A Cancer Story

8/13/2019 A Cancer Story

1/5

A CANCER STORY

By Dr ALBERT LIM KOK HOOI

Despite the best of preparations, dealing with death is no easy matter, especiallyfor those who are grieving.

An 81-year-old man was diagnosed to have an advanced pancreatic cancer. He

was in fairly good physical shape. He had good insight to his problem. Of one thing he

was sure. He wanted chemotherapy if it would mean a prolongation of good quality life.

That put me in a quandary. Pancreatic cancer is a deadly disease. The average

life span, even with state-of-the-art chemotherapy for the younger patient, is six months.

Luciano Pavarotti (the maestro Italian tenor) and Patrick Swayze (the Hollywood

actor) survived less than a year with the best possible treatment. My patient, Mr A, was

two decades older.

Pancreatic cancer ... Luciano Pavarotti and Patrick Swayze survived less than a year

with the best possible treatment.


2/5

I told A that a good quality life was very realistic without chemotherapy. We could

treat the symptoms as they arise. I tried to dissuade him from undertaking

chemotherapy. The chances of him living a year, (even if he responded favourably to

chemotherapy) was remote, say 1% to 2%.

Moreover, he was 81, and whatever we can say about biological age (actual

physical condition) versus chronological age (how many years since birth), he was still

81.

He would not budge. Reluctantly, I agreed. I first ascertained his

cardiorespiratory, liver, kidney, and bone marrow functions. If one of these functions

were inadequate, I would be on solid ground to refuse him chemotherapy. As it turned

out, all his functions were adequate as far as chemotherapy went. Moreover, he was

self caring, mobile, and mentally acute.

I estimated his survival to be between three and six months. Accordingly and

delicately, I prepared him and his family for the eventual outcome. With each visit, I

reinforced my message about his short survival time. I wanted A to have an opportunity

to sort out his affairs (the sooner, the better) and his family members to go through

anticipatory grief.

In this way, A will be better prepared for his last journey and his family will have a

smoother bereavement. That was all simple textbook stuff. Most oncologists would have

done the same.

The chemotherapy programme began with the anti-cancer drug gemcitabine.

There are a few other regimes available consisting of two, three, or even four,

chemotherapy agents. Even with one agent I was wary. I told my oncology nurses to

keep A within their telescopic lens.

I advised him and his relatives to tell me as soon as something was amiss. To

the relief of all partiesthe patient, relatives, doctor, nursesA tolerated


3/5


4/5

His tumour had spread to the liver, lungs and the abdominal cavity extensively.

Coincidentally, he developed a stroke and became comatose. We gave him oxygen and

put up an intravenous drip of normal saline. This treatment was more a salve for the

relatives than anything else.

You could not have asked for a better medical story. We have an intelligent, well-

motivated patient who knew what he wanted. He had no regrets about undergoing two

lines of chemotherapy. He had lived a good quality life with cancer, easily six to nine

months more than expected. The relatives were counseled repeatedly and had

apparently accepted it all. We had the textbook all played out according to script. All

honky-dory, or so you would have thought.

For three days, A hung on. He appeared peaceful in his comatose state. His

breath became shallower and his blood pressure slowly dropped. A Do Not Resusitate

order was issued. During those three days, some of his relatives (there were 30 in his

room), became agitated. They made unreasonable demands. One suggested CT scans;

another even suggested a transfer to the Intensive Care Unit. All this happened even

though counseling went on for a year.

A.s heart stopped beating. Two relatives vehemently insisted on calling the crash team.The code blue button was pushed by one of the relatives and an announcement was

made over the public address system of the hospital. Ten doctors and nurses rushed to

the patients side and started cardiopulmonary resuscitation.

Of course it was all in vain. There was only one outcome.

Perhaps, the reaction of the relatives was not that unexpected or bizarre. At least not for

a minority of us. There were 30 of them acting out roles determined by complex social

dynamics. Each was trying to vie with the other on who cared and loved papa and

grandpa more. Was it the one who denied his death? Was it the one who cried and

mourned the loudest? Could it be that this outward show of filial piety was therapeutic to

them? Did the bedside charade make their bereavement easier?


5/5

BIBLIOGRAPHY

The Star, (2011). Health. Retrieved on 20th February 2011 at

http://thestar.com.my/health/story.asp?file=/2011/2/20/health/8086137&sec=healt

h

The Star, (2011), Health. Retrieved on 21stFebruary 2011 at

http://thestar.com.my/health/story.asp?file=/2011/2/21/health/8095837&sec=healt

h
http://thestar.com.my/health/story.asp?file=/2011/2/20/health/8086137&sec=healthhttp://thestar.com.my/health/story.asp?file=/2011/2/20/health/8086137&sec=healthhttp://thestar.com.my/health/story.asp?file=/2011/2/21/health/8095837&sec=healthhttp://thestar.com.my/health/story.asp?file=/2011/2/21/health/8095837&sec=healthhttp://thestar.com.my/health/story.asp?file=/2011/2/21/health/8095837&sec=healthhttp://thestar.com.my/health/story.asp?file=/2011/2/21/health/8095837&sec=healthhttp://thestar.com.my/health/story.asp?file=/2011/2/20/health/8086137&sec=healthhttp://thestar.com.my/health/story.asp?file=/2011/2/20/health/8086137&sec=health

A Cancer Story

Documents

Transcript of A Cancer Story