Saturday, July 27, 2013


   I wrote about the drug reaction . Some of the drugs may be commonly used and the reaction may be unusual or the drugs may be unusual . But in every case there is a host and there is an agent . What I mean by that is that every body does not react to the same agent in the same exact way . So how we react to an situation is our individuality .. But then how do we react or more than how do patients react to a diagnosis or a bad news ?I do see patients with lung cancer, and as it happens to be in many cases the cancer may not be operable or resettable. This may be due to the spread of the cancer or it may be due to the age of the patients or other medical conditions , like bad heart or limited lung capacity or other causes that precludes the surgery .Even today , in the year 2013 , the resection or the cancer is the best treatment. Not the chemotherapy nor the radiation therapy . So when I tell patients that the cancer is not resettable , their  reactions are different. I am going to tell you couple of stories that the reaction stunned me and I was at the receiving end of the bad reaction .
      Several years ago I saw a 58 years old patient, who was a smoker . She smoked since age 12 or 13 years. She had persistent cough for more than 6 months and she thought that it was due to the smoking .  She took some over the counter  remedies But as the cough did not get better , but got worse and she noticed some blood .. So she saw the family doctor . He started the antibiotics for possible acute bronchitis and did the X-ray . The X-ray showed a mass . So she was referred to me . I did the work up In those days we did not do the PET scan , but did other scans , The scans suggested that the cancer had spread to liver , couple of ribs and gland called adrenal. I did the bronchoscopy and the biopsy of the mass blocking the right lower lobe bronchus . The biopsy showed that it was a Small cell cancer . The small cell cancer is non  resectable as such as the history tells us that  by the time  we diagnose it , it has already spread . So cutting it out does not prevent the recurrence . In this case we had scans to suggest wide spread .The patient came to my office  after the biopsy . Our office policy is such that we tell patients the results of each test when we get it . So she was aware of the scan reports . I discussed with her the diagnosis of the cancer , the type of cells and told her that the best treatment would be the chemotherapy . On our first visit I had told her about the 3 potions and what is the best treatment . So the news was not good and she knew about it before she came for the follow up . So I was not expecting the response that I got . She was MAD AT ME . She had some sore nose after the bronchoscopy , as we put the scope through nose . I had told her that it should improve . Then she told me that I don't care , as she is complaining about the nose and I did not care . I told her that I was more concerned about the inoperable cancer and how to treat it The she stood up and told me that she will like to see a different doctor , as I was not concerned about the  sore nose .I did not know what to do . I gave her couple of names and offered her to make the appointments .
    I really did not know why she reacted to my honest discussion as I always tell patients about options and the truth , but I am never harsh or heartless .  Then unexpectedly  the answer came to me . The patient worked in a hospital . And on of the coworker told me . She had a daughter , who was mentally challenged and was solely dependent upon the my patient for every thing . So she was upset with future . The future in which she would be gone and the mentally challenged daughter would be there and there would be no one to take care of her .So her anger was directed at the messenger and I happened  to be the bearer of the bad news .

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