Wednesday, December 30, 2020


     We act in our life with desire  and advice that we can change the fate or outcome. We want to eat healthy food and not smoke and not drink too much of alcohol and not do drugs . I do believe that this is good behavior and everyone should try to do what is right . In medicine we also act and advice patients that certain way of treatment or work up will help us in getting good or desired outcome. I still remember , when many years ago one of my professor of preventive and social medicine had a heart attack . In those days not much was known on heart attacks , but we still knew that smoking and not doing exercise  and cholesterol were main culprit and we also knew that diabetes and hypertension were also risk factors. So when I saw him after his heart attack he made a comment to me saying that he does not smoke and does not drink and has no hypertension or diabetes and he still had heart attack . This type of unexpected medical elements are known to someone who ahs been in practice for long time but what I am talking today is the out come of the treatment or we not getting expected outcome. 

    I saw this patient in hospital. I had seen her sister and one more family member  and one of them had cancer. She has been smoker  and she had quit smoking and then she had shortness of breath .She had 2 years ago heart attack or tales chest pain and was found to have blockages and had stents  done . She was seen by PCP and that was telemedicine follow up and he gave her antibiotics and she did not get better and was still short of breath .So she came to hospital and had abnormal chest x- ray and then had a CT scan done and that showed a mass at the central part of the lung . If one can imagine lung with a stock like a fruit, then this mass was exactly at the stalk area. The main bronchus and the main artery all go in the lung at that area  and the mass or the tumor was pressing on the bronchus and it was narrowed . So there was a high suspicion for cancer and they called a cancer specialist . I was also consulted . I saw her and when I saw her I knew that this was not good . She also had a second mass  and she had shortness of breath  and she was on minimal oxygen supplementation.. The cancer doctor had ordered a biopsy of the lung mass. I explained to her and her husband that I was quite concerned  about a cancer  and that too will nor be operable  and the position was bad and that may compromise the air  and blood going to the one lung . I also ordered a PET scan. She did not feel good on the next day and so the biopsy was postponed  and so was the PET scan. Then the next day she had problem  oxygenation and so we had to increase the oxygen and that continued to get worse  and so I transferred her to ICU.I again talked to the husband and the patient and I also called radiation doctor to see if he could start emergency radiation without the diagnosis of cancer as otherwise that was going to get worse . They felt that getting a stent to open up airway would be better . So we consulted one of the interventional lung specialist . She was transferred to another hospital . As it happened, she had a heart attack and she was started on blood thinner and she had gastrointestinal bleeding  and then she vomited  and had cardiac arrest  and she was on ventilator  and continued to get worse. 

     So we did all the right things , Oncologist was consulted and Pulmonary was consulted  and we also called radiation doctor and then interventional pulmonologist. We had cardiologist see her when she had heart attack  and inspire of that she did not have good outcome. That is what we call fate.

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