Tuesday, September 11, 2012


      I have known people , that remember their loved ones after their death in different ways .Many have pictures , some have tapes , and many others have different means of remembering them . The story that I am going to tell is one such story .
       I saw this 55 years old male with persistent cough. He was a smoker, 1 pack a day for almost 40 years . He was treated by primary care for a while and when the cough did not get better, he ordered a x-ray.It showed 'pneumonia ' . He was treated with more antibiotics. He did not improve , so was referred to me . His examination was unremarkable, except for some wheezing.I looked at the x-ray. It did not appear like simple pneumonia. There appear to be a volume loss, which means , that the size of upper lobe was smaller , I was concerned about the tumour blocking the bronchus and causing the cough , pneumonia, and persistence of the  symptoms .
      I ordered the CT scan . It did confirm my suspicion . There was centrally located tumour.I did the bronchoscopy. It did show the cancer and biopsy confirmed the diagnosis of the cancer . Due to the location of the tumour, he was inoperable. I did further work up and unfortunately the cancer had spread to the liver . So the only option remaining was to do radiation treatment and chemotherapy . He and his wife were very optimistic . 'We will beat the cancer ' , they told me . The wife was a nurse , and worked at the hospital where I practiced . So she was medically knowledgeable.They had a 15 years old son .
       The radiation was completed and chemotherapy was going on . He had lost significant weight . His appetite was poor and nausea made it difficult to eat.He was admitted to the hospital with nausea and inability to keep food or liquid down .I saw him and knew that it was more than just effect of chemotherapy.I ordered the Ct scan of the belly . It showed the intestinal blockage .I was hoping that it would resolve on it's own , though by looking at the CT scan I knew that it was due to cancer . Since he did not get better, I had no choice but to call  surgeon. He was operated and it showed that there was cancer in the small intestine and it was blocking . The surgery did help and he was better , But the cancer had spread and was worse in spite of all the  treatment .I have seen many lung cancers , but never seen cancer going to small bowel and causing obstruction. I had along talk with the wife and made him DNR . I knew that not much could be done .
      He died in next 3 weeks. I talked to the wife , she was expecting it and took it well
      Six or eight months had passed , I was sitting at the desk , writing my notes . I saw her,the wife . I asked if everything was OK. She said 'fine'. I started talking to her .When it came to her husband , she told me that they had done the cremation . When we talked about the memories , she told me something that shocked me . He had total knee replacement . Before he died he had told her two things . One was to get married to his close friend, who had helped them , including taking care of the young son and second take home the 'artificial knee ' home and' keep it as his memory.'

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