INDEXING TITLE: JPINGUL’S Medical Anecdotal Report [5-04]

 TITLE: Fight on Cancer

 PERIOD OF MEDICAL OBSERVATION: April 15, 2005

 NARRATION:

     A 29 year-old-male patient had cancer of the colon which presented initially as an abscess on the anterior abdominal wall.  His mother, assuming that the mother knows the personality of the son, requested that the disease of the patient be concealed from him for the time being.  She plans to have the nutritional strength of her son to be regained.  Although they were given the option for chemotherapy for a stage IV cancer, the mother and other family members opted not to give it.

The patient went home with a colostomy.  The mother would text short messages if they were problems concerning her son.  Two weeks went by, and the only complaint was back pain.

I was at home then, when a text message came into my phone, saying that the patient had difficulty of breathing and there was no colostomy output.  I advised them to have the patient admitted, which they did.

On physical examination, the abdomen was not surgical, hence work up for intestinal obstruction was done.  The symptoms were relieved by irrigating the colostomy with saline solution, but the intestinal obstruction recurred again and again, so I directed the patient to the operating room for an exploratory laparotomy.

Upon opening, I saw massive ascitis, multiple carcinomatosis, the mass was frozen into the anterior abdomen and with parts of the small intestine, urinary bladder, and omentum.  Every movement would make the tissue bleed, even the slightest blunt dissection with a finger.  It was unresectable.

We did an ileostomy (a by pass of the small intestine) proximal to the mass.  After the operation, I advised the relatives of the findings.  The patient was maintained on a ventilator, and needed it at the ward.

He suctioned his own ET tube, adjusted the O2 saturation settings, and extubated himself.

After a dialogue with the relatives, I told the patient his disease, and he asked me “May pag-asa pa ba?” I told him that while he is alive there is hope, most studies say that for a stage IV colon cancer, average survival is 6 months.

4 days after that, the patient decided to go home

INSIGHTS: (discovery, stimulus, REINFORCEMENT), (physical, PSYCHOSOCIAL, ETHICAL)

     Fight against cancer goes on.  For a very long time, I have heard of testimonials from patients, and the different ways they have adjusted to fight their disease, to combat cancer for survival.  This time, the patient, who eventually became my friend, is slowly losing the fight.  Was I able to give him a fighting chance?  Did I go wrong in my decision making?  If I made the right choice would he be better off today?

     Heal the person rather than the disease.  At this point, human capablitity is limited, and cancer had progressed.  No human is in control of life, but we are in control of how we react to events in life, even in the event of dying.  This patient is convinced of his life after death, of going to heaven after death.  He is secured in his relationship with his Creator.  And this state of mind have somewhat made dying, a phase in life to go into everlasting life, easier to face.  What is harder to address is the loss and the loneliness felt by the people who are left behind.

    When to tell the person he has cancer?  I would usually say it immediately after the diagnosis to the relatives, but for particular patient, the relatives requested to hide the diagnosis.  Was it unethical to hide it from him?  If he had known he had cancer, would he have made the same effort to get well, in spite of knowing that he had very little time.

    More questions were made, rather than answers.  And we can never know the answers because we have not taken that path.