Another one of my cancer patients died from disease progression today at home, the 7th since the world shut down. In the past few weeks the patient has quickly developed spinal cord compression, secondary infections, and multiple metastases. We had her scheduled for vertebral spine RT, but she has quickly deteriorated and never got to leave the house.
The situational assessment and the risk/benefit calculation and the logarithmic computations required in this pandemic have become so complex I sometimes fear that I would turn into a borderline alcoholic if there weren’t a liquor ban. Under normal conditions my patients already have to deal with a lot of crap, so imagine the spiky hoops in flames they now have to go through. Whether a P250,000 chemotherapy regimen is reasonable used to be the dilemma, now even the indication for a blood test is something that has to be justified given the difficulty of transport to the hospital and the risk of infection.
A patient called me a few days ago asking if shifting IV chemotherapy to tablets is a good decision. I discussed with them the risks and benefits of doing so, but while I was speaking I realized I was not really trying to make them understand–I was actually trying to explain to myself. Like if I hear myself using these big words in a soothing manner, I would be convinced that I am making the right choice. Because the bottom line is, nobody really knows. Hard enough that we have to estimate the benefits of treatment on data sliced and diced by statistics, but to be introduced to a totally new variable would require a rather preternatural approximation.
|TT-Gang since 2011|
This preternatural approximation being the systematic approach called “TT” something that we have been practicing to some degree when faced with cases with no standard treatment. No need to google what it stands for because it would only lead back to this blog–TT stands for tantya-tantya. We would be obsessive with the guidelines, ask for expert opinion, look for good trials that would support the decision, etc etc but at some point, application becomes TT. Once we plug in real-life factors like the patient’s finances, the ability to go back to the hospital if complications arise, family support, the list goes on, it would be difficult to insist on the written guidelines.
Back in hell-owship Uni-Horned Beef Jerky Alanis Whore asked out loud, about a rare mixed-tumor, “Kikimo ko kaya to?” to which I said, “Uuhm, I think so. TT?” Which, of course, she didn’t TT, because we had expert consultants around to pester. We went to the office to ask, and the case puzzled even the expert. We knew that puzzled look. It was the look… of TT.