Sunday, April 27, 2014


       I did write about the destiny and if we can change it or not .This was in connection to the question , "if we can not change the destiny , then how can we be held responsible?" As I stated in that blog, we can change anything if we have 'enough' time .and if we try 'hard' enough. The classical example that I could give was the one studying for any examination . If one starts studying for the examination only a day before the examination , then the destiny is not going to change . But if he starts studying long before the date of examination , he can change the outcome .This is very simple to understand , when it is an examination and we know when it is to take place . But the problem occurs when we don't know the date of the examination and so don't know if we acted in time, The story that I am going to tell is one such , where I did not know if we were acting in time .
        I had a call from a primary care physician on one Wednesday before Thanks Giving.He had seen a patient 49 years of age , who had acute bronchitis. He treated her with antibiotic. She continued to have significant cough and had now had some shortness of breath. He did  X-ray. It should fluid around the lung.So he called me , so I can get her in the hospital and take care of it.I could have done this as outpatient , but she was short of breath and I did not know as to the cause of the fluid . If it was due to pneumonia , than the treatment would be different , than if it was cancer.So I admitted her . She was a smoker , had no fever and was somewhat short of breath . So o the Thanks Givings day I did the procedure to take out fluid . I removed almost 1200 ml of the fluid.The report came back as cancer.I also did a CT scan of the chest after the fluid was taken out and it showed abnormality in right lower lobe . I did a bronchoscopy and she had significant narrowing of the lower lobe bronchus and the biopsy showed the cancer . So in essence she had a lung cancer and it had spread to the covering of the lung and the treatment of the cancer was going to be combination of radiation and chemothery. The question that I ofetn get is why can't we cut out the entire lung and explain it to them is that once the cancer spread to the covering of the lung , then taking out the lung , though it is possible technically , does not alter the outcome or the prognosis. I did consult the chest surgeon for recurring fluid collection and he put in a talcum powder . The talc causes the reaction and it stops the fluid recurring in more than 85% of the cases.
      So she was started on the treatment and did very well . She got the radiation , followed by the chemotherapy and she had some side effects , but overall did well . I continued to follow up . She had quit the smoking and had some COPD but was doing well. The oncologist continued to do the follow up scans and there was no evidence of the cancer recurrence . Due to the previous tumor, and the radiation, there was abnormality in the right lower lobe.Since she was doing so well, I had the question popped up again . Why can't we do the surgery . I did a another bronchoscopy and saw the narrowing of the bronchus , but there was no tumor and the biopsy was negative for the cancer . It was almost 20 months, since the diagnosis of the cancer was done . I spoke the oncologist.He had no plans to give any more chemotherapy.The patient was pushing for the surgery and I had no  answer as to why we should not do surgery . I told her that the surgery is possible , but if we agree to do it , there is still risk of recurrence and with major surgery it would be risky aand all the efforts would be wasted.
      I spoke to the surgeon and he saw the patient and talked to patient and the family . He told them that doing surgery was not conventional and there was risk of 'unwarranted ' surgery. By then it was 22-23 weeks ,almost 2 years . The family and the patient decided to do the surgery . The surgery was done . The lung was taken out and the pathology did show that cancer was still there , ( even though there was no clear cut evidence of it on the scans . So the patient and the family was very happy. But upon follow up in 3 months, with the scan  she had spread of the cancer to liver . She was restarted on the treatment , but did not do well. She died in about 6 months .
      So when we did diagnose the cancer we knew the destiny and did not know if we had enough time to change  it . Then when we decided to do the surgery, we thought that we werre going to change the destiny , But we were wrong . WE DID NOT HAVE ENOUGH TIME TO CHANGE THE DESTINY, AND OUR EFFORTS FELL SHORT!!!!!


1 comment:

  1. Dear Doctor,
    I am right now reaching 50 year. I had been smoking about 10 to 12 cigarettes a day between 1998 to 2008 and brought this down to 8-9 for the past 6 years, Now average 45 a week. For the last 1 year or so once in month get short pain in the upper top of left chest.At times the pain used to be acute and I drink hot water mixed with Ginger , the pain vanishes. My breathing is normal, Can you help me with some advise on the present situation whether I will get an cardiac arrest due to this pain.
    What exactly is the cause??
    What food habits to follow??
    I am now delaying my smoking by having one every 1.1/4 hrs and only between 10 to 1800.