Sunday, September 9, 2012


     I have always felt that our spoken words have impact . In today's society  we have politician say things , promise things to get elected , and once in power they don't keep any promises , and the we never take them to the task . I have tried to keep my word , with my kids .Otherwise our kids have  have no role model. But even our spoken words can cause impact , and we need to be careful.
    I have had incidences in my life , where I said things inadvertently , without realising the impact of my words . There are several such incidences , that happen to us , but I Will tell you  one or two'
    I had seen a patient in the hospital , for the complaint of shortness of the breath. She was 50 years old female , who had history of breast cancer and came to the hospital with shortness of the breath . The reason to remember her name and the case is due to her ancestry , she was from Guiana and had her last name which sounded very much like one of the Indian names . When I met her husband , I realised that he indeed was 'Indian ' , except that he had no relation to India . His forefather had  or must have migrated to Guiana and he neither had Indian language nor religion or any affinity for India . (I have often wondered about the 'melting pot ' as the US is called and thought about what would happen to my grand kids ). Her X-ray showed that there was fluid around her lung on the Right side . With the diagnosis of the breast cancer , the possibility of this being related to the cancer spread , was quite high . I did do a CT scan and it confirmed the fluid . Under the ultrasound guidance I did put in a catheter and drained 800ml of fluid . It did show cancer cells confirming the diagnosis of spread of the cancer to the lungs . This was not good news . She was on chemotherapy.and in spite of that she had spread of the cancer .
      Normally we continue to treat the cancer in hope of preventing the recurrence of the fluid .If it comes back, then we drain it again or put in a chest tube to drain the fluid and put in talk powder.The talk powder acts as 'glu' and this prevents the fluid from recurring , as there is no space to accumulate . I talked to her and her husband . She was discharged .
    I did a follow up X-ray in 3 or 4 weeks and it did show that the fluid had increased . The time that it took to come back was too short for me to redo the drainage . We need some semipermenent 'fix'. .So I called a chest surgeon . She was readmitted and had the surgery . The talk was put in . Everything went well . She was discharged and was continued on chemotherapy .
     Then it happened . She was readmitted with the shortness of the breath . I had not seen her for the six months. She was doing fine , the chemo was doing OK and they were thinking that all was well . Noe with the  shortness of the breath, she was admitted . I saw her in the hospital . She looked OK when she was sitting in the bed , but least little activity , she got short of breath . Her oxygen level was normal . The x -ray showed abnormality which looked like the fluid was worsening . I did CT scan . It did show some fluid , but it was not 'free ' It had pockets . It also showed that there were tumour nodules on the covering of the lung called pleura. There was no way I could do any drainage of the fluid.So I called the surgeon , who had done the previous surgery , putting in the talk.
      I was not too sure if he could do much . One possibility was that he could go in and 'peal off  ' the pleura .The normal covering of the lung is loose , just like covering of tangerine. So it is easy to peal it off . But in case of the cancer spread, the covering becomes thick  like avocado, not very easy to peal it off .
    I had talked to the husband and told him about the difficulty that we were facing .I was home and was with my 5 year old son . We were watching some cartoons , when I got a call from the surgeon . I was talking to him , and I had forgotten that my son was in the same room . I was under the impression that he was watching the TV . The surgeon had seen her , had seen her CT scan and felt that he could not do much . "Can't do much , she is going to die " , he said . I told him that I had talked to the husband , and will sit with them and tell them that not much could be done and she is likely to 'die' .
       I hung up the phone and looked at my son . He was looking at me , with disbelief . He had heard every word and was shocked that 'his dad ' who is suppose to 'help patients' and 'save ' them was going to let the patient die .

        It took me several minutes to explain as to what was going on .
        My words had impact , without me realising it .

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