Sunday, January 17, 2021


      Since we were born we know that we will die - well may be not when we are in our childhood , but certainly we know about the death even when we act as invincible as young adults.One can see this in the risks that are taken by teenagers. But at the same time we want to live for EVER. All the  TV  and radio commercials that we see are related to extend life expectancy and also how to look or feel young. This is from skin care products to various nutritional supplements which is billion dollar industry. And I see this in many of my patients. There is nothing wrong with the attitude that we must do everything to prolong life or make it better  and that is the role of medicines and physicians. But that thought process should not obscure the reality that everybody dies. That brings me to story for today. 

    I saw this patient 90 years old . He was diagnosed to have cancer of rectum.He was treated with radiations  and he was doing OK but the cancer was mot cured and so he was now on CHEMOTHERAPY. Then he was admitted with what looked like pneumonia  and then had further work up  and was found to have obstruction of lower lobe bronchus on right side and that was biopsied  and it was cancer  and to surprise it was not spread of rectal cancer,but it was new Lung Cancer. So ow the radiation therapy physician was called . He was not a candidate for surgical resection and so radiation was started and it was completed  and then he got more chemotherapy. He had the side effects  and was weak and had no appetite  and has drop in blood counts  and he had some shortness of breath. He also was confused  and he has reduced responsiveness. He had the full work up and had CT scan and consult with cardiology - he also had atrial fibrillation and so had cardiologist to look at him  and also infectious disease doctor  and lung specialist.- This is very typical now a days as primary care doctors do  not come to hospitals and the hospital doctors call various consultants. The CT scan showed collapse of the lower part of the lung  and this was related to the blockage from the cancer that was diagnosed 3 months ago and treated with radiation , but now he had more fluid around the right lung. I thought that this could be due to inability of lung to expand due to blockage from inside due to cancer or could be due to cancer spreading to the covering of the lung - pleura . In any case I felt that this was not good . He was severely anemic  and cancer doctor nurse also saw patient. I felt that there was not much that would change much by doing more interventions as diagnostic test. HE was 90 years old  and had 2 different cancers  and bot did not seem to have been cured  and also he had side effect from chemotherapy. My feeling was that we could treat him for fluid  and that may help him but beyond that doing additional therapy was not going to change much on long term.I also thought that since the  fluid was  locculated - had formed a pocket - may be due to radiation, putting a catheter would be better idea in this 90 years old patient. I did not feel doing more chemotherapy would change much . When I asked patient when he had improved in his mental status as to what he would like to do. He wanted to know why we can not do surgery on lung and rectum? I did not think he either understood or accepted the reality of having 2 cancers and the prognosis.

    So we all know that we are going to die  and are not mortal but even at age 90years  and with 2 cancers one is not ready for inevitable end of life.

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