Saturday, February 4, 2017


     I have been quite comfortable in talking to anyone at any time on almost any topic. I try to limit my talk on politics as it creates problems. Talk leads to  difference of opinion and then that leads  arguments and then shouting and bag words and fight. It leaves bad taste in mouth. So I try to avoid it, though I am not successful always . But today I am telling a story of one of the patients , that made me speechless.
       I was called to see this patient who came with fever. I was not too sure as to the exact reason for my consult, may be because it was sometimes ago or may be because she had some other issues that were more impending than why I was called in . She was a 52 years old female and was not a smoker . Long time ago she was told that she may have bronchial asthma. She had acute leukemia and then was given treatment and even bone marrow transplant. She did OK and then had recurrence. She was treated at out side oncologist at a cancer center and our local oncologist was basically seeing her for need for transfusion or some other problems that her out of town oncologist could not handle. She had fever and chills and it looked like she had respiratory infection. Her oxygen saturation was OK , she had some bronchospasm. Her X-Ray was OK . She was seen by number of consultant including infection specialist and cardiologist and oncologist. So other than doing some nebuliser treatments and short course steroids. She was started on antibiotics by ID specialist. She was doing OK There was no fever but she was feeling tight in chest . So a CT scan of the chest was ordered. It showed fluid around heart. So the cardiologist ordered Echo cardiogram. It confirmed the fluid around the heart . So we called chest surgeon. The problem was that her leukemia was active and blood counts were low and she was needing transfusion every other day. The main problem was platelet counts. The platelets help clotting and one can not do any simple biopsy , let alone major surgery. Draining fluid from around the heart was not going to be easy with low platelet counts. The surgery got postponed for couple of days as in spite of platelet transfusion. Then one day the count was better though not normal and the surgeon did take to surgery. I was concerned but everything went well . Few days down the road the tube that was put in was taken out as it had stopped draining any more fluid . In between the periodic transfusions continued.  days after the tube came out she had some chest tightness and so new CT scan was done and it showed new accumulation of the fluid around the.heart and this time also around the left lung. I recalled the surgeon and the cardiologist, both of them had stopped seeing the patient.New echo cardiogram was ordered and it confirmed the fluid. But her platelet count was very very low. 7000 ONLY when normal low is 150000.
     So the surgeon talked to her and her family,He told them that risk of surgery was very high.I was not sure what to do or how to talk to her. I had explained it to her and her family several times that risk was very high and even if she comes out of surgery the long term prognosis with active leukemia was not very great, So I asked her as to what was her expectation. I was not sure if she understood and accepted the bad prognosis. She told me that she wanted to 'live' foe 2 more years. At age 52 , I was not sure why she wanted to 'live' only for 2 more years. The answer left m speechless. Her daughter was junior in college  and he wanted to be alive for the graduation!
                                 What was I going to say ?I was left speechless. 

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