GOOD ?BAD?OR UGLY?

       All of us know about the movie called the GOOD THE BAD AND THE UGLY. (May be all of us who are old enough to remember and not too old to forget).The words like good  and the bad are relative. When I diagnose the cancer of the lung and tell some one about the diagnosis, I often get a question , "Doctor , what stage is the cancer?" My answer is ,'Don't worry about the stage . It is only for treatment decision and the data collection. What I like to know is , is it operable and can be resected or can not be  resected."But sometimes I am lost for the words. That brings me to the today's story . I had seen this patient may be a year and half ago . She was admitted with the pneumonia and was quite short of breath. She was a smoker and had smoked for more than 5 years . She had some fever and cough .On couple of times she had noticed blood in the sputum . She neglected it , but when she started getting more shortness of the breath , she had to come to the hospital . She needed to be put on oxygen and we also started her on antibiotics . She also got steroids and number of medications. We did the CT scan and it showed the extensive pneumonia. But it also raised the suspicion of cancer . When she improved a little bit , I did a bronchoscopy. It showed a cancer which was blocking the main bronchus . The biopsy came back " highly suspicious for cancer , but not conclusive "So I had to do a needle biopsy of a lymph node above the collar bone and it gave the definite diagnosis of the cancer . She had 'inoperable cancer ' .It was inoperable due to multiple reasons , type of cancer , spread of the cancer to the number of lymph nodes and lastly her poor lung capacity . So she was started on chemotherapy.
        She actually did quite well and responded to the treatment . Her shortness of the breath got better , she was off oxygen for most of the time and she was not short of breath on usual activity. Then she had a mild heart attack. She also had one episode of irregular heart beats. But in spite of all this she did well . She had new scans and was doing OK . Then she had episode of the shortness of the breath and was admitted. This time she was very short of breath. I did do new CT scan and it showed that there was fluid around the lung .I decided to take the fluid out . So I took her to ultrasound department and did the procedure. When I put the catheter in I was surprised . The fluid was milky . I had not seen this kind of fluid in last 3 years!This was the fluid due to cancer clogging the lymph nodes and the drainage and that had caused the fluid . So the fluid did not show the cancer cells , Normally that would be a good news , But in this case the milky fluid itself in presence of cancer was bad news . I am not sure which one is BAD and which one is UGLY. But certainly NOTHING IS GOOD !(Though on surface when the family knew that the fluid was negative for cancer cells , they thought it was good news .)