Some years ago.
I was involved in a research during my surgical rotations.
I worked with a reknowned transplant surgeon.
We had this patient ZA (not real initials).
Mr ZA had one of those rare conditions.
He had a primary angiosarcoma of the kidneys.
It meant that he had a potentially malignant cancer that was located on blood vessels in both of his kidneys.
It was a fast growing tumor.
The cancer was discovered in it’s pre-metastatic phase in which the cancer had not started spreading aggressively.
So there was a dire need to get the patient ZA compatible donor for transplant.
Getting him on the long transplant list and closest possible date was quite miraculous, but that we did.
A week or two went by.
He was checked regularly for metastases.
We were hopeful.
Fortunately, we got a good donor match for a left kidney transplant.
We sent him off to CT one last time.
Just to make sure all parameters were in check.
The CT brought in a painful shock.
He was lit up like a Christmas tree on it.
The tumors.
He had metastases (spread) to his lungs and his liver.
Some specs were already ascending up his brain.
So aggressively fast.
We wouldn’t be able to transplant him with this development.
It’s an absolute contraindication to do so then.
I was asked by my senior colleagues to break the bad news.
I still remember that day.
As I sat down next to patient ZA and his 4 months pregnant wife, I took a deep breath with smiles.
That day stays fresh with me.
His prognosis and numbers said he had less than 5 months to live.
The most.
While settling down to begin the conversation, he said “Give it to me straight,”.
I replied,
“If it’s ok, I’d like to ask you a few questions.”
He thought for a minute, then replied,
“Go ahead doc”.
Looking far away, I asked him,
“What would you like to do more than anything?”
His fastidious facie was blank.
No response.
Then I continued,
“Whats your favorite hobby?”
He said,
“I like to travel and play golf”
I continued,
“Travel by land, sea or by air?”
He replied,
“By land”
I asked further,
“Long range gulf or short?”
He replied,
“Both depending on my mood”
I proceeded,
“Is there any golf course you’ve always wanted to play on?”.
He said, “yes”.
Then I suggested,
“Put some of your affairs in order. Go play on that golf course very soon because in about three months you may not feel very well to do so.”
I looked away from him towards his pregnant wife who was sobbing now.
She held his hand.
And clutched on them intertwined.
I told them,
“I would suggest you take your wife with you and let her watch the beauty of your golf and traveling.”
And just as we wrapped it up, I broke the worst of the news to him of the result of the CT metastases.
There was that long deep silence.
I did not go further.
After a moment, the wife in tears said to me,
“Doctor, I am pregnant.”
I smiled.
Then turned to the man,
“There’s a chance your unborn child may or may not get to see the father. But you both can brave it.”
I held his hand looking straight into his weary eyes.
I gently squeezed his sweaty hands.
…and let them go slowly.
No word.
Then I got up, …and left.
He took my advice.
They went traveling and playing golf.
He took his pregnant wife with him for weeks with his medications.
When they came back.
He fought this cancer gallantly.
He beat the numbers.
He exceeded the maximum time he was told he could live.
He saw his only son given birth to.
He christened the child.
He died 8 days after.
LESSON:
- Give hope…
I could have told him he had 5 months to live. Not only would I have been wrong, that would have been cruel. - Primum non nocere.
Above all, do no harm. - Patients are humans, not statistics or numbers.
Patient ZA lessons, will stay with me forever.
PRIMUM NON NOCERE…
Dr James King
August 2017
fblifestyle
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