Palliation

Life is an ongoing challenge. To deal with terminal patients on a continuous basis requires strength. Fungated post penectomy inguinal mass, a post operated carcinoma prostate-bleeding for more than 12 hours, a Carcinoma lung with metastasis to almost the complete spine, a unknown primary with carcinomatous meningitis and multiple metastasis, etc etc.
Few get palliated and few don't. It is our duty to do the best to them.
The penectomy patient has improved after palliative radiation.

The prostate patient's relatives were not ready to spend. Inspite of me offering radiation at free of cost to them, they were not ready to get the required blood to support him. His hemoglobin was less than 4 gm%.
The patient got discharged without any treatment and I felt a tinge of regret. The inevitable must have happened.

There was another patient referred from my alma mater 'Tata Memorial Hospital', Carcinoma lung with brain metastases. The patient was in good shape. The sons decided to only offer Steroid medication as supportive care to their dad, fearing that radiation is painful. Both sons were well educated but decided to go against a treatment which would have improved thier dad's life as well as given him a better quality of life.

At present there is another patient of carcinoma lung admitted, who has multiple vertebral metastasis. His pain due to metastasis has reduced but he still continues to be breathless. He has bilateral lung infiltrates. Everyday is a challenge to treat him.

Peripheral Radiotherapy Center

I have moved from Tata Memorial Hospital to a peripheral Cancer center. It is entirely different experience to discuss issues with patient and counsel them as an independent doctor. I am learning each day.
I have a tough 60 year old gentleman suffering from multiple myeloma. He has visited a tertiary care center at Bangalore and is not happy with the whole experience. He is not interested in any kind of treatment and is preently in a denial mode.
I have at present just promised to relieve his pain. I hope he improves with pain relief and get backs for further treatment.