This is a sad story, narrated by John (not real name) about his mother’s problem before her death.

CL was a 63-year-old lady. About six/seven months ago, she had abdominal pain and felt bloated. She went to a private hospital and the doctor did an MRI. She was told that it was due to stone in her gallbladder and had to be removed. CL underwent surgery immediately. This procedure cost RM 7,000.

Unfortunately, her problems did not go away. John started to consult some doctor friends who was told him that it was normal. After the surgery, the pains and bloating would not go away immediately. John also asked the doctor who did the surgery why the problems were not resolved. He answered, “There are so many other patients who had the same problems and they did not complain!” The doctor then prescribed medication of gastritis.

In October 2016, CL became very weak and started to vomit and went back to the same hospital again. A CT scan was done and the son was told that shadows in her liver. CL was referred to an oncologist in the same hospital and was told that it could be Stage 4 liver cancer.

Chris: When they removed the gallbladder, did they not check the liver as well?

John: I asked the doctor this question. The answers were: “We only focused on the gallbladder and not any other area during the first time. Also, MRI could not detect liver cancer as easily as the CT scan.”

The oncologist told John that this was a stage 4 cancer and CL had a maximum of 6 months. To confirm, a biopsy was done.

While in the hospital, CL continued to vomit and was put on drip. When she got better, she was discharged; went home and started to vomit again. CL became dizzy and John brought his mother back to the hospital again. The doctor did another MRI. This time he targeted the brain. There was nothing in her brain!

John was told that the cancer was very serious and CL had only 1 or 2 months to live. The oncologist proposed that CL try the oral drug, TS-One.

Chris: Did you take the TS-One?

John: No.

C: Did you ask if TS-One is  going to cure your mother?

J: I asked him that question and he did not answer my question. He only said, “Take the drugs for 2 weeks and come back and see me again. And we will see what happen.”

C: Did you ask how much this is going to cost you?

J: No, I did not ask but from the internet I understand that it is expensive.

C: People would tell you that at this point when the patient is at the last stage and is dying, we should not think about money. Money is not important. Do what is necessary. But I think money is important. You do not want to do things just for the sake of doing things — futile efforts with no chance of any positive results.

J: Money is important! But I understand that by giving her the drug, it is going to cause her more problems — the side effects would be severe. There is no quality of life.

(The above is just a gist of our conversation. For more detail, listen to the video carefully. CL died one week after this conversation).

Comments

It is really hard to swallow the idea that when they zoom in on the gallbladder, they could not see or know what is going on in the rest of the surrounding organs! Let’s try to understand a bit of basic anatomy.

The diagram below shows the gallbladder in relation to the liver and pancreas.

The MRI and CT images below show the gallbladder in relation to the liver and pancreas!

According to the images of subsequent careful examinations, we know that from the ultrasound of the abdomen LC had:

• an ill defined 3.8 x3.3 x 2.5 cm mass in the left lobe of her liver.
• an ill defined 5.9 x 5.8 x 4.9 cm mass in between the left lobe of liver and pancreas.

CT showed more tumours:

• ill defined enhancing areas in segments 2,4,5 and 8 of her liver.
• ill defined 2.3 x 2.1 cm enhancing areas in the anterior part of the body of the pancreas.

It is not for me to suggest that LC’s problem and subsequent death could be a result of incompetence, carelessness, wrong diagnosis or wrong treatment. It is up to you, those who know how to read, to figure that out. But for one, none of us would want such thing to happen to our own mother. Money gone, suffered and died!

How can we avoid such tragedy? My answer is: Be an empowered patient. Before you undergo any operation, seek a second or third opinion first! Don’t just immediately jump into any hole that you are asked to.

There are three more disturbing events which I think we can learn from this case.

1. John was told that his mother had Stage 4 cancer, very serious and at most could live no more than 6 months (later reduced to 1 or 2 months). These were masses in her liver and pancreas. She needed a biopsy to confirm this. But, did she really need to do a biopsy? What benefit can a biopsy bring to LC?

Anyway, the USG and CT scan suggested cancer of the pancreas with liver metastasis. Then there is the results of her blood test below:

Total bilirubin	108 H
Direct bilirubin	82.3 H
Alanine transaminase	80 H
Alkalline phosphatase	318 H
Gamma glutamyltransferase	433 H
AST	98 H
CEA	9.9 H
CA 19.9	48,577.12 H

With the above blood test results, ask again: do we really need a biopsy to be performed on a dying person?

2. LC went home after the biopsy. She started to vomit and later felt dizzy. MRI was ordered. Again, you would want to ask, is this necessary? What benefit can MRI of the brain bring to LC? Yes, there may be brain tumour. But so what if there was a brain tumour? What can we do about it?
3. After the biopsy result confirmed metastasis to the liver and pancreas, the oncologist suggested LC try TS-One!

Smart of John to ask what TS-One can do for his mother. This is the classical example of the mantra,”Cannot cure but we have treatment.”

Wait a minute doctor, but what is TS-one actually used for? Is this for treating liver cancer and/or pancreatic cancer?

From the internet, we learn that TS-One Capsule is used for the treatment, control and prevention of stomach cancer! Was LC having stomach cancer?

Beside the money — having to pay for the expensive drug, you also need to know that you may be led to buy misery in the form of the following side effects.

Source: http://www.mims.com/singapore/drug/info/ts-one?type=full 

When I first read what Dr. Anton Chekhov wrote, I thought it was meant to be just a joke since he was also a dramatist besides being a doctor! Now, with the above story do you see what he wrote may not be a joke? Do you want this to happen to your mother?

The point we want to ask further is, can medical error happen? Yes, it can … more often than we care to admit. Read what Dr. Atul Gawanda and Dr. Paul Ruggieri wrote in their books.

 

One patient sent me this note ….