Wednesday, March 11, 2009

STI: Good days and bad

March 12, 2009

Doc talk

Good days and bad

By Dr Ang Peng Tiam 

 

My family dinners tend to be rather noisy affairs with the kids talking all the time. Sometimes, one of my four children would include me in his or her conversation. 'So, dad, how was work today?'

 

Most of the time, I would respond: 'It was a good day.' And they would carry on with their chatter. I have two girls, aged 22 and 15, and two boys, aged 19 and 17. Of late, I have been reflecting on what a 'good day' means to me. As far as work is concerned, four factors determine whether my day is good or not.

 

First, a good day is one in which I see patients with interesting and challenging medical problems. Cancer is a difficult and, at times, worrisome disease, but it also presents an intellectual challenge. I enjoy that part of medicine, especially if there is a chance that I can help make things better.

 

It is a little like solving a mystery. You begin with a murky picture, then a clearer understanding of the problem. You examine the evidence, do a bit of detecting and offer a solution. The more difficult the problem, the more satisfying it is to find an answer.

 

Secondly, I enjoy interacting with patients and learning about their lives. My consultation room is like a confessional. Patients unabashedly tell me almost everything going on in their lives. An unfaithful husband's liaison with the maid, the fear of retrenchment because of the recession, birth of the latest grandchild or travel plans to yet another exotic destination.

 

I discuss current issues of the day - the rising cost of living, politics in Malaysia or the annual budget debate. There are days when I feel like I have had the benefit of several expert opinions for which I ought to be paying consultation fees.

 

Thirdly, I like busy days. I've been told that I walk very fast during ward rounds - I enjoy the feel of high energy. I'm usually at work by 6.30am and get home by 7.30pm. I know that there are patients waiting to see me so I don't take a break for lunch - I drink a bowl of soup, or have a quick bite at my desk. Working hard makes me feel useful.

 

Lastly and most importantly, what really makes my day is when patients do well. As I write this, I am celebrating a good day. Madam Yu, a middle-aged woman from Myanmar, first came to see me eight weeks ago. At that time, she was in severe pain and her face was as yellow as a lemon. Her liver was markedly swollen and hard as a wooden plank.

 

She has cancer of the bile ducts (these are the conduits within the liver which allow the flow of bile juices from the liver to the intestines). As the cancer had blocked the ducts, the biliary fluid could not be excreted, resulting in an 'overflow' into the blood.

 

These bile juices turn the skin yellow and the patient often complains of intractable itch and tea-coloured urine.

 

Madam Yu was not a candidate for surgery as her cancer was advanced. We started her on weekly chemotherapy, which was at best palliative. Only one third of such patients would respond well to treatment.

 

Thankfully, Madam Yu belonged to this one-third. Her cancer marker had been dropping from week to week. Over the past eight weeks, it dropped significantly. Seeing her get better made my day.

 

Her latest computer tomogram (CT) scan showed that her tumour had shrunk significantly.

 

However, not every day is a good day. Some days are just tough - some patients do not do well despite our best efforts. Some days, I feel frustration, anger, helplessness and plain bewilderment all at once.

 

In the midst of all this, I have to remember that there is yet another patient for whom I will need to be calm and collected. There may be a patient whose cancer poses a challenge that may test my knowledge and energies to the full.

 

No matter how each day evolves, I derive great satisfaction from my work. I am sometimes asked whether I wish I had studied something else, or whether I would discourage my children from becoming doctors. That is something I cannot understand.

 

In the middle of all the dinner chatter, I make it a point to share with my children the joys and frustrations of each workday. On some days, they actually condescend to listen to me. Hopefully, they will share my passion, want to follow my footsteps and become doctors one day.

 

angpt@parkwaycancercentre.com

 

Dr Ang, the medical director of Parkway Cancer Centre, has been treating cancer patients for nearly 20 years. In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.

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