Three patients come into the hospital complaining of tummy pains. Here are their stories.
============================================================================
Robert is in his 70s this year, he has been controlling his HIV well for many years up until recently where it seems he has had a relapse. He looked unkempt and malnourished and it felt like his pains may be from a lack of food. Initially, he says that his tummy pains have been bothering him for years, but when asked to elaborate, he speaks tangentially and paints an inconsistent story that almost hinges on confabulation. When quizzed, he is able to accurately state where he lives and how he got to the hospital; but is unable to state what year it is or do simple mathematics.
His son who moved out last year pointed out that on occasions, Robert was unable to tell family members apart and had started forgetting how to operate his circuit box. Thankfully, when family visited, it still seemed like Robert was coping adequately whilst staying alone.
It seemed like Robert's tummy pains were the least of his concerns now. His agnosia and apraxia are suggestive of a progressive loss of executive function. What was causing this? Is this cognitive impairment causing him to forget to take his medications thus leading to a relapse of his HIV? Or is his relapse of HIV causing him to have this cognitive impairment?
A MRI of his brain revealed a large growth in his frontal lobe. Neurosurgeons are involved, families are called down, radiologists debate the nature of this growth. The path forward seems convoluted now.
Do you put a 70 year old man through invasive brain surgery to find out if his growth is benign, malignant, infectious, or something else altogether? If he does go through surgery, you'd have to plan for the best possible resources to aid in his post operative rehabilitation. If he doesn't, then you'd have to prepare for when he starts declining and be unable to care for himself.
A multidisciplinary discussion was had with Robert's family, and the decision to proceed with surgery was made. In blessed fashion, his surgery was uneventful and his growth was a benign tumour. Robert's road to recovery was not an easy one and ensuring he had sufficient community support was challenging but eventually Robert went home with his loving family.
============================================================================
Abdul is a 50 year old man who came in after a fall. He seemed well, apart from a few bruises. That was until halfway through the day where he developed a sudden searing pain in his abdomen.His heart rate skyrocketed, blood pressure plunged as he went into shock. Initial efforts at resuscitation bought some time for further investigations to be done.
Blood work revealed a drop in his haemoglobin levels as well as an increased blood clotting time. A CT scan revealed a haematoma at least 1L in volume. Abdul was bleeding into his abdominal wall from acquired haemophilia.
His body was flooded with donated blood and he was promptly started on immunotherapeutics. It was a stormy month for Abdul, where he developed new bleeds that would bring him close to the brink of death every few days. One could only imagine the mental turmoil Abdul experienced each time he experienced a setback. Nonetheless, the medical team stoodfast and stabilised him each time.
One day, his blood work indicated a remission of his haemophilia and Abdul was able to make a recovery.
============================================================================
James was 83 this year. He had a peculiar gnawing pain in his epigastrium that went to his spine. It had been bothering him for a month, but honestly, it was more of a slight discomfort to James than anything.
If his family gave him a choice, he would have preferred to stay home watching TV and spending time with the grandkids. But his daughter was concerned as James had lost a considerable amount of weight. True enough, James was found to have metastatic pancreatic cancer.
At 83 with a diagnosis of metastatic pancreatic cancer, James' prognosis was grim. He mentions that he has had a fruitful life and was blessed with a loving family. He treasured his independence and valued his quality of life. Was it a surprise when he expressed that he only wanted palliation? It was to his family; his daughters could not understand why their usually healthy father could so easily say no to life.
The family conference was an emotional one. James was able to convince his family of his wishes. The healthcare team worked together to ensure the family had all the available resources to allow James to pass away comfortably at home.
============================================================================
A long read I know, but here's a few questions.
Did you manage to stick through the entire trilogy? If so - perhaps medicine may be for you?
Which story did you find the most engaging? I myself am not sure yet. Do I enjoy the diagnostic process, the treatment process, or the communication aspect? Can I aspire for holism? I can only hope to have an answer in the next few years.
