[암시리즈] 3 – In the words of cancer

“Natural Course” or “Natural History”is an expression that refers to how a disease progresses.

cells that grow abnormally tumorIt is called cancersilver malignity An expression used to refer to a tumor. Among tumors, It grows quickly and infiltrates surrounding tissues, and can metastasize, posing a threat to life.A tumor that develops is called malignant.

in other words Cancer grows and divides. Surroundings without control destroy normal tissueAnd radically Take that placeDo it. As cancer grows, it invades or metastasizes. Patients’ symptoms and prognosis vary depending on the area.. Cancer that originates in the abdominal cavity commonly metastasizes to the peritoneum, grows multiple times like sowing seeds, and blocks the intestines.

The patient who came today is like that. A patient with intestinal obstruction due to ovarian cancer metastasizing to the peritoneumIt was. She was a woman in her 40s and had undergone multiple surgeries for ovarian cancer. The prognosis for metastatic cancer varies depending on the type of cancer. Even if ovarian cancer is diagnosed at stage 4, Also called cytoreductive surgery or debulking surgery. Through tumor reduction surgery, anti-cancer and hormone treatment increase survival rateYou can do it. If you endure surgery after surgery like that, at some point your stomach will be full of cancer. Situations where surgery is no longer possibleThis is coming. that setting a point in timeIn some cases, it is an obstetrician/gynecologist, and in some cases, if it is difficult for the obstetrician/gynecologist to make a decision, the surgeon is consulted. First of all, this patient has been able to eat for a while, but has his intestines become blocked again? It became difficult to eat anymore The obstetrics and gynecology department asked if surgery could be performed again.

The patient had noticeably thinned over the past few days and visited my outpatient clinic looking very tired. The eyes Earnest and indifferent at the same time They were mixed together.

It is said that there are five stages in which we commonly accept death. Denial – Anger – Bargaining – Depression – Acceptance. In these long-term cancer patients, there is a gap between depression and acceptance. “Exhaustion”A new step must be added. It’s depressing, but I can accept it to some extent. But more than anything, it was just this If you’re tired of all the painThere are a lot. Especially as the treatment becomes more painful, treatment is sometimes refused at this stage, but in this patient’s case, Symptoms of not being able to eatThis is a situation that is so painful that there is no choice but to attempt active treatment.

“I can’t guarantee whether the surgery will be possible… Still, try it once Let’s do it.”

I spoke carefully. Actually, I’m going to try it too. It didn’t come out easily After much deliberation while scrolling up and down the CT, As if giving up Those were the words I spit out. Did the patient feel it too? Looking at myself again talked about it

“I’m sorry… I feel like I’m always causing trouble to you, teacher…”

I looked at the patient in surprise. There is nothing to hear in this situation It wasn’t what I wanted to hear. I’m a human too, and hearing those words broke my heart.

“What.. don’t say that. Why is this the patient’s fault? What did the patient do wrong?“

“yes…”

“The patient did something wrong. Not even one no. It’s just… this disease is nasty. Cancer is so evil. It’s just a bad illness.“

The patient cried slightly and nodded. I’m a patient held my hand. When I was a student, there was a test called CPX, which involved administering treatment to simulated patients (actors). Role-play practical testam. at that time “Breaking bad news”There was an item called A scenario where you have to hold hands and hand over tissues.There was. so did 50% is learning effectAs, the rest 50% are caught up in the situation It was an action that had to be done. In any case, if the patient is unmotivated and depressed, the disease will not be cured. Revitalizing the patient’s morale was also part of the treatment.

“Cheer up! This won’t work. If you want to receive this treatment, you have to make an appointment with me. Never say sorry again in the future. “Okay?”

The patient kept nodding and smiling shyly. And he said he had something to give and gave me chocolate. I say thank you I took the chocolate she gave me.

I mentioned it before, but I’m working. I don’t like emotional and dramatic situations. work is workI think so The simplest method is to dry it. however terminal cancer When I meet a patient, I become cautious about everything and it is not easy to ignore it like that. It is not easy to adapt to surgery because we do not often see patients with terminal cancer.

Unlike the aforementioned ovarian cancer In case of stomach cancer or pancreatic canceris active the moment it is transferred cancer without surgeryThere is also. This patient was a male patient in his 60s, and he was an acquaintance of a professor at our hospital who even contacted us to ask for his help. However, when I looked into the stomach with a laparoscope, the cancer was so severe that it had spread to the peritoneum. Situations where cancer cannot be removedIt was.

It’s not easy to explain this situation to the guardian after surgery, but the feeling doubles when you tell the story to the patient. to the patient Findings from the operating roomexplained. Since I haven’t seen it in person, there are times when it doesn’t make much sense to me. Take a picture of the laparoscope screen It can also be shown to patients or guardians. of course Do you want to see it?You should ask first. Some people want to see it and some people don’t. This patient I want to see it in person So I showed him the picture and explained it. Although he was nervous, his face was surprisingly calm. Then he asked me.

“Then, if you receive chemotherapy, therapyCan you do it? Even if it metastasizes to the liver There were people who lived…“

“hmm… Chemotherapy for stage 4 cancer It is not implemented with the expectation of a complete cure. Mitigation purposeThis is done by. If the medicine is effective, the survival rate may increase, but…”

The guardian understood what I meant, but the patient still in denialIt seemed like it wasn’t easy to understand. And I introduced the patient to a professor who does cancer treatment. After receiving several rounds of chemotherapy Intestinal obstruction due to peritoneal metastasisThis occurred and I was hospitalized again for surgical treatment. At this point, you have some understanding of your situation. receptionIt was a situation.

