Friday, October 9, 2020


    In life most of the time we have situations where average person or for that matter even kids know what is right and what is wrong. Even when child is caught with his hand in cookie jar , he tells mom that he was getting the cookies for mom. So we all know most of the time and there are some situations where the situation is not clear  and one could go either way and both things may be right. We in medicine have certain situations where we could go either way and will be considered right. Just to give an example, one at certain time in our life can decide not to go on respirator  and some may want to do it even with the odds against the survival and we can not fault the decision . I came across such a situation recently . 

     I was asked to see a patient in office for abnormal CT scan . I was told my office that there was a patient who had lung mass per primary physician and they wanted me to see him soon. So I saw the patient soon He was 89 years old male who had not smoked for 40 years. He had dementia  and so the family wanted to put him in day care for day time  and the center needed  chest X- ray  and it was abnormal. So the primary care did CT scan and that showed a mass and so he was sent to me . 

  When I talked to the family - the wife and daughter , the patient did not answer any questions  and he could not tell me the day or the month and also the name of the US president . He had bladder cancer many years ago and he had no pulmonary complaints He looked very comfortable  and had no idea as to what  was going on and why he was in my office. I reviewed the CT scan and talked to the family. He had what looked like cancer . As his bladder cancer was many years ago I felt that this was likely to be due to cancer of lung . So I told them that we normally like to answer 3 questions  Is it cancer , Has it spread  and What is the treatment choice. So I asked them as to what would be the choice of treatment . I told that  I don't think he would be a candidate for surgery due to dementia and age even though the stage of the cancer was resectable. The chemo would be very bad  and should not be considered. So the only treatment  that could be considered would be radiation . I   i also told them that DOING NOTHING would be also an option  and that may not be bad idea as with his dementia, not much could be changed and he was 89 years old . So the good patient and physician could do PET SCAN and offer radiation and good physician and patient or family could consider no treatment and no work up. Either way is right  and wrong 

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