Current Affairs, Real Medicine

Treat Aggressive things Aggressively

I think we have established that I do not enjoy surgery very much. SolitaryDiner says that as a doctor you either lover surgery or you hate it – I can understand that.

But despite my dislike of the insinuation that the scalpel should become a replacement for the rod of Asclepius, I believe people must think rationally about surgery. There is a good place for surgery – and here I embark on the Steve Jobs train before it leaves:

I read recently that Jobs put off surgery for his cancer for at least nine months. It is now postulated that those nine months may well have cost him his life. Pancreatic cancer is an aggressive and deadly cancer and I have seen devastating cases thereof the past month. You are very lucky if it has been detected at a resectable stage.

My belief? Treat aggressive things aggressively.

I’m not a doctor (yet). And I by no means have the right to judge Jobs’ decision without knowing his reasoning behind it.

Nevertheless.

Several years ago, an aunt of mine was diagnosed with an intraocular cancer. Her ophthalmologist and oncologist felt that they could save the eye’s vision and opted for radiation. Suffice to say the ophthalmologist who treats my father did not agree. He warned that the eye should have been removed immediately. At the end of the radiation all she could see with that eye was dark and light.

In 2007 she woke up sick one morning. A single trip to the doctor revealed that her cancer was back. This time it was everywhere – stomach, bone, liver. She died less than two weeks later.

My uncle never recovered losing his wife. He committed suicide last year.

Incidentally a family friend was recently diagnosed with the same cancer. Her doctors removed her eye immediately. She is still doing well.

A friend of mine has an older brother who was born with malignant melanoma. At the time, he was one of the few such babies who would survive – due to an aggressive approach. More than two decades later, he is still alive and kicking.

Sometimes there are too many contraindications for surgery. That I understand.

But doctors must learn to look after all their patient’s needs. And patients must make educated decisions.

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