Terminal 2

NO, I did not go watch terminal again.

Yesterday's afternoon lec was on palliative care. Touchy-feely subject. It was probably an awesome lec due to the fact that lala land has taken over the Henley lecture theatre for those few hours - i was prodding my classmate and she didnt' even nudge. Not to be disrespectful to the palliative care stuff but I guess its all too depressing for us to face it?

We were passing notes around asking "What is the meaning of death?"

I answered "Death is the end of life"

Death is when you resign from your share of life and pass on that space to the next person to arrive into this world.

There were topics on e.g. how to break the news to someone etc. Recently, we had a 53year old man who came into hosptial for a biopsy of his L3 verterbrae cos Lumbarspine XR showed a bulging mass which is highly suspicious of tumour, most likely to be metastatic bone spread. Clinically we also found a hard lump in the axilla - probaby a met to the lymph nodes. Now, how do you explain to a person why hes in hospital? From talking to him we all know that he suspects something. He suspects that it could be something malicious like cancer - and even asked that question.

We know that in ordering tests e.g. biopsy, we always havesome sort of idea in mind of what we are gona find - and in this case - its cancer. Biopsy results takes a few days to come back. Should we put him through the hellish process that the test results that are going to take a few days to appear may be metastatic cancer (and likely to really reduce his survival chance?) Therefore our line of approach was that we told him that there's some changes we see, and although we are not sure, it could be an infection process (which it could be, but for his age and his othre hard axillary node, its probably ...) or some other thing like cancer. ( so we tried to downplay the cancer part).

It turned out that the biopsy show that it was indeed cancer mets in both his spine and axillary lymph node, and the primary cancer being his melanoma (since he got that previously).

But - is it right to not tell them what we really think it was - since we know that the tests bascially showed that he has cancer already...?

Well this was Ilia's patient anyhows, not mine, altho I did see him a few times in the ward rounds. Seems like a nice guy...

I also remember talking to a patient with end stage breast cancer, undergone extensive chemotherapy, and presented to hospital woith Shortness of breath and coughing. She was in her 40s, with nice hair and just looked like a normal tired woman from Eastern Europe. She told me that she learnt most of her English in the hospital after arriving from Eastern Europe and being diagnosed with breast cancer.
She now has metatstatic spreads all over her skin (of cus she's already had mastectomy bilaterally ie. no breasts) ...by met spread on skin i mean huge patches of unsightly lumps and bumps all across her chest extending to her back looking, with ulcerating lesions too.

She also has met cancer spreads to her brain.

And her presentation this time, Shortness of breath and chest infection (i tihnk it was some sort of pneumonia), makes me think she's having lung mets as well.

And yet she was able to tell me and talk to me like a normal person without breaking down into tears any second. She mentioned how her husband is not coming well and mentioned about her children too.

and she knows she doesn't have much time to live.

All this - i couldn't have noticed from this neatly dressed (well ok in her hospital clothes) but nicely groomed (as eastern europeans always are) complete with makeup woman.

...

and then she told me if i can get a head cap for her so she can sleep and take her wig off.

.........

that really took me off guard eh. I suppose that's expected, but i didnt' think that it was a wig she's wearing. I just thot she had really nice hair...