Sunday, April 5, 2015


      I was reading an article on the role of physicians in telling the "bad news" to the patient or their family. Whenever there is a diagnosis of cancer or whenever there is bad prognosis, we a physicians have to tell it to patient and their family members. I sometimes have to tell the patients or their family same thing again and again. I am not sure if it is due to sometimes  patients 'blocking ' it out or may be the information is not clear or may be there is a wishful thinking. I came across a patient that I really felt bad , really could not explain why 'bad things' happen to good people.
     This was a patient who was a young male. He was referred to me for persistent cough, or that is what I thought. When I entered the room he was coughing a lot . I actually could hear it even before I entered the room. I started the my interview and the usual questions about the high blood pressure, diabetes, and asthma etc .He was smoking 3 -4 cigarettes a day and was sick for may be 4 weeks. He was treated with antibiotics and cough medicines and he continued to have cough. So chest X-ray was done and it showed possible pneumonia and some fluid around the lung. So a CT scan was ordered and he was referred to me . The CT scan was done and they brought the report with them . (He was accompanied by his wife. )The chest CT scan report was bad. There was significant fluid , much worse than was seen on plain chest X-ray.And the fluid was causing pressure on the lung and significant part of the lung was collapsed.From the other findings seen on the CT scan, it  was obvious to me that we were dealing with most likely a lung cancer.He was short of breath and coughing and I felt that to work up done quickly we should admit him. He was going to need number of tests and to do them as out patient, it would have taken long time . ( in addition to the scheduling issues that would occur, we would need 'refferel' to do every test.)So I spoke to patient and his wife and decided to admit him .
    He was admitted  and his chest X-ray showed complete collapse of the lung. THERE WAS NOT MUCH AIR GOING IN THAT LUNG. So I did the procedure to take out the fluid . I too out more than 1200 ml of fluid and his chest X-ray showed no improvement.So I consulted  a chest surgeon to put in a catheter to drain the fluid and do any additional biopsies to get the diagnosis. The fluid that I had sent did show the cancer cells , most likely lung cancer.I had told the patient and his wife in my office about the suspicion of lung cancer. They had asked me if it would be operable .I had told them that once the fluid is showing the cancer cells , it can not be operated to cure the cancer. So after the fluid came back, I sat with them and told them and explained that the treatment would be chemotherapy and not surgery.  I called the oncologist and and he had the catheter put in . We talked about the results of the surgery . He had tumor in the covering of the lungs all over, So I again talked to them about the chemotherapy and the radiation treatment . The question came again as to if we could do surgery . I had hard time answering that for two reasons , one was I had told them the answer few times and he had just introduced his 12 and 16 years old "kids" to me . I had to be very careful about the words that I spoke , but I still had to tell them the reality. This is what I call as the big job. I wish that the patient would not have asked me the SAME question again , But he did and I had to answer it . 

No comments:

Post a Comment