trust

The result appeared without elaboration among the usual pile of pathology reports. I felt nauseated.
She had first come to me nearly two years ago for management of a cyst on the left side of the pelvis. She had placed her trust in me when I decided not to operate. I believed that it was benign. On ultrasound it was simple, thin walled, mobile and without any increased blood flow. Her other ovary was easily seen, small and normal in appearance. She had been told that the left ovary had been removed in a long and difficult operation which suggested, first, that the cyst should not be ovarian, and second, that surgery in that area might carry a greater risk of serious injury. As a final reassurance her Ca 125 antigen was normal, only 4.
Now it was1460.
I rang the laboratory to find out if there could be an error, but they couldn't check before her appointment the next day which by coincidence had been booked months ago for routine review.
Guilty and upset, I couldn't sleep.
Next day, when I called her name in the waiting room, I could instantly see her distended abdomen, though she was unaware of its significance. In the consulting room I explained my concern about the result then performed an ultrasound scan. She was indeed distended with ascitic fluid, most likely due to ovarian cancer, but the original cyst was still there, unchanged, floating free in the watery milieu.
It was not my fault. My relief made me feel unworthy as I prepared to make arrangements for the treatment of her coincidental carcinoma of the opposite ovary. It was no relief for her.