Mr L

Mr L used to be a high-ranking IC engineer in Silicon Valley. I wouldn''t have gotten to know him if he was not inflicted with lung cancer.

He did not smoke and only had minor health problems previously. However, he began to suffer from lower back pain during the summer's peak a couple years ago. Mr L took painkillers and underwent rehab after seeing his family physician. Yet, the pain did not go away. A spine MRI was thus undertaken, right before the Christmas Holidays that year, and reportedly showed multiple metastatic lesions along his vertebrae. He was diagnosed as having adenocarcinoma of the lung and started the latest targeted therapy available.

A miracle did not happen. By the time I saw Mr L, he was undergoing another cycle of palliative radiotherapy for the agonizing metastatic bone pain in both of his shoulders.

Mr L appeared depressed; his wife, Mrs L, on the other hand, was anxious and sometimes a bit demanding. Even though that was understandable, it was cumbersome for myself and nurses, to some degree, to take care of such a patient and his family.

I'm not good at encouraging others, let alone those who are dying chronically. I've tried a couple of times to comfort Mr L. Yet, it sounded awkward and lacked genuineness, especially when the medications I gave him did not work while he was suffering from intractable pain, or instead rendered him nauseated.

In the context of taking care of terminally ill patients such dilemmas are not uncommon. For example, using morphine to ease pain may cause severe, distressing constipation. Palliative paracentesis, if not undertaken judiciously, may jeopardize a patient's renal function. As patients lose their physical capabilities, and must obtain nutrition via a nasogastric tube for example, they sometimes become very depressed and even lose the faith and strength they had to stay alive. Some even become indignant and refuse treatment even when suffering from severe symptoms. As you can imagine this can be quite problematic for us as their care-givers.

Luckily enough, Mr L's pain was relieved and his nausea and constipation were more tolerable after several rounds of morphine titration, along with administration of antiemetics and laxatives. Toward the end of that month, he received another course of chemotherapy with a different regimen.

Sometime later after I rotated to a different ward, I met Mrs L down the corridor. She said that Mr L is going to be discharged home in a few days. Although the effectiveness of the new regimen is yet to know, she told me that Mr L's general well-being is now good and she attributed this to my meticulous care the previous month.

"That's what we are supposed to do," I insisted but could not help smiling.