In our life we have things that we expect and they do happen and then things that come as absolute surprise. So we have things that are predictable and we know that things are going to unfold in certain way and so we have expectation and our mind is ready for it and so the impact is not that much. But when we have things happen which we did not expect , and then we face them we are not expecting them and so we are not prepared for them and we are shocked. So that brings me to the story for today.
I have been seeing this patient for many years and he has had multiple problems but main was pulmonary fibrosis . He also had aortic valve problem and I ha =d told him that needs to be fixed and he saw cardiologist and they did not feel it was that bad . After about 1 or 2 years they felt that the valve needed to be repaired and so he was admitted . He had check up for carotid artery and he was found to have narrowing and so he had stent and then he had stroke. . So then he partially recovered from it. His wife helped him and he had missed follow up and after a gap of 8 months ,he came to see me. He was doing OK from my stand point and had some limitations on walking. But is wife was with him After the visit was done , he asked me if I could help his wife. I said sure , what is the problem. He told me that she ha shortness of breath and so she went to ER and had CT scan and that was abnormal. The Ct scan showed a large mass. So I agreed to see her in 2 days as emergency. I had neve seen her and since she was in ER and was not admitted , I presumed that she was OK . I saw the CT scan before she came to my office. I knew that the mass was large and was not in best position and so I had scheduled her for biopsy. She came for the appointment and when I saw her and checked her she was not in the best shape, She was diagnosed to have COPD and has been on oxygen and she was short of breath and when I checked her , her heart rate was vey high and her oxygen was very low. The heart rate was 170 and so I increased the oxygen and told them that she will need to be admitted . The mass was close to major blood vessel -pulmonary artery going to right lung and it was encasing the artery and also the bronchus . So that was bad to start with and I had anticipated difficulty with getting biopsy and also the treatment part. Certainly she was not surgical candidate and the option of treatment was radiation and chemotherapy. But now with the heart rate issues and oxygen problem I was not sure as to how much can be done at this stage .
So I was aware of the fact the CT scan was not very great for the treatment but did not expect that we will have such a difficulty now even without even having done work up. This is predictably unpredictable.
