Sunday, March 22, 2015


      Since I moved to Florida, I have witnessed the afternoon rains that many a times are 'norms' . The rain sometimes could be very heavy , heavy enough that at times one has to pull car on the shoulder if we are driving on a high way.I have though experienced the real meaning of this saying first hand on many occasions. Multi system failure in ICU patients is not uncommon .So in a sick patient one may start with pneumonia and then in turn it causes respiratory failure.And then nest day we find that the kidneys are not doing the job and the liver test comes back abnormal and then make it worse, the coagulation of the blood is affected due to sepsis. But I am talking about today is something different which brings me to today's story.
      I saw this patient in my office for shortness of the breath. She was a66years old female , who had smoked her entire life . She quit smoking about 4 years before I saw her . She may not have come to me except that she needed a hp surgery. The orthopedic surgeon wanted a pulmonary clearance. So the primary doctor send her to me. I did a chest X-ray and did the breathing test. The X-ray was normal and the breathing test though abnormal was acceptable for the taking the surgical risk. So I cleared her and told her to start some inhaler for the COPD. She must have had surgery and did well and did not come back for the follow up. Then about 8 or 9 months latter, she started cough and the family doctor treated her with antibiotics and then the cough medicines . She did improve , but the some cough continued and she noticed little blood in the sputum. So chest X-ray was done and it was abnormal.So CT scan was done and she was sent to me . The CT scan showed that her one of the segment or a 'lobe' of the lung was collapsed. This is highly suspicious for the tumor blocking the bronchus , so the secretions can not get out and the lobe gets collapsed. So I explained this to her and her and her family. She had just lost one daughter. So the word or the thought of cancer was unnerving.
    I did the bronchoscopy. As I expected I saw the tumor blocking the bronchus. It was quite friable and  there was necrotic material on it . I did the biopsy. I went to talk to the daughter. After I told her that most likely it was cancer, she started crying. I tried to console her ,telling her that this cancer may be operable .So we had some 'chance' of the cure. Then what she said caught me with surprised. She said,"I was just told that I have inoperable cancer ,I came to know only yesterday."
     She was not my patient , but I had to talk to her . She had noticed a lump in her neck and so the primary care sent her to a surgeon .She had a biopsy and it showed the cancer. (I might have done a needle biopsy instead of 'biopsy under anesthesia')She was given the copy of the report and was told to see a cancer doctor. I did not know what to say , I sat with her and told her that the biopsy report did not indicate as to the origin of the cancer and she would need further work up,like PET scan , and additional scans. She asked me as to what could I do.She had not called any cancer doctors and wanted to stay in the area that I had the office. I asked her if she wanted I could get her to some one soon . She agreed and I called an oncologist.He was gracious enough to see her same day.
   I don't want to go further as to what happened to my patient or her daughter. But think about the situation, 2 daughter and the mother having 'bad luck ',like having cancer in span of 2-3 months , that is what I call 'when it rains it pours!!!!"

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