I had seen a church member in one of the famous medical center yesterday. He was diagnosed with adenocarcinoma of lung 1+ years ago and currently staying in a hospice ward.
His initial symptom was weakness of right hand ->unable to write properly. The first doctor who saw him could not differentiate a peripheral neuropathy from a central one and referred him for cervical and thoracic spine CT. A 3cm nodule and some infiltration was seen over the CT and he was suspected to have pulmonary tuberculosis which leading to isolation of his family and workup for his family. However the were no suitable explanation for his weakness and a brain CT was done where multiple brain metastasis was noted. He was then referred to a chest physician where he was diagnosed as lung adenocarnimoa with distant metastasis.
He had come to our church after someone introducing him to us. He had undergone a course of chemotherapy and radiotherapy for his brain metastasis. His wife had chatted with me and I had fed her with some proper introduction. The chest physician had misled her that they would get Iressa would be provided by insurance after they had undergone chemotherapy. I had told her that Iressa had limited effect on brain metastasis and if the medical insurance would not cover the expanses as the lung nodule was relative small. He had suffered from multiple seizure attack due to the brain lesion and they had chosen to be treated in the famous medical center which was 35 km away(40-50 mins drive as there is no freeway…). Every time he suffered from an attack he would be sent to my ex-hospital and after some stabilization in ED, they would spent RM500 on ambulance transferred sending him back to the medical center.
He suffered from less attack some times and his condition become worsen as weakness was more prominent. He was admitted again 3 weeks ago and later referred to the hospice ward.
I had spent sometimes in the ward during the visit…and was so sad that the so call hospice care was almost the same as an ordinary ward apart from the huge narcotic dose.
His port A was clogged as phenytoin was given through it. The IV insertion site was noted with erythema and a new line was needed today. He was edematous after a long term use of steroid and poor nutrition. It would be better for him to insert a central line however I wander any resident (junior or senior) have the guts to do it on a patient which could barely show his neck…..As for the attending staff -> no way, aggressive management had seen to be contradicted to the principle of hospice care and after practicing such principle for sometimes, one skill would be reverted to an apprentice level after a short while….
Patient was having swallowing difficulty and aspiration pneumonia was likely as he had a lot of phlegm and low grade fever, however he was still fed orally and his wife was reluctant to insert a NGT for him worrying that NGT would irritate him more. No one ever tell her that feeding orally in such situation might ended up in aspiration pneumonia.
The wife kept awaking him from his sleep however patient was so drowsy owing to the heavy dose of morphine and sedative. Her wife was so worried about his constipation despite of heavy laxative use – no one had told her that after such a heavy dose of narcotic use, ileus is likely to happen….
His wife looks so helpless, trying to do something that she things would get him better which in some instance causing the patient to suffer more….A sub standard care as I think the hospice care team would have explain properly to the family about the management strategic and the final process…..
Everyone is hoping for a miracle that he would get out from his bed and returning home well…. I felt so sad during the prayer…During the 1st meeting, I had told his wife that the best way for him to return to the hug of LORD is a sudden onset of intracranial hemorrhage cause by the metastatic tumor. But I knew, no one would pray for that…..
I had seen miracle – there was this female lung cancer patient, she was rushed into our ED for dyspnea and fever. She was also a stage IV lung cancer patient. I had done a short discussion with her family prior to the intubation. Her family was so dedicated for intensive management as her daughter was getting married in 3 weeks. I intubated her and after aggressive management, she had managed to get out from the ICU and later attended her daughter wedding. She continue to live for another year…I received a thank you card from her husband after she passed away…..I considered it as a miracle as we managed to let her gone through so many great event during that year….
I felt great pain – to know more about the process but just don’t know how to help them as I was not the attending physician of the patient…..
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