I have been in medical practice for many years and I have myself changed in my thought process. But the main thing does not seem to change . We all want to LIVE. We often say that we have no attachment for living if we have suffering. But I have often seen that NO ONE is ready even under extreme conditions. That brings me to my story for today.
I had seen this elderly patient few years ago . Her problems were not major from my stand point and after doing follow up for 2 or 3 times ,she stopped coming. Then after 4 years of gap she came to me . She came with her daughter . She is 82 years old female and had some shortness of breath and she went to er and she had chest X- ray done and that showed larger fluid collection on rt side . She was admitted and they consulted lung specialist and he decided to put in a catheter to drain it . Normally we drain fluid and then based on response and findings of the fluid we decide if patient needs further intervention. But for whatever reason she had the catheter inserted and then she was discharged . The daughter came with her and she was draining the catheter at home and when I asked her if they ever established diagnosis , she did not know , though she did know that cancer was suspected. I looked the work up done at the hospital and realized that no diagnosis of cancer was done and part of the problem was the daughter's refusal to do additional biopsy since the fluid itself did not show cancer cells. She was weak and cachectic and she was not eating and had lost weight. She was so weak that she could not walk .They had seen oncologist and they did not like him / her and so they had not done follow up . She had no home help and no direction as to how often to drain the fluid.
I talked to them and looked at the reports from her hospitalization. She di have tumor in the covering of the lung and so from such a biopsy . So she did not have it. I told them that one can not get much treatment without knowing the diagnosis of cancer and what type. So i asked a surgeon to do the biopsy and at the same time consider talc powder instillation to stop the fluid from coming back. She agreed and the biopsy was done and the diagnosis of cancer was established . She came to see me and she had worsened. She had lost more weight and there was not much fluid left to be drained and in spite of that she was short of breath and had no appetite and had low oxygen. I spoke to her grandson and also to daughter and after discussion they decided that they could not do any treatment and that it will be futile. So at their request i called hospice . They wanted comfort care only. 3 weeks went by and I get a call from the daughter , she had talked to oncologist and they wanted to start her on treatment immunotherapy . So they had cancelled Hospice and they wanted me to get her oxygen and some other stuff from other company .
(I have often stated that if you ate vegetarian do not go to stake house ,if you go to oncologist they will do chemo/immunotherapy)So none is truly ready