Thursday, June 28, 2012


    There are times when we get a question ,'Doc , How long do you think I have or he has or she has ? ' We tend to avoid it , if not completely , at least partly . We truly work on stastics and it may be true in many cases but not in all the cases. ( I often make fun of stastics by saying that ,if you put your one hand in boiling hot water and other in ice cold water, then statisticaly you are at comfort! ).But this 'wisdom ' of not telling the truith or so called truith, does not come till you are proved to be wrong . This story is one from my earlier years of practice .
    I was called to see a patient , who was caughing up blood . He was 75 years old white male , who was a retired priest . He was married ,and had never smoked or drank alcohol. He had developed memory loss , and further work up revealed that he had pressure build up in the brain , which has caused damage to the brain and has caused memory loss . This is called 'hydrocephalus ' . This also caused weakness in both lower extremity and urinary incontenance. Now he was wheel chair bound and had to were diper and was not thinking right . He also had history of skin cancer , called melanoma . This type of skin cancer is notorious in relapsing , sometimes after many years . So when I saw him I was worried about CANCER.
      I spoke to his wife and did CT scan anad then decided to do Broncoscopy i.e. to see inside the bronchial tubes to find out cause of bleeding and to find out if there was a cancer and then decide on the treatment. She agreed .
      The CT scan showed that there may be a tumour in the trachea--the main wind pipe. I proceeded to the bronchoscopy . As I expected , it did show the tumour in the trachea. I did biopsy it . I explained to the wife that there was a tumour in his maain wind pipe and it was most likely a cancer . The next day I got the biopsy report and it did confirm the diagnosis of cancer . I told the wife that it was cancer and the only treatment that can be done was the radition treatment . With his condition I would not consider chemotherapy. and the surgery was out of question due to the location . She seemed agreeable for the radiation treatment , but asked me the age old question . 'How long does he hace ? '.I told her that the location of the cancer was bad and even if does well with the radiation , it is likely to grow and and it may bleed or compromise the breathing . So the life expectency was not great .. But she wanted more specific answer. I gave it . I told her may be 6 months or 9 months . The tumour was quite large and was bleeding .
       There was no way for her to bring him to my office as he was parplegic , demented and was quite heavy . 6 months passed . I had forgotten about him . Then I got a call from his wife . She wanted to talk to me . I thought for sure he must be short of breathor caughing up blood . So when I called her she said , "Doc, It is allmost 7 months and he has not died yet , whit do you want to do ? "
    I had no answer. I did do another CT scan and di another bronchoscopy . The cancer was still there , but it was very small and was not compromising his air way at all ! 

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