Friday, October 19, 2007

The Blind Man's Dilemma

Writing this right now is utter insanity because I have not started reading the syllabus yet and it's Friday night before a Monday exam. However, I wanted to write this down before it becomes forgotten.

The aged Chinese man sitting in the closet-sized exam room was looking at an obscure point in space about 1 foot away from my head. He was a friendly grandfatherly character, with black plastic glasses, eyes clouded by cataracts, and a distinct scholarly air perhaps manifested by his fastidiously pressed striped shirt, bright red suspenders, and black trousers. Around his shoulder was a green cloth bag.

The CT scan had shown cancer in his prostate, bladder, and in the right pelvic region and his kidneys were backed up with fluid -- but he knew that his case was difficult. As the doctor began describing how he must begin chemotherapy within a week as a palliative measure to shrink his large prostate cancer and permit him to urinate again (a quality of life issue), the blind man interrupted the scheduling by saying, "Wait, not before my birthday party! It's on the 28th."

The oncologist reminded the blind man that the tumor would only grow larger if they waited 2 weeks, but the blind man remained adamant.

"Can you guarantee that I won't feel nauseated and half-dead from the chemo?" he asked.

"No, of course not," said the honest doctor.

"Well, now that's a problem. I want to feel good during my 82nd birthday party."

"It's up to you," said the doctor, "The chemo is not going to cure you, but the tumor is just going to grow bigger."

The blind man seemed to relax after he heard the words "not going to cure you."

During the physical exam, the blind man lay down on the bench without removing his green cloth bag. It was a curious omission, but it became clear after the doctor lifted the patient's shirt and pointed out how there was a tube emerging from the blind man's back, wrapping around the front and ingeniously hidden by a seam in the black trousers (mended by his wife). The tube emerged from the trousers and dove into the green cloth bag (created by his wife's female friend). Since the blind man could not urinate with the prostate cancer blocking the ureters, there was a tube implanted to drain the kidney, allowing the urine to emerge from a plastic pipe and draining into a plastic bag hidden by the innocuous green cloth. In my mind, the man was carrying an external "pee-bag" around.

Talking to the blind man, it was clear that he was well-educated and that he knew that his case was (in his words) "terminal." He looked forward to gathering his friends and family for his birthday, and he seemed so spirited, saddened, and strong. He proudly said that he would like to finish a manuscript before he dies, apparently he was a scholar in Asian-American studies, and I knew that he still looked forward to the future and had goals.

Somehow, when I am talking to elderly cancer patients, I feel like they have reached the delicate balance of acceptance and hope that continually escapes me.

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