We often see people that have lived for ever. I have recently seen at least 3 patients on same day who were 90 years plus old and were good in health and then I see patients who are mid forties and have multiple elements and are not in great health and don't do well and die at early age. Some die young and some old and some are retaining their faculties even at advanced age and Others don't have it at at younger age . What determines the TIME OF DEATH .That brings me to story for today.
I have known this patient for many years may be 10 years .He had smoked in past and had COPD . Over the years of my follow up he got older and also had some worsening of he disease. He could not do much physical activity and needed oxygen . And in spite of using oxygen he was short of breath. But he was stable from my stand point. One day he had some trouble eating and as per his story it was less than a week and so he was admitted to hospital and he ha d work up and he had canner of the food pipe or esophagus. I saw him in the hospital. I had extensive discussion with him and his son and daughter who were out of state . His wife had dies 3 years ago. The hospitalist had admitted him and had not known him and had not started his usual medications for COPD nd so he was quite short of breath. He was seen by oncologist and then they had called a surgeon for possible surgery. I saw him and i knew him well from medical stand point . He was not a candidate for surgery as he had severe COPD and would not have survived the major surgery to cut out esophageal cancer. I told hi that and also to his family . They had known that.as they had seen the father walking and using oxygen etc. The oncologist also called radiation oncologist and the plan was to do both- radiation and chemotherapy. I had told him that the chemotherapy may be too much and the side effects may be worse and with his COPD he may not do well and there won't be quality. I had suggested Radiation and told him that that will get him some time . The other physicians convinced him that if he does both he has a 'chance 'of cure , which I knew was remote. Who does not like the thought of being CURED of cancer. So he and the family agreed.
He was discharged and the plan was to star the treatment in a week or so. But he was readmitted with pneumonia . The esophageal cancer had blocked his food pipe and he had stent, but he had vomiting and then that went in his lungs and he had shortness of breath and he needed to be admitted . After 2 weeks of treatment it looked like he was getting better . No treatment for cancer was possible at this time . It looked like that will have to wait till he gets stronger and infection to be gone. But one day he became worse and I called family and told them to come back and in next 36 hours he died.
My question is what decided that he would die in less than a month after diagnosis of cancer and could not get any treatment. I have some thoughts. The short answer is that the KARMA WHICH WERE GOING TO COME TO FRUITION had come to fruition and this physical body had done it's job and so it was time to go.
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