lung.

I think about him often. Not because anyone did anything wrong, but because of how long he waited, and how sorry he was for coming in at all.

The lesson

Pain that keeps getting worse, pain that wakes you up at night, and pain that doesn't act like a normal injury are worth a call. Not in a few months. Now. Most of the time it turns out to be something simple. But "I didn't want to bother anyone" should never be the reason something serious gets found late.

This Month

Lung Cancer Awareness Month

Lung cancer is the leading cause of cancer death in the U.S., and it's usually found late, when there are already symptoms. A yearly low-dose CT scan can catch it early, when it's far more treatable.

You may qualify if you're 50 to 80 and have a 20 pack-year smoking history (for example, a pack a day for 20 years), even if you quit long ago. Many people who qualify have never been told. If that might be you or someone you love, ask.

Practical Tip: When Pain Deserves a Call

• It wakes you up, or it's worse at night
• It keeps getting worse instead of better
• It comes with weight loss, fevers, or night sweats
• There was no clear injury
• It just doesn't feel like your normal

From Anchor Point

In the spirit of early detection: Anchor Point now offers the Galleri® test, a blood test that looks for signs of many types of cancer, including several that have no routine screening today. It doesn't replace standard screenings like colonoscopy, mammograms, or the lung CT above, and results need careful interpretation, so I talk it through with everyone before ordering. If you're curious whether it makes sense for you, reach out.

The point of having a doctor who knows you is that you never have to apologize for calling. That's what I'm building here in Bethesda.

If you've ever wondered what a concierge practice actually includes, I wrote a short guide:

What to Look For in a Concierge Doctor →