Monday, September 24, 2012


    In practice of the medicine , we often tend to see things that reminds me of the story of ' 7 blind men and the elephant '.I also think of saying in one of the scriptures, which states that the the Truth is one and wise men interpret it differently. I have personally seen this and experienced it too . It reminds me of old story .
     In old days there was a train and it had 4 people in a compartment. There was an old lady , one young lady , and 2 young men . As the train was moving at night , the electricity went off ,and there was transient darkness. At that time there was a sound of kissing and it was followed by sound someone slapping . When the lights came back, the old lady thought that one of the young men kissed the young girl, and she slapped him . That was her truth. The young lady thought that how stupid are these men , I am here and they or at least one of them is kissing the old lady . That was her truth. The one man thought that the other man kissed the young girl, and I got slapped . So all three had thought that they 'knew' the truth.AND The REAL TRUTH was that one of the men kissed his own palm and slapped the other man .
    In medicine we often think that we 'know the truith'. And when the truth is out it comes as a surprise on at least some occasions .The story that I am going to tell is one such case .
    I saw this 67 years old male for cough that was going on for 2or 3 months .The primary care doctor had done a chest X-ray,and it was reported normal. He was treated with antibiotics.He was also give cough medicines and was even given a short course of steroids. He felt little better, but the cough continued . It was so bad that he had blood tinged sputum.So he was refereed to me .
    He was ex smoker and had quit smoking 5 years ago and was little obese .He had no fever nor had he lost any weight. He did have some shortness of the breath. On examination , he had some wheezing and rest of the examination was normal . I looked at the X-ray, and I thought that I saw a nodule in the left lower lobe .I was not sure if it was 'real ' , or I was imagining it .Anyway I decided to do a CT scan and also decided to do bronchoscopy . The Ct scan was a surprise , even I had not expected it . The CT scan showed a mass next to main wind pipe called trachea and it was partially pressing on the trachea. My bronchoscopy was completely normal, except for little bronchitis . I did not not see any tumour, even though the scan had shown almost 4 or 5 cms size mass . I know this can happen. The mass was out side of lung and the bronchial tubes . I called in a chest surgeon and he did the biopsy , which showed it to be the lung cancer .
    So when the primary care MD did the X-ray , and it was reported normal , he thought he knew the truth . When I saw the X-ray and thought that there was a nodule in the left lower lobe, I thought I knew the truth, and 'the real ' Truth was that he had a right sided lung cancer that was not seen in the lungs even with the CT can or the bronchoscopy.

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