Emotionally Involved - Episode II

Upon further reading, my assumption right now is that she might have gastric carcinoma with secondary metastasis to the liver and neck LN (these are just my mere postulations since the results are yet to be known).

As I continue my reading, my heartbeat was drumming faster and faster. I find myself reluctant to know more, since the reality is too painful to swallow.

"Gastric carcinoma is a HIGHLY MALIGNANT adenocarcinoma” was the 1st sentence of the subtopic Gastric Carcinoma. I braved myself to read more.

"This aggressive cancer metastasizes early by way of lymph nodes, blood stream, and peritoneal spread".

As I scrolled more down the topic, I learned that treatment of this cancer involves radical surgical resection, either partial or total gastrectomy with resection of adjacent lymph nodes as well. It provides the only hope of cure and is also the best way to palliate the patient’s symptoms.

Unfortunately, the few last sentences were really heart-wrenching to me: “A palpable tumor in the left upper quadrant or an enlarged liver is an ominous finding, usually indicating advanced, inoperable disease. Radical gastric resection is contraindicated if liver metastases are present. These patients cannot be cured.” And in another book, “The detection of liver metastases often alters the surgical management of patients with cancer. Since most of these patients will have incurable disease, the primary goal of surgical intervention is to palliate distressing symptoms rather than undertake radical surgical resection. Overall, less than 10% of patients will survive more than 1 year after diagnosis."

Ya Allah… Beratnya rasa dada ni… Innalillahi wa inna ilaihi raaji’un...

"Setiap bencana yang menimpa di bumi dan menimpa dirimu sendiri, semuanya telah tertulis dalam Kitab (Luh Mahfudz) sebelum Kami mewujudkannya. Sungguh, yang demikian itu mudah bagi Allah. Agar kamu tidak bersedih hati terhadap apa yang luput dari kamu, dan tidak pula terlalu gembira terhadap apa yang diberikanNYA kpdmu. Dan Allah tidak menyukai setiap orang yg sombong dan membanggakan diri…” (Al-hadid: 22-23)

I began to wonder how am I going to explain these harsh facts in a patient so hopeful to be cured. Especially after I grew close to her 2 daughters. Everyday when I salam her to go back, she will hug me and whisper, “Doakan makcik sihat ye Hana”. But just today, she looked into my eyes and asked, “Dari bacaan laporan makcik ni, penyakit makcik ni dah teruk ya? Kalau dia buat lagi teropong tu, katalah memang asal ketumbuhan dari perut, jadi Dr nak buat macamana? Boleh lagi ke nak baik penyakit makcik? Kalau tak, makcik nak cuba rawatan alternative”… I felt like crying...

This patient is religious too, she is the only patient in the female ward whom I saw praying when she was sick. Sometimes when I visit her during my oncalls, she would ask, “Ni semua ni kerja tak tentu masa ya?” I replied, we have oncalls every week. Then she adviced me so softly, “Nanti dah kerja esok, sebelum keluar rumah tu niatlah dua perkara, nak cari rezeki dan redha Allah. Barulah dapat kedua2 perkara ni. Kalau nak cari rezeki je, dapat satu je.."

Antara cara yang dianjurkan oleh Islam untuk mengingati mati adalah dengan menziarahi qubur, dan menziarahi orang sakit. Just nak muhasabah semua medical students, nurses, doctors, etc… berapa ramai patients yang kita jumpa setiap hari? Ramai kan? Tapi, berapa kali kita mengingati mati dalam sehari? Bila kali terakhir kita mengingati mati sampai berdebar dada, menggeletar badan dan menitis air mata? Bila kali terakhir? Adakah hari ini? Semalam? Bulan lepas? Tahun lepas? Atau tak ingat bila last time kita ingat mati?

Atau, setiap kali kita jumpa patients tu, hanya utk kepentingan studies kita semata-mata? Nak cari case best-best, nak cover patients utk case presentations, nak cari case write-up, nak present case kat OT… macam selfish je bunyinya kan?