I hate...

There are many moments in your medical school “career” that you would think back with fondness, loathing, anger, resentment – or whatever emotion it evokes in you.

Last month, I was privileged to be part of the team taking care of one of the patients. She wasn’t my first choice for patients, but I picked her up as a patient. This middle aged woman presented with nausea and vomiting, abdominal distention. Turns out she had liver cancer mets (meaning the cancer did not arise primarily in the liver but was from some other site). For over 2 weeks before I took her on as a patient, she was already receiving “treatment” in the hospital. By the time she became my patient, she was really sick.

One thing one of the doctors n the hospital said to me and which has stayed with me- cos you know a lot of things hover with u for seconds- was “Do you know how cancer kills you? You die from the failure of the organ involved”

So For instance, if you have lung cancer, the cancer cells outgrow ur normal lung cells, your lungs fail, and you die from respiratory failure. Obviously if you have breast cancer, you don’t die from breast failure, but the cancer cells can spread to other organs and cause failure of those organs.

This lady had liver cancer, so we were essentially treating her liver disease. The liver clears your toxic waste (eg. Ammonia), makes your proteins, and clotting factors. Her ammonia levels were building up, and when these go to your brain, your mental status decreases. Her protein levels were low, so she was swollen everywhere.

Every morning, I dreaded going in to see her, examine her, knowing that there was really nothing I could do. She was in constant pain all the time, and even with the pain meds she was getting, her moans were hard to ignore. She had her children beside her for most of the time. It was just heart wrenching to watch.

She gave up the ghost on my last day of the rotation.

Last week, I started a new rotation, oncology. There was another patient with a similar presentation- almost exact. The only difference was he wasn’t as out of it as the previous lady was. He could talk, and wasn’t as sick. He decompensated in a couple of days, and this morning, we found out that he had passed.

I hate cancer!