a life to live
I went home feeling sad and bitter. It had been a rough and busy day, because I have many patients that were very very sick and… probably dying.
I was bleeped many times by the nurses about a patient who deteriorated rapidly during the day. She has a history of metastatic cancer of the kidney. She was initially admitted for chemotherapy, which has to be delayed because of her poor immune system status.
9.00 am – she was talking and smiling to me during the ward round
2.30 pm – suffering from symptomatic hypercalcemia
4.00 pm – severe abdominal and back pain, I had to give her Morphine for relief
6.00 pm – very weak, difficult to rouse, low blood pressure. ( ?nazak )
I attended her, did what I could until she was stable enough, and went home. I wonder whether I will see her again tomorrow.
On another ward, another patient of mine started vomiting blood. His blood counts came down too low, that 3 units of blood transfusion has to be given. My consultant strongly felt that this man should not be given any further chemotherapy, because his clinical condition is getting worse. In this situation, if we continue to do so, he can actually die from the chemotherapy, rather than from the cancer! Yes chemotherapy can kill the cancerous cells, shrink the tumour, but please know that it also kills everything else in the body, damages the bone marrow, weakens the immune system, makes people bald, nauseated, weak and very sick. Besides, his most recent CT scans showed his cancer is spreading rapidly despite everything we tried. We are loosing the battle against cancer in this man.
It is the most difficult news to break to him and the family. They were very angry, in denial, emotional and blaming us for being negative about the future and giving up. We,the doctors, just kept quiet. Let them scold, cry and shout to us. Accepting that nothing else can be done to save a loved one is not easy. We did not and had no heart to tell them that according to a recent research, the average live span for patients with such cases (which i am not going to mention here) is only 21 months after diagnosis.
What did i learn from the whole thing?
First of all, after working for only a month in Oncology, I know for sure that this is NOT the field that I’d like to specialise in. It is depressing. The patients on my death list are almost as many as my discharge list! As I deal with death almost on a daily basis, it is one of my greatest fear that I become immune and insensitive to death, that the heart is frozen and fail to react when remembering it. Dzikrul Maut will be a problem then.
It also made me realize that, death is the same, what differs is just the cause. Whether it is from cancer, or an accident, or homicide. The plain truth is, I may die even before my sick patients. When the time’s up,the angel Izrail will come to fetch us. Therefore I would like to quote the much beloved late as-Syahid Dr Abdul Aziz Rantisi (may Allah have mercy upon him):
“We are all waiting for the day to die. Either it is by Apache, or by cardiac arrest.. it is the same. I prefer Apache!”
For those who don’t know, Apache is Israel’s attack helicopter, sending missiles and bullets to the Palestinian land. As-Syahid Dr Abdul Aziz Rantisi once said, he preferred to die being shot by an Apache, rather than simply from a cardiac arrest. He wanted to die from a noble cause, wished to die as a warrior. He worked hard for this dream. He fought in the battle, and was one of the top Palestinian Hamas leaders. And Allah granted his Doa, he was attacked by 3 Apaches in 2004 and was martyred.
“Janganlah kamu mengira bahawa orang-orang yang gugur di jalan Allah itu mati, bahkan mereka hidup di sisi Tuhannya dengan mendapat rezeki. Mereka dalam keadaan gembira disebabkan kurnia Allah yang diberikanNya terhadap mereka..” (Surah Ali-Imran: ayat 169-170)
If I was put in the position of one of my patients, knowing I have only days to live, what would I do? What would you do? Would we change our ways? Is there anything that we would stop or start doing? Think about it. Perhaps that is the way we should always live…
Oncology Medical Officer