I have seen a patient 3 weeks ago, and I saw him again today.
He is a 30-year-old engineer who lives in New Territories with his wife and a 2-year-old son. He has been well along before presented to us with acute onset of shortness of breath for one day. He is aferbile, without cough and sputum production. However, he complained of low back pain for few weeks, loss of appetite and weight loss of 6 pounds in 3 months. He denied of any smoking habits.
Physical examination revealed reduced expansion and air entry, with stony dull percussion note on the right chest. The impression of unilateral plueral effusion was made and its differential diagnosis included lung carcinoma, followed by pulmonary tuberculosis and pneumonia, which the latter two are quite unlikely. After chest drain insertion, more than a litre of fluid came out every day, and a few days later, he was transferred to the cardiothoracic surgical ward.
It has been two weeks from now. Today I saw him in the medical ward again, this time he was admitted for blood stained fluid in the chest drain. "Oh God. Have a chest drain in-situ for so long. What had happened to him actually?" I flipped through his case notes and searched for the laboratory reports. "Holy shit!", I shouted.
"Stage IV adenocarcinoma."
Horrified by this piece of information, I took a glance on his progress note, written by his case MO, "Discussed with patient's wife and mother, ... DIAGNOSIS NOT DISCLOSED to patient as asked. Explained the patient still had the right to know and I had no choice but tell him if he enquires."
I cannot imagine how I would react if I, being a non-smoker, had an end stage lung cancer at the prime of my life. With a little boy playing toy car on the carpet and a pretty wife sitting beside me watching television, this is ridiculous to think that this kind of blissful living will end in months' time. May be I will go mad and crazy, or depressed and gloomy, or bipolar manifestation.
Later a PET scan revealed two cystic lesions at the left frontal lobe, which is, a brain metastasis. One may shift the blame of his mood changes to those lesions in the frontal lobe, but irrespective of the cause, it is not difficult to think of his family members who are also suffered. He should have a longer road to go, but the finishing line is only meters in front of him. Problems arise prematurely: What about the financial support? May be his wife. Then, who takes care of the little boy when his mum's out for work? May be his mother. Fine, where is their happiness?
End of life issue is always taught lightly in lectures. "To care about patients' feeling and needs, and provide holistic care, blah blah blah." Yes, words are cheap. What if, the patient is your beloved one?
Death is an inevitable destiny for every creature under the sun. Only its cause can never be fair.
He is a 30-year-old engineer who lives in New Territories with his wife and a 2-year-old son. He has been well along before presented to us with acute onset of shortness of breath for one day. He is aferbile, without cough and sputum production. However, he complained of low back pain for few weeks, loss of appetite and weight loss of 6 pounds in 3 months. He denied of any smoking habits.
Physical examination revealed reduced expansion and air entry, with stony dull percussion note on the right chest. The impression of unilateral plueral effusion was made and its differential diagnosis included lung carcinoma, followed by pulmonary tuberculosis and pneumonia, which the latter two are quite unlikely. After chest drain insertion, more than a litre of fluid came out every day, and a few days later, he was transferred to the cardiothoracic surgical ward.
It has been two weeks from now. Today I saw him in the medical ward again, this time he was admitted for blood stained fluid in the chest drain. "Oh God. Have a chest drain in-situ for so long. What had happened to him actually?" I flipped through his case notes and searched for the laboratory reports. "Holy shit!", I shouted.
"Stage IV adenocarcinoma."
Horrified by this piece of information, I took a glance on his progress note, written by his case MO, "Discussed with patient's wife and mother, ... DIAGNOSIS NOT DISCLOSED to patient as asked. Explained the patient still had the right to know and I had no choice but tell him if he enquires."
I cannot imagine how I would react if I, being a non-smoker, had an end stage lung cancer at the prime of my life. With a little boy playing toy car on the carpet and a pretty wife sitting beside me watching television, this is ridiculous to think that this kind of blissful living will end in months' time. May be I will go mad and crazy, or depressed and gloomy, or bipolar manifestation.
Later a PET scan revealed two cystic lesions at the left frontal lobe, which is, a brain metastasis. One may shift the blame of his mood changes to those lesions in the frontal lobe, but irrespective of the cause, it is not difficult to think of his family members who are also suffered. He should have a longer road to go, but the finishing line is only meters in front of him. Problems arise prematurely: What about the financial support? May be his wife. Then, who takes care of the little boy when his mum's out for work? May be his mother. Fine, where is their happiness?
End of life issue is always taught lightly in lectures. "To care about patients' feeling and needs, and provide holistic care, blah blah blah." Yes, words are cheap. What if, the patient is your beloved one?
Death is an inevitable destiny for every creature under the sun. Only its cause can never be fair.
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