A Physician’s Clinical Diary-Episode 47: A Lonely Flower in the Crevices of the Mind(3)
120 Days Fighting the Solitary
Fibrous Tumour of the Dura
[Reversal: Insights Gained Between Life and Death]
The Day of Reckoning
The 120-day follow-up MRI appointment arrived with an unsettling
stillness.
Hospitals have a way of amplifying time. Minutes stretch into emotional
eternities, especially when patients face imaging results after brain tumor
surgery for Dural Solitary Fibrous Tumour (SFT).
Minseo arrived early that morning. She wore a pale blue dress, her hair
grown just enough to soften the surgical scar beneath.
“Doctor,” she said quietly, “I didn’t sleep last night.”
“That’s normal,” I reassured her. “Even doctors feel anxious waiting for
MRI results.”
She smiled faintly, but her fingers trembled around her coffee cup.
Reading the Silence of Images
MRI interpretation is less about looking and more about listening.
Radiological images speak in shadows, densities, and contrast enhancement
patterns. For postoperative Dural Solitary Fibrous Tumour patients, we
search for three primary dangers:
• Residual tumor tissue
• Local recurrence
• Distant intracranial spread
The scan loaded slowly onto my workstation.
Slice by slice.
Coronal plane.
Axial plane.
Sagittal reconstruction.
Nothing.
No enhancing lesion.
No abnormal vascular proliferation.
No new mass effect.
The surgical cavity appeared stable—clean, quiet, almost serene.
For several seconds, I simply stared.
Not because I doubted the result.
Because relief sometimes requires confirmation from disbelief.
I turned toward her.
“The MRI is clear.”
She blinked twice as though translating a foreign language.
“Clear… means?”
“No recurrence. No residual tumor. Your brain is healing beautifully.”
Her husband covered his face with both hands. His shoulders shook
silently.
Minseo, however, did not cry.
She whispered instead,
“I feel… guilty.”
Survivor’s Paradox
Survivor’s guilt is rarely discussed in neurosurgical oncology literature,
yet it frequently appears in patients recovering from rare brain tumors such as
Solitary Fibrous Tumour of the Dura.
“Why guilty?” I asked gently.
“There were patients in the ICU who didn’t wake up,” she said quietly.
“Why was I allowed to come back?”
I paused before answering.
“Survival is not permission,” I said. “It is a responsibility.”
She stared at me, absorbing the concept.
“Responsibility to what?”
“To live deliberately.”
📚 Medical Insight
Psychological adjustment after survival from rare brain tumors often
involves existential restructuring. Studies show survivors frequently experience
identity transformation, heightened mortality awareness, and increased life
purpose.
The Doctor’s Confession
Later that afternoon, during her discharge consultation, Minseo asked a
question I had spent fifteen years avoiding.
“Doctor… have you ever lost a patient with this tumor?”
“Yes,” I answered honestly.
Her expression softened—not in fear, but understanding.
“What happens to you when that happens?”
I looked toward the window where winter sunlight diffused through sterile
glass.
“A small part of me never returns to normal,” I said.
She nodded slowly.
“I think that part of you is why you saved me.”
The Unexpected Return
At postoperative day 135, Minseo returned unexpectedly without an appointment.
Her face carried tension.
“Doctor… I had a headache yesterday.”
My clinical instincts sharpened instantly. Headache recurrence in postoperative
Dural SFT patients demands careful evaluation due to potential recurrence
or delayed intracranial complications.
“Any visual disturbance? Nausea? Weakness?” I asked.
“No… just pain,” she said nervously.
We performed an urgent neurological examination.
Normal findings.
To reassure her—and myself—I ordered an additional MRI.
The scan remained clear.
Her headache was diagnosed as tension-type cephalalgia.
When I delivered the reassurance, she burst into tears.
“I thought it was back,” she whispered.
📚 Medical Insight
Not all headaches in postoperative brain tumor patients indicate
recurrence. Differentiating tension headache, medication withdrawal, or
cervical musculoskeletal pain from tumor recurrence requires imaging confirmation.
The Moment of Emotional Collapse
Minseo’s emotional release that afternoon revealed something deeper than
fear.
“I wake up every morning wondering if today is the day it comes back,” she
admitted.
Post-treatment anxiety is one of the most underdiagnosed conditions among brain
tumor survivors.
“Fear of recurrence is common,” I explained. “Your brain remembers trauma
even after the tumor disappears.”
She looked exhausted.
“How do people live like this?”
I answered with complete sincerity.
“They don’t eliminate fear. They negotiate with it.”
Teaching Hope Through Medicine
Over the next few weeks, I introduced Minseo to survivorship counseling,
mindfulness-based stress reduction therapy, and cognitive behavioral