Saturday, January 18, 2014


   I was driving on the highway and I saw a billboard. It was an advertisement for one of the hospital . It stated " we do miracles !". It made me think . Do we really do any miracle at any time or any place ? or we just 'think' that we are in 'charge or control".I am in practice for long time and I do not want to take any credit for 'saving ' anyone nor do I want to get any blame for the bad outcome . When someone states that they do miracles , they simply do not understand the reality of medicine . It remind me of old story that I had read about a gastric surgery , that was done quite commonly many years ago , not done much now . In a meeting of the surgeons , the speaker was talking about all the complications associated with the particular procedure . One of the surgeons from the audience stood up and stated that he has done many of the same surgeries and never had any complications . So the speaker answered , " Sir , either you have recognized the complications or you have not done enough surgeries to get them . Because if you would do enough surgeries , then you will get complications . ". I feel the same about the medical tests or the treatments and the outcomes. The story that I am going to tell is one such case .
    I had seen this 68 years old white female for long time . She came to me for abnormal chest X-ray and further work up showed that she had a lung cancer and I sent her to a chest surgeon and she was operated and did well . There was no evidence of spread and she did not need an additional treatment . The only unusual thing was that when the lymph nodes were resected out to 'stage ' the lung cancer , they were negative for cancer , but they showed findings of a disease called sarcoidosis . The sarcoidosis causes lymph node enlargement and lung nodules or scar tissues .It may cause shortness of breath .So we followed her up . She continued to have the abnormal X -ray and it was attributed to be due to sarcoidosis . The PET scan came to market and her oncologist would do the PE scan and then then when it came back abnormal , would send to me . and the I had to look at the old scans , CT scans and decide if any further work up was needed .This is because the sarcoidosis also can cause abnormality on PET scan .So it becomes difficult to know if cancer is coming back or is it sarcoidosis . To our surprise she developed second lung cancer and we took it out .We continued to do the follow up She developed a lung nodule and it grew . I could not do any test to find out if it was cancer or sarcoidosis . So after discussion we decided to do a open biopsy , to resect it out .The surgeon decided to do lymph biopsy . The lymph nodes were not enlarged or changed from the old CT scans . So with the diagnosis of sarcoid I did not feel that lymph node biopsy was needed . But to my surprise he did the biopsy and IT SHOWED CANCER and so she was not resectable .So the PET scan and the CT scans were not helpful and the biopsy that I thought was not indicated,( based on the findings of CT scans and PET scans ).gave us the diagnosis .
      The story did not end there . She was treated with radiation and chemotherapy .She was more and more short of breath and needed oxygen . And then one day the oncologist told me that she developed Breast cancer .
     SO in my mind we do not do any miracles nor are we capable of doing any miracles . With all the new tests we still feel like we are wandering in dark and are lucky if we are successful(!) in treating patients .

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