On just the first day we saw four cases of a disease I've only seen once in the US. Periampullary carcinoma is a cancer of the biliary tree , which is the structure that drains bile from the liver down to an opening the the section of the small intestine called the duodenum. This is a cance at or near the opening of the pancreatic duct into the duodenum, and has very poor prognosis in general, much worse if metastatic.
The last clinic patient of the day I saw was diagnosed with widely metastatic periampullary cancer at a hospital in Bangalore, and the family decided to go to CMC for a second opinion. And unlike the previous cases where the patients/family did not seem to mind other patients barging into the room during their interview, here the family guarded the curtain fiercely to prevent the anxious hordes from interrupting their time with the doctor.
Prior to the second opinion, neither the patient nor the family were aware of the terminal nature of the diagnosis, and Moriah and i were both pretty shocked at how the oncologist broke the news. He was incredibly blunt, and unlike most conversations I've observed where a doctor is telling a patient for the first time that they have a terminal illness, the doctor let the family know that no cure was possible and the patient would soon die of the disease, taking less than five minutes to do so. I was amazed to see the ease with which the family accepted the news. When I have observed this interaction in America, even when the doctor tries to be this honest, the family seems to react with a fair amount of doubt, even if this is only temporary. To be honest I have grown to be rather uncomfortable with the amount of hope many oncologists give to their patients, and it was refreshing though admittedly shocking to see how bluntly it is handled here.
The last clinic patient of the day I saw was diagnosed with widely metastatic periampullary cancer at a hospital in Bangalore, and the family decided to go to CMC for a second opinion. And unlike the previous cases where the patients/family did not seem to mind other patients barging into the room during their interview, here the family guarded the curtain fiercely to prevent the anxious hordes from interrupting their time with the doctor.
Prior to the second opinion, neither the patient nor the family were aware of the terminal nature of the diagnosis, and Moriah and i were both pretty shocked at how the oncologist broke the news. He was incredibly blunt, and unlike most conversations I've observed where a doctor is telling a patient for the first time that they have a terminal illness, the doctor let the family know that no cure was possible and the patient would soon die of the disease, taking less than five minutes to do so. I was amazed to see the ease with which the family accepted the news. When I have observed this interaction in America, even when the doctor tries to be this honest, the family seems to react with a fair amount of doubt, even if this is only temporary. To be honest I have grown to be rather uncomfortable with the amount of hope many oncologists give to their patients, and it was refreshing though admittedly shocking to see how bluntly it is handled here.
only in America is death considered an option - all the psychological underpinings we have here in the west -how well do they translate to Indian culture?
ReplyDeleteMost Indians believe in karma and therefore are quite accepting of their situations and fate. They accept it as being predetermined by the universe, so do not resist when there are no more options for cures.
DeleteMost Indians believe in karma and therefore are quite accepting of their situations and fate. They accept it as being predetermined by the universe, so do not resist when there are no more options for cures.
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