When I went back into the operating room, fortunately, it wasn’t too serious, so instead of creating a stoma. Bypass surgery to bypass blocked intestineswas implemented. Because of this situation Chemotherapy was delayed by a week. Hurry and the surgery site heals Once you are able to eat, you should continue with the next chemotherapy treatment. did it While we were discussing when to be discharged from the hospital and when to have the next round of chemotherapy, the patient said.

“Actually, at the end of this month My daughter booked a trip to Namhae.. “I want to go for chemotherapy before that, but is that possible?”

If you want to do anti-cancer before that We need to expedite surgical treatment and discharge patients quickly. did it When considering only the patient’s physical condition, it is unreasonable to hastening treatmentis pretty dangerous workIt was. But oh my For patients with terminal cancer The approach is bound to be a little different from other general patients. sometimes Things more important than living and breathingThere is. Especially in the case of patients who become more anxious than usual.

patient’s to make your wish come true I rushed the feeding process a bit, and although I wanted to wait longer and then discharge him, I pushed the discharge forward a little too much.

“Just in case If you vomit or do not pass gas (fart) Go to the emergency room right away…”

Because of his anxiety, he emphasized more precautions than other patients.

“Persistent abdominal pain… high feverIf this occurs, visit the hospital immediately…”

“Yes, yes. I think it’ll be okay.”

The patient smiled and tried to reassure me. But I still felt uneasy and continued to worry. What not to dodid it I took out a business card from my pocket and handed it to the patient.

“I can’t do it because I’m anxious. Since Professor Park is an acquaintance… here’s my number. If anything happens, contact us right away.“

The patient who received the business card was surprised and grateful. Exchanging contact information with patients is implicitly prohibitedIt is done. However, this patient was also an acquaintance of a professor from another department… I thought he might be okay and gave him his contact information.

I forgot about it because I didn’t have any other contact after that, but one day I got a KakaoTalk message.

[선생님 안녕하세요. 저 ㅇㅇㅇ입니다. 다름이 아니라 저희 집에서 농사를 조금 하는데 배 한 박스 보내드리려고요.^^ 혹시 주소가 어떻게 되시나요?]

I am thankful in my heart, but just in case, Kim Young-ran LawI politely declined because it was likely to violate the law.

[괜찮아요마음만받을게요^^[괜찮아요마음만받을게요^^따님과 여행은 잘 가셨나요?]

[아그게사실[아그게사실지금 내과에 입원해 있습니다.]

[네??]

[[여행 전 날 갑자기 피가 나서요… 내과에서 입원치료 중이고 32병동에 있습니다.^^]

I immediately rushed over and interviewed the patient. I came to the emergency room because I was bleeding, but since it was not a surgical problem that could be solved, I did not contact the surgery department. I was admitted to the hematology/oncology department and was receiving blood transfusions and symptomatic treatment. at last The trip was postponed a little longer. Do it. If this treatment goes well, I will be able to go on a trip… Words of comfort that I am a little unsure ofdid it

How great would it be if we only met patients with cancer that can be treated?

Actually, that’s why I chose surgery. Advantages of working as a surgeon One of them. However, when performing intestinal surgery, you also encounter patients like this. Just as humans become infinitely weaker in the face of natural disasters, In the face of the natural outcome of irreversible cancer, I Became infinitely incompetent.

And the patient had been hospitalized for a long time in the internal medicine department, and every time I visited, very happy to see you greeted me. For these patients, a doctor is The last savior we meet at the end of lifeIt’s the same as coming. Even though there isn’t much we can do So that I can escape some of the pain Is it because I thought I was someone who could help? depend a lot Even if I can’t do anything for you, I’m happy to see you. Every time I visited, I asked questions such as what kind of treatment I was currently receiving, what my internist’s future plans were, and if my diet was okay. The patient always wanted to talk with me a little longer.

However, unlike the patient, I Feeling more and more miserableI felt it. As a surgeon, there is little I can do to help, so every time I see a patient, my incompetencemust face. and simultaneously the last of a lifeI am affected by that painful feeling while watching. I thought to myself, ‘I’m getting my main treatment at an internal medicine clinic now, so I won’t have to go there that often…’ Little by little, visits became less frequent.. cowardly choose to run awayIt was done. I can’t keep receiving and accepting those feelings. very immature personIt was.

Suddenly, it occurred to me that the hematology and oncology doctors were amazing. Seeing terminal cancer patients every dayIt was a very difficult task for me. Of course, each person will receive training and their personality will change according to the characteristics of their job. If this happens over and over again, you will get used to it at some point. Nevertheless As a doctor, I couldn’t save someone’s life.No matter how much you understand with your head, your heart will always be bitter.

Cancer cells constantly divide and grow, invading and consuming surrounding organs. The end is in the end Even though all cells, including cancer, die It won’t stop its destructive actions Devourer of Madnessall. For oncologists Cancer is the first and last enemy It’s Sam. Even if it doesn’t happen in my generation, I hope that one day humanity will truly conquer cancer. This is the wish and dream of all doctors.