10th February 2009
As a medical student, I try very hard not to get involved emotionally with the patients I see everyday in the ward, especially those patients assigned for me to clerk, examine and follow-up. However, despite preventive measures, these attempts – of not getting emotionally affected – usually fail.
I was recently assigned a female patient who is 52y/o, nearly the age of my mother. Because this pt is sooo motherly and kind and caring, I grew sooo attached to her and began to love her more and more everytime I see her.
She presented with massive hepatomegaly (enlargement of the liver), so massive that the liver capsule is already stretched and thus causing her pain. Lower border of her liver could be palpated 18cm below the subcostal margin (imagine how big the liver span would be), and even the left lobe was enlarged, huge enough to be felt in the left upper quadrant, up till 10cm below her left costal margin.
Back to her case, suspicion of hepatocellular carcinoma was rendered unlikely by blood investigations of liver function test which was relatively mildly impaired and alpha fetoprotein which was normal. Hepatitis screening was also negative.
To cut the story short, the primary tumor turned out to be a gastric tumor. Biopsy showed atypical cells but the histopathologists were unclear of the exact diagnosis. Therefore gastroscopy was adviced to be repeated for a second tissue biopsy. However, currently the patient refused due to unbearable pain and discomfort during the process.
This evening I tried persuading the patient to redo the endoscopy and she asked a lot of questions regarding whether or not the agonizing process would affect her Mx later on. I promised her I would read more and explain to her again tomorrow, including the treatment options that the patient was so interested in.
To be continued...