The Patient as Teacher

Medical students in Pathology 201 occasionally have guest lecturers who are patients of SUNY Upstate physicians. The patients speak candidly about the physical, psychological and emotional toll of living with a disease.

For students, it's a unique, intimate perspective they wouldn't otherwise hear in such detail.

"We get to meet patients who talk in detail about their disease and the impact it has on their life," said Irony Sade, a second-year student. "It puts a human face on the pathology we learn in class."

Or, as Kara Kort MD put it, "Behind all the endless lectures you sit through are real people who will be affected by what you learn." Kort, clinical associate professor of surgery, and three of her breast cancer patients visited a Pathology 201 lecture.

Steven Cucci, another recent guest, told of the constant knee pain he had in the mid-1990s, when he was a teenager and an athlete. For months, he kept hearing it was a "sports injury."

Doctors prescribed pain medication and fitted him with a knee brace, thinking it was torn cartilage. They didn't investigate why Cucci had pain in his lower thigh when he sat in a chair.

They missed red flags such as Cucci's loss of appetite and weight (160 pounds to 145); his increasing pain over time (sports injuries typically don't do that); the off-and-on pain, especially at night.

Cucci said the typical reaction to his description of symptoms was, "Nothing does that, so nothing's wrong."

But there was something wrong. Cucci came to SUNY Upstate, where orthopedic oncologist Timothy Damron, MD, diagnosed Ewing's Sarcoma in the femur, the major leg bone above the knee.

"It's an easy thing to do, to just look at the knee and not the thigh," said Damron, who accompanied Cucci during his visit with students in the Weiskotten Hall Medical Alumni Auditorium. "You've got to think about 'referred pain.' Knee pain can come from a region above the knee."

Damron told students to consider alternative diagnoses if the initial evaluation doesn’t seem to fit. "You are an advocate for the patient," he said. "You're here for the patient. Nothing else matters."

Almost 15 years later, after several bone fractures, surgeries and rounds of chemotherapy, Cucci is cancer-free with some restricted mobility.

"The worst thing about the disease is not the disease itself – it's the chemo," Cucci said, noting that he dropped another 20 pounds, to 125, after chemo started. "It knocks a lot out of you and kicks your butt."

Pathology coordinator Steve Landas, MD, asked Cucci if he had any advice for the medical students in the audience.

"Listen to the patient, understand what they are telling you. If the patient keeps coming back (with unusual symptoms), do tests you don't necessarily have to do," Cucci said. "Just listen to the patient, talk to them and force them to think about what's going on. Ask them different questions that can help YOU understand what's going on. At first, I didn't explain my symptoms as well as I should have, but I didn't know any better at 16."