HCC taught me all This article didn’t require much effort to make it interesting or readable but through it I have definitely learnt my learn and now hear only one thing from my professors: “You deserve to be a postgraduate in general medicine” thanks to Ismail the patient who made me that capable and whose story I am putting forward in this article . The feelings and emotions was just all over me and I must say for few days till I recovered back myself from the dreamy reality. I had now to know the difference between dreamy reality and the true reality. Working as an intern started off with nervousness, how it could be to treat the patients for real, its nerve wrecking for reality. You must have heard for doctors and doctor why fantasized people that being in medical world is something different , I reckon too. In just two months of postings initial of my internship, it has made me strong that I should deliver quality medical service and healthcare to all my patients , how did that happen, is the story I am going to tell now.. On my second week of my posting in the general medicine department , AJIMS, it was a Monday I clearly remembered, me, my fellow colleague and my postgraduate and consultants sited on another table were looking at patients coming to outpatient department patients, I remember those days how it used to be hectic and creating a havoc of my emotions and making me confused whether the irritation is caused by my half let breakfast in the morning or the patients not able to understand me talking..but anyways I am an amateur In this way …dealing really with patient in real life and while you are studying is different. Its like a ship which we see on the top of the water when we are as medical students and the reflection which we see when we are in the water from before when we are as doctors. Hats off to all those doctors who once upon a time didn’t have the advantage of using ct/us/scan/ routine blood investigations . I do imagine all this whenever I send patients for investigations to rule out any mass in the abdomen ( an ultrasound) , if PUO send the blood for routine blood test , culture and sensitivity, cough with expectorations then chest x ray. It became a routine and was set in our day to day opd day work. I remember at 12.00 pm noon, as I was always expecting to get more exhausted because of laborers who come from their factory or work place and come for checkup. I recall nothing less than 100 patients I have myself admitted for dengue and malaria, as my place is known for having mosquito breeding all over and workers living places are always crowed and unhygienic environment. At sharp 12.00pm I saw an old male aged 55 years came near me and bypassed me and when to my postgraduate as he wanted to examine the patient. The patient named ismail who had breathlessness, jaundice, elephanit is, distended abdomen, shrunken face came in a lungi and bunyan with his wife and two sons. I didn’t pay much attention to his case history but sure he was worth a million dollar but yet obduracy when it came to studying, I continued with my 5 cases all dengue positive , wrote admission for them and got them admitted by making them scared, that’s my trick I don’t like people falling sick and dying for a problem which is treatable for free in our hospital. Later at 1.00 pm it was out break time , next lot of patients would come after2.30 pm , some with their reports and some again fresh for checkup, some for admission , some for meeting their doctors that’s our consultants. At 2.230 pm, back to opd after a really good lunch, as usual had our second half od our day and then at 4.30 pm we were done with the opd, I always reckon of the good feeling when a hectic day like this gets over . well it isn’t over in real sense, in the evening we have rounds being in first unit where the consultants come for rounds and see the patients which me, my fellow intern and my postgraduate admit during the opd, to my surprise I was the first to come and again astounded to see Ismail admitted , he was with his fair, shorter than him wife with a scarf around her head, I headed towards the patient and gave a smile and as I told you it’s a million dollar so I gave a million dollar smile, thank fully the patient knew my language though he was a muslim malayali. I spoke to him took his history and then when sir came presented the case to him, he ordered for few more investigations to confirm some differential diagnosis which was running in his mind while I narrate the history. Alas , rounds was over, we left after that and went back just to drop dead in our beds to sleep, I still feel the still in my body I wouldn’t shake abit after I come from hospital. Next day, time to run for investigations, reports to be ready so that when our head of the unit ask , we should blurt it out as if it was a mistake and not done with intention. Ismail was there smiling at me, we have become friends now in a day and his wife a sweet lady indeed was another adorable woman. Like this days when by, I was asked by professor to drain his fluid from abdomen as he was diagnosed to have ascites, I got an opportunity to do ascites fluid tapping not one or twice , but five tiimes on this patient. It gave me a curiosity to know why is it actually happening to him but I always knew my professor were the best and they stayed calm in all such cases, their calmness, calmed me and my curiosity. But 1 day I saw Ismail condition getting worse , he alway complained for sleeplessness and breathlessness and with days he wouldn’t sleep flat but sleep at 60 degree when the bad was adjusted for him. I used to see him walking catching ht walls of the wards, walking had indeed been a curse to him, infact his body had become a curse to him. After 2 weeks of treatment, he had to get a discharge though he was not suppose to as his mother –in –law expired and he had to be there. While I write his discharge sheet, I came across a sentence whose meaning I didnt know but that actually changed everything, I happened to ask about the short cut used in the sentence. My postgraduate told he was a known case of hepatocellular carcinoma, that is what is written in the sentence. I frowned the haboob was due to premise reports but still tried to manage my shock in a low prolife. So is this the answer to all the questions I had about the patient for the past so many days. I rushed through his sheet to and fro and found his liver function test were screaming the truth they say it all. I took a deep breathe trying to recall how he once told me that how badly he needs to see his younger son zayd 5 year old after he get discharged , as he never gave him importance after he started falling sick on and off for past 2 years, I turned to my right ismail sitting and smiling at me with exhaustion on his face and dropping shoulders pointing downwards. I realized 1 thing there was time when I assured him that he had nothing and that now I come to know he has HCC without having past history of smoking and drinking for life. I came home after finishing my work still having patient Ismail image right infront of me, I felt I failed as doctor, I cant save his life anyhow. I went through net to find out whether there was any treatment for HCC , all not assuring for complete recovery and no promises for further expansion of life span. At that moment I thought I wished I had a vaccination in my hand so that I could inject in him for his wellbeing and save him. At night, I was silent, mom could notice it , she asked me and I broke down . what made me weak? That’s the question I asked myself at the moment I felt my tears on my cheeks. I told my mother I failed to treat my patient I failed as a doctor to understand his condition, I failed to correct his misconception of longevity of life, I assured him of LIFE! Which I am not suppose too. Mom could see it and she felt my pain, she mourned for the bad fortune of the patient, she told me that it wasn’t my fault, I mat the patient for the first time 2 weeks back, and that other doctors are treating him, I still had to learn more about healing. She told me show love and kindness to the ones who need it the most. Those words linger till date in my head. Researches show that dendritic cell based tumor vaccines achieved encouraging results and cellular vaccines based on DC’s have already clinical trails. Use of DNA- based vaccination raises exciting possibilities in preventing HCC in high-risk individuals such as those with cirrchosis. But finance was the problem for low social economic people. From there on I had decided, however, whatsoever, be it from different colours, background, races, I will make sure everyone should get the came best quality treatment because its their right. Like my professor had once told me in the lecture class, “ your every patient should be treated like your first patient of the day”. I reckoned those words and I have made them my living policy, as long I treat I will workship those golden words till my last breathe. My message through this article was for all those brilliant doctors out there, sometimes you suffer and you suffer the fillest maybe alone or crowd sometimes in the OT or wards sometimes while doing procedure or sometimes in lecturer halls, we are humans after all, we have our own stakes and priority but as doctor , we got to make other people health as our own priority live like a doctor and die proud after all it was fun taking Hippocratic oath, its more fun when it complete it with finesse …
Posted on: Sat, 06 Jul 2013 13:07:17 +0000
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