Friday, January 4, 2013


    I often say that to get to The GOD we need to have 'unconditional 'love .Most of the times we say that we love someone or something , it is neither unconditional nor it is ever lasting.Wnen mother loves the child --son or daughter , it is one love that comes close to the unconditional love . The love between the husband and wifeis is based on many conditions . In fact with the birth of a child the love is reduced , as part ofthe love  goes to the son or the daughter. I do see many patients that do get married , for convinience after the death of 1st spouse for many reasons . To avoid lonliness, security, safety etc are some of them.. Not in every case these marriages are accapted by the children . Sometimes they 'encourage' it , but in many cases don't accept it all the way.I am going to tell the story of a patient that I came across sometimes ago .
    I saw this 84 years old lady for the cough andit turned out tobe mild asthma . She was followed by me and was doing fine . One day I was consulted to see apatient with the same last name . It was not uncommon name , so I did not think much about it . But when I entered the room I saw my  patient . This new patient was her husband . He was diagnosed to have got melanoma . This is skin cancer and it was taken out . But it had recurred and so he was getting chemotherapy . He was doing poorly , and now he had a episode of passing out . The CT scan of the brain was naormal (except for some loss of brain tissue to aging ) . He was 89 years old . The CT scan of the chest showed many masses , suggestive of spread of the cancer. So I was asked to see him to see if biopsy could be done and diagnosis be established . I spoke to him . He had some dementia .He could not answer many simple questions to me .I asked the family , the wife , who was my patient, and the 2 daughters that were present. They did not want any any further chemotherapy . The side effects were quite severe and they did not feel it helped , as otherwise he would not get all these new lessions in the lungs . I told them that if they did not want any treatment , there was no reason to put him through a invesive procedre . He was dischrged .
      I thought that the case was over ,till I get a call from the wife . Patient was seen by the oncologist and he convinced them to get needle biopsy , which was done and it showed a cancer , but not definate melanoma . So now the oncologist wanted new biopsy . So the wife and the daughters wanted to discuss with me . I saw them and asked them if a PET scan was done . It was not done .I asked whythey were asking for the direction to the place that had no intention to go ? ( why do a biopsy , if they are not interested in the treatment .)He was having quite a bit of pain in hip and low back .I decided to do the PET scan to see if there was spread of cancer, so we can think of pain controll and /or hospice . The PET was positive in Hip and pelvic bones . So now the question was , should we do radiation for the pain controll or do nothing . I sent him to a radiation doctor and he called me and felt that the PET scan bnormality was due to arthritis and not cancer and did not need any treatment . I saw patient and his wife and the daughters in the office . After extensive discussion , I refered him to Hospice .
      He died in next month or so . The wife came for her follow up . I asked her as to how the things were as she had lost her husband . She said not very good , but she was trying . I presumed that it must be due to loss of long time spouse . But at that time I came to know the real story . She was married to this guy for 8 or 9 years only . She had lost her husband and he had lost his wife . They knew each other for many years and no one had any objection to them getting married . Her kids and his daughters were very happy that they were getting married . So the daughters that I met were not her daughters , but they were his daughters . There was no problem till he was alive . The all got along well . They all made the decision to make him DNR and get him to Hospice .But now that the husband was  gone , the things changed . The daughters took all his pictures and personalitems , not nesseraily expensive . She did not get anything as his 'memory'. So there was no problem and there was 'love ' till the father was alive ( or they needed some one to take care of the old father ) Now thta he was gone , who cares for the emotions for this old lady ?

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