Wednesday, October 18, 2006

The Living Dead

You can tell I'm gearing up for haloween can't you.

Thing is, there have been a few patients recently who could be said to fit that category, including one charming gentleman this morning. They all have one thing in common. A terminal prognosis. That is to say that we have identified in them a condition that will, whatever we do, and unless some other catastrophe intervenes, claim their lives. They have crossed some invisible line between the curable and incurable.

It is very easy for patients and their relatives to hear one message at such a time. "I'm very sorry Mr Bloggs but there's nothing we can do".

Well that's just not true, there's plenty we can still do. For my patient this morning the introduction of steroids have transformed his appetite and his sense of wellbeing. They have also, coincidentally, done a great deal to help his arthritis (not his terminal condition, but a potent source of misery in its own right). In restoring his appetite they have also brought some pleasure back to mealtimes, both for himself, and for his wife who was beginning to doubt her culinary abilities quite unneccessarilly.

He has also been able to have a number of pulses of palliative chemotherapy which have helped at least slow his disease progression. And throughout it all, despite the fear that came with the original diagnosis, he has managed to keep his good humoured nature and positive outlook. We both know that he is already as good as dead given his diagnosis, but he is determined to keep on living, in the very best sense of the word, for as long as he can. And today he reached a landmark.

Back at diagnosis he asked how long the oncologist thought he might have left. She was pretty clear in her prognosis-- a month or two perhaps, probably not six months. That was six months ago, and today he feels fitter than he did back then and is "very happy to have proved her wrong".

12 comments:

Anonymous said...

When these specialists give a prognosis, do they just suck something out of their thumbs? Are they deliberately conservative?

You know - my Dad was told the same thing - he was given at the very, very most 3 months..and he lived for 9 months..and in the end it was an internal haemmorrhage that did him in - not the cancer per se...although it may have been related...I just wonder how much do these guys actually know about giving out a time line.

Z said...

It seems to be the first thing people want to know - a timescale. But that depends on so many things that can only be guessed at. Maybe it isn't fair to ask, however natural the question is.

Anonymous said...

Z - yeah it is such a natural question..I'd ask it too....but..well I just wonder how are patients actually informed..I mean..are they told.."Well you are riddled with cancer cells..your guts/brain/lungs etc etc are rotten and basically not there anymore...realistically you should actually be dead right now...so, let's just say...maybe another month or so?" Or are they told "Hmmm..well it's hard to say really..the body is such a mysterious and unknown machine and anything can happen...so perhaps, to be on the safe side...you can count on another month..maybe more if you are lucky? Or unlucky if the pain happens to be crucifying you. Really Mr X - just wait and see and make the most of every day."

Shinga said...

On the other hand, when my father was ill, I had no expectation that he would recover (he had the dubious distinction of being the UK's first mortality for Legionnaire's Disease) but the nursing staff told my mother that he would recover and be fine: the doctors were more equivocal but never told my mother that the outlook was bleak. Right up until 20 minutes before he died, the nursing staff were discussing the time scale for when he might leave ICU for the general ward, and how with a little rehab he would be back at work in no time at all.

The conflict of information and mis-information was even greater for the colon cancer that contributed to my mother's death (a long time ago).

All in all, this was a very jolly story for Halloween, Dr. J. Can we look forward to more janitorial spirits and ghostly japes nearer the time?

Regards - Shinga

Potentilla said...

There now, I never thought of myself as the living dead before. I shall do a rebranding.

wendz, good doctors nowadays will answer a direct question with lots of "it's very hard to say and everyone's different". If pressed, they will give a statistical answer - "the average life expectancy for untreated gastric cancer is 3-4 months". Is that the same as being "given 3 months?" absolutely not, because the average is just that, the average - quite likely the average of a wide range of individual outcomes.

Basically, it's a case of "ask a stupid question and you get a stupid answer".

Anonymous said...

"The Median Isn't the Message" by Stephen Jay Gould
http://www.cancerguide.org/median_not_msg.html

Anonymous said...

My name is Ben Fawkes - I work at onexamination.com. I hope you don't mind me messaging you like this - onexamination is going through some big changes and we would like to hear your opinion basically.

We have recently set up a 'med news review' feature. This basically collects all the medical news from across the whole web and centralises it on our site - allowing you to keep up to date with current medical affairs. You can then vote and comment on these stories and influence what the community reads. As a tech savvy individual, would you be prepared to be one of the first reviewers of this new 'playground'? Have a look and sign in here: http://labs.onexamination.com. Previous username and passwords can be used if you have had an account with us.


We would love to know what you think. Please take a look and have a play - if you have any feedback you can contact us via the labs site or me personally at ben.fawkes@onexamination.com. And if you feel inclined to write about the site in your blog we would really appreciate it, no obligation though!



I look forward to hearing from you!

Ben Fawkes
onexamination.com

Doctor Jest said...

anon-- fantastic link. Thanks very much for that. i hope everyone got a chance to take alook.

potentilla-- may you follow in Dr Gould's footsteps (see anon's link above). Of course in reality we all have a finite span. Some of us are sadly made aware of it sooner than others.

Doctor Jest said...

shinga-- sorry got distracted by the advertorial above :-(. Rough tales re your folks. I'm hoping to have something diverting for all hallows eve, but am teaching again at present so the posting may be more sporadic than usual.

Anonymous said...

Dr Jest,

I am the Editor for Blue H News. We are interested in printing some of your entries. Please contact me at george.page@bluehnews.com for details and your permission of course.
Thank you,

George

Doctor Jest said...

George-- I treid to find Blue H News on the web without success. Perhaps you could give me a url to look at before I reply?

George said...

Of course! www.bluehnews.com
My email is editor@bluehnews.com

George