Friday, August 31, 2018

LUCK

      I was reading an article from one of the Indian magazine . It was about the statistical probability and the prayers. But the question that arose in my mind is can you change the destiny with efforts or prayers? There is  story of a king in Mahabharata , where the king knew that he was going to die of snake bit .So he gets out of his Kingdom and becomes easy  pray for the snake . This brings me to my today;s story .

    I have known this patient for several years . He had bad lungs and had sleep apnea .He was obese and had cardiac issues . He had open heart surgery too . he was doing OK . But he had multiple problems . One day he was hospitalized for pneumonia and then he had pus collection in the pneumonia -what is called lung abscess . He needed antibiotics for long time . He improved , but the chest X- ray and the CT scan continued to show the abnormality I continued to do follow up for several years . I had also done Bronchoscopy and all the work up was negative for cancer . This  continued for 5 years . Then he had back problem and went for surgery . He had major problem and was in and out of hospital and needed antibiotic . He did improve . The a year down the road he was in hospital for heart problem . I did  see him and did CT scan of the chest . It showed the same abnormality , which was due to old abscess may be 4-5 years ago . But there was a new nodule . So we decided to do some work up . He was ot in the best shape , but we did follow up CT scan and then the PET scan . The nodule increased in size and so I did send him to Radiation doctor . . We decided to do the biopsy . The needle biopsy was done and it showed the lung cancer . It was very small and so we did radiation treatment called steriotactic radiation. He did well and the repeat CT scan and then the pet scan did not show any cancer . He did OK for next 5 months . Then one day he had nausea and vomiting and felt weak and could not do much walking and so he came to hospital.
I saw him and then the work up was done . He had no sign of the cancer where he had biopsy confirmed cancer , but the other nodule - which has been stable for few years was minimally enlarged . But he had nodules in Liver . We did additional work up and he has cancer in spine and liver and lung . The biopsy was done and it was confirmed that he had what looked like lung cancer , but the type of cancer that he had this time was different than the first one that we treated 6 months ago .

     He was seen by radiation doctor and cancer specialist . Next 2 weeks down the road his condition deteriorated to a point that we decided to put him on Hospice .

    So we watched the nodule and it was stable and we treated the cancer that we diagnosed , but we could not  'change' the outcome or may be destiny  or LUCK !!!