Dear PCP

Hey there, Dr. Brown.

Just wanted to send a little note to warn you that I’m coming to see you soon for my “check up.” You and I both know that this will be my yearly opportunity to spew all of my worries on you and for you to reassure me that I’m not dying. Have you blocked at least an hour for me? I’ve got a boat load of random symptoms that I’ve managed to catastrophize into a handful of different terminal diagnoses.

We went to med school and residency together, so you know how my brain works. And you know that as a palliative care doctor I live in the world of worst-case-scenarios. When you have a patient that comes in with a headache, 99.9% of the time it’s a tension headache or a migraine and they end up being perfectly okay. I see the other 0.1% of patients who presented with a pretty benign complaint and ended up having cancer all over their bodies.

I try to rationalize my fears and for the most part I think I do a decent job….that’s why you don’t get calls from me every single day. But I’ll tell you, it takes a lot of deep breathing, Uptodate searches and sometimes….even a google search. I know, I know…we tell our patients not to google their symptoms. We also tell our patients not to drink too much and to get plenty of exercise.

I’m going to get my fasting labs drawn soon, per your recommendation. I’m pretty sure my hemoglobin will come back a little low again. In which case I will assume I have a GI malignancy that is the source of the blood loss…that was missed on the previous, thorough work up you so kindly and astutely ordered when I emailed you in a panic. Thank you. I’ve thought about taking the iron that is in my cabinet, but I perseverate nightly wondering if this will just mask the evidence of the cancer or if it will actually help. Be ready to talk me through this. Should I get an EGD?

My labs will probably show that my creatinine is on the higher side of normal. I’m pretty sure this is because my only fluid intake is in the form of coffee and red wine. I’ve actually never taken care of a patient who developed renal failure from drinking too much coffee, but surely this could happen. Should I cut down on my coffee? Also, there was an article on MedScape that suggested coffee actually has some protective benefit. I’m so confused. What should I do?

I may also mention my occasional frequent heart palpitations. I palpated my carotid a while back and had an episode that felt like trigeminy. I’ve been having palpitations for over 10 years though and haven’t died yet, so that’s kind of reassuring. I don’t know if you’re going to want to work this up or not. Maybe a holter monitor? An echo might not be a bad idea, but those are expensive. And you know…deductibles. I do drink a lot of coffee (see above) which could probably be exacerbating them. Maybe I’ll just keep monitoring it. Should I text you when it happens again?

Did I mention headaches? Sometimes I have them. Usually after I’ve slept funny or consumed too much wine (see above). Do you think I need an MRI? Because it could be a glioblastoma…or metastatic melanoma. Or maybe even an aneurysm that’s about to rupture. Coffee seems to help them. Which leaves me in a bit of a pickle.

Sometimes I’m a little forgetful. Like straight-up can’t remember certain words. Specifically “acorn” as it pertains to squash. We have acorn squash at least once a week and I always struggle to remember the word “acorn.” We also eat butternut squash and that never trips me up. Is that weird? Do you think I might have early onset dementia?

Last week I ate a bunch of popcorn and immediately my tongue started to tingle a little. At first I thought I was having an anaphylactic reaction to popcorn….which sounds weird, but I googled it and it’s a thing. But then I looked at my tongue in the mirror and it was FASCICULATING. Like, fine tremors all up in my tongue. And, of course you know where my mind went next. ALS. Bulbar onset ALS. FUDGE BROWNIES! I googled that too and it turns out that coffee (see above) can trigger fasciculations in otherwise healthy subjects. I’m still a little worried though. Should I get an EMG? Can I still eat popcorn?

I have a lot more thoughts…and questions, but I’ll leave you with these for now.

I’ll see you soon. Thanks, in advance, for tolerating my crazy. Do you think an hour will be enough?

Your friend and patient,


This is only my second cup today.

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