Tuesday, May 17, 2016


      I was reading a book which was suggested to me by several people . The name of the book is WHEN THE BREATH BECOMES AIR .' This was written by Paul Kalanithi . When I went to library to check it , I realized that it was quite popular book . There were 50 plus people ahead of me . This is a story of a neurosurgeon who was diagnosed with metastatic lung cancer at age 36 and died of it. The book it written by him and published by his wife after he died . Couple of points that I want to make is that 1 it is quite depressing book especially towards the end , and I did expect it . Even though I see this every day I was not very happy with the end even though I knew the end . Secondly I felt that too many physicians FEEL that working HARD and neglecting family is OK. I am not surgeon ,but I have heard that in all the surgical branches there is hard work and rude behavior and it is carried from residency and then in practise . (I want to make it very clear that Dr Kalanithi was not rude )But why is it OK to work 16 hrs?(In my residency time I did do 34 hrs straight too ).This may be the cause of stress and suicide. But the reason I started this blog was to tell you about my patient.
       So I was consulted on this 35 years old female who was having some shortness of the breath and question of pneumonia . When I talked to the patient and her family , I realized that I was dealing with a sad story.She never smoked and did not drink alcohol and about 20 months ago she was diagnosed to have a stomach cancer . By the time it was diagnosed , it was inoperable. So she was given chemotherapy and she did OK , She was in 'remission '. But then as many times happens , she had recurrence . She was given radiation and chemo and continued to struggle The cancer had gone to bones and brain and lungs. She was short of breath and needed oxygen . Due to the spread of the cancer to boned , she was needing blood transfusion every other day . I reviewed her chest X-ray and the Ct SCAN AND FELT THAT THE CANCER WAS NOT ONLY IN LUNGS , BUT WAS BLOCKING THE LYMPH DRAINAGE . This was making lungs 'stiff' .The lungs  which are normally like dry sponge , are now filled with water -or in this case due to cancer and these stiff lungs needed much more energy to open or expand them and that resulted in shortness of the breath . This fluid in lungs also caused the oxygen transfer to be poor and needing oxygen .So there was not much I could do . Just like in case of Dr Kalanithi , sometimes we can not offer anything but prayers .
      Even though I believe in reincarnation and the Law of Karma , I am not sure how I can explain this or accept it I still call it BAD LUCK !!!

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