And Oscar goes to

 

My Reward ..

I get occasional rewards from my patients which to me is better than any Award .

I had recently taken up a metastatic rectosigmoid malignancy referred to me from another hospital who had plenty of issues .

 I saw him on Thursday in a wheelchair rolled into my consult room in Indira Gandhi coop hospital .

Dr ...he told me I havent eaten for few days as I cant swallow ,I have lot of pain in abdomen and back and I havent emptied my bowels for days .

All this are common in such patients .

His distended abdomen was firm so I was thinking of possibility of a sub acute intestinal obstruction ie the food doesnt move down due to obstruction in alimentary tract .

In advanced malignancy surgery to relieve it is not an option but no food by mouth ,IV fluids and medications give bowel the  rest it needs and it clears conservatively .

The other possibility was Acites ie fluid in Abdominal cavity which if confirmed by ultrasound of abdomen can be drained .

I ordered an USG abdomen and a plain x ray abdomen to look for obstruction.

USG confirmed moderate ascites .

Luckily the medical oncology physicians support my one man dept and they would do the tapping and taking care of patient as I would come only after weekend .

I admitted him and his fluids was drained by night more than 1600 ml .

The rest IV fluids and enema and medications made him much better and I was informed he has started taking soft diet .

Sorry for all these details .

These are routine for my Dr friends but Iam writing this as I wanted non medical people to know what we also do in palliative medicine .

Another lady admitted with advanced cholangiocarcinoma was sent by me for biliary duct stenting but since she had a cardiac comorbidity it was not done .

So palliative medicine is not just Morphine or end of life care or just tender loving pats or hugs .

Its judicious use of modern medicine to get the best qaulity of life for patient albeit not pinching his wallet too .

The best part of the story is  I called up patient yesterday and told him I could discharge him today but he told me 

Doctor first of all let me thank you for relieving me of pain ,relieving  my bowels and  my swelling abdomen and making me eat well .

Iam a happy man and I dont want discharge till you come back and I see you again and I can wait any time for that.

And I got my oscar and nobel prize together thus .