Thursday, October 30, 2014


    When I used to drive on interstate in this town , I used to see a billboard, making an announcement that "we do miracles".I could never understand as to why a hospital would like to claim to do miracles as many of the religious leaders can't claim the same.Then I was reading a book by a surgeon named Atul Gawande.He has written 4 books and written several articles related to the medicine and related topics. In one of his book he states that the medical knowledge is vast and incomplete.I could not agree more .In one of the books where he talks about medical malpractice,he described a case of melanoma , a deadly skin cancer.The case describes a patient who had melanoma and it was taken out and there was a difference of opinion between two pathologists and the doctor claimed that he asked patient to consider 'wider and more resection'. But patient refused and then developed wide spread metastasis. So the doctor got sewed.This reminded me of one of my patients.We doctors claim to know everything and the hospitals claim to do miracles. So it is not of surprise that patients expect that we will 'know everything ' and can' predict 'every outcome.
      I was called by this doctor about a patient that he wanted to me to see. The patient was having a cough and so the doctor treated her . She was a nonsmoker and had no other medical history.When she did not respond, he did chest X-ray. Then he did a CT scan .The scan showed a small mass in the center of the chest.He wanted me to see patient ASAP. I checked with my office and they gave her an appointment within 5 days of the call. I was thinking that she probably has a benign thing called THYMOMA. This gland called Thymus is present in early infancy.And then it disappears in adulthood. Some people continue to have it or in some patients it enlarges or even becomes cancerous.In a patient who had not smoked this was the most likely possibility. So when she came to my office ,I came to know that several years ago she had uterine cancer. She was followed by the oncologist.When I saw the CT scan , I also saw a small mass on the center of left hill um.I was concerned about it .I was worried about may be a lymph node cancer called Lymphoma.I decided to do the PET scan that picks up cancer in almost 90 %. She was also scheduled for bronchoscopy.The PET scan was done and then before she was to have the bronchoscopy,she got very short of breath and her oxygen was very low . So she was admitted to the hospital Another CT scan of the chest was done .It showed that there was also a congestion in the left lower lung.The lung was still inflated. The other areas of the abnormality were same . When I saw the PET scan it showed increased activity in the center of the chest , left middle part and also on right side and also in the lymph node in the neck.I did the bronchoscopy and I saw the tumour in the left main bronchial, completely blocking it. This was not expected.I could not do biopsy as I felt it was too risky.The appearance was was that of a tumor called carcinoid. These tumor bleed on doing the biopsy. So then a surgeon saw her and did the biopsy under anesthesia . I also had radiologist do biopsy of the lymph node in the neck. So we got multiple biopsies and enough tissue to analyse as to the type pf the cancer. We continued to have diagnosis of "adenocarcinoma",a type of a cancer which can arise in several different organs. The best that they can tell us is that it could be uterine in origin or lung as the origin of the cancer. So we still did not know . (FORGET about doing a miracle,we can't even tell where did the cancer start.)
      That is why the medical knowledge is vast and incomplete.  

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