INDEXING TITLE: CLeyson’s Medical Anecdotal Report 06-04 

MAR Title: OBLIVIOUS PATIENT 

Date of Medical Observation:  April 2006 

Narration: 

One evening in April, junior resident referred a 39 year-old female with breast mass on the right. As we were approaching her bed something hits my olfactory nerve, I cannot help but make a face… and my resident told me “That’s the reason why her husband brought her to the hospital and the husband said that he cannot take the smell of her wife anymore”. I thought to myself…what a weird reason for a chief complains.  

As I approached her, I introduced myself and I started to take the history of the illness. According to her, she noticed the mass five months ago. It was about the size of a santol seed and was gradually increasing its size. No consult was done.  She thought that the mass will disappear in time. After the holiday seasons, the mass erupted and bleed but still no consult was done. When I asked her why she didn’t consult a doctor, she just formed a shy smile.  

For the two months after the mass erupted, she has been living with her foul-smelling breast mass and she doesn’t mind having it. Although she experienced tolerable pain she self medicate with pain relievers. At that moment, her husband came hurriedly walked towards us looking so worried and intently concerned. I told myself that maybe this guy l loved his wife more than his own, for him to tolerate, such nerve wracking, smell of his wife’s necrotic breast.    

When I examined her, I saw a 20 x 25 cm ulcerating mass at her right breast with purulent discharge. Swelling and erythema of the surrounding skin and soft tissue were noted. We suspected that she has cancer of the breast. As a physician’s obligation to his patients, I explained to her the present working impression and the possible treatment options. As I was explaining, I was observing her reactions to the news. It was blunt and empty. It seems that she was looking straight through me. In my years as a surgery resident, I fairly have an idea how people reacts when given such a bad news. But this particular patient of mine seems oblivious of her surrounding. A few days after admission I asked her the real reason why she let the mass grows and be in that condition. She admittedly said that she was afraid that the examination revealed cancer.

INSIGHTS (Physical, Psychosocial, Ethical,)(Discovery, Stimulus, Reinforcement) 

Breast cancer is one of the dreaded cancer diseases among Filipino women. Due to nationwide advocacy against breast cancer, many people seek consult every time they felt something around the breast area. But still some people deny the existence of such an illness or the patient itself denies that she might have the disease. Sometimes denial leads to a graver outcome.  

Denial, anger, bargaining, depression and acceptance, these are the stages of grief. DENIAL—the first reaction of patient receiving a bad news, they usually said that it can’t be happening to him. ANGER—patients usually exhibited anger, rage and some are pushing every body close to him away, even be angry with God. BARGAINING—at this stage, patients usually realized that nothing changes, the reason for the grief is still there. The next will be DEPRESSION—this time patients were depressed because what ever he/she do nothing seems to be working. ACCEPTANCE—the last stage of grief where patients eventually accepts his condition and for terminally ill patients sometimes they will make the rest of their life’s worth the while.