Friday, October 10, 2008


Part of the every day challenge is to find the really sick patients amidst the, what at times seems like endless, stream of faces who come through our doors each day. Cancer patients are often in the really sick category. At times, it is easy to recognize someone with cancer, but often it isn't. Sometimes there is a smell so as soon as they walk into the room you know they have something bad, others use towels or hats to cover up what to them seems like a gross deformity of some part of their body. However, often they come through our triage system like someone with HTN here for f/u and it is only through listening to a history, doing a physical exam, ordering blood tests, or checking an ultrasound or Xray that we find that they have cancer.
Recently, I have had lots of patients who I have diagnosed or confirmed the diagnosis of cancer. This is never easy, especially when they are so young. Just yesterday, I told an about 18yo boy that he has AML, acute myelogenous leukemia. Despite having some chemotherapy that we can give him to try and keep the cancer under control for a short period of time, we aren't going to heal him, only God can do that. I told an elderly lady that her breast cancer is too big now and we aren't able to operate. I also saw Buldung, who was back for a recheck and looking good. His WBC was too low to regive chemo, but his tumor is shrinking some - Praise God.
In the last month, I had to tell a family that their 2 boys both have cancer and that we aren't going to be able to do anything for
them. One boy, we thought might have a lymphoma, but he didn't respond to chemo and was getting worse. The other boy has a huge sarcoma of his hip and we have no options to remove or decrease it. I have also seen 2 girls come in with osteosarcomas of their legs. One was so huge her R thigh was 3 times the size of her left, and she already had metastasis to her lungs. The other was a younger girl, like 12, with this huge mass of her tibia and her parents didn't believe it was cancer. I had to reassure them that it was and send them back to Mt. Hagen for the surgery. Just this week, I have told 2 others that they have metastatic breast cancer, one that his tongue cancer is beyond the point where we can help, others that they have cervical cancer, and gave chemo to Nathaniel for his Burkitts.
The tough thing about cancer is that we can't always fix it, in fact, most often we can't. Many patients come in once the cancer has already spread, others we find it early, but don't have the treatment to give them. So, although making the diagnosis is good, it doesn't always fix things. There are lots of things in medicine like that. The diseases and illnesses that I see everyday continue to exceed my medical knowledge and/or medicine available. I treat everyone I see each day, some with medicines, some with referrals to the specialist, some by giving reassurance, and some by praying. When it seems like medicine has let us down, that there is nothing else to offer, there is always prayer. I am thankful that medicine isn't the end, that hope remains in our Great Physician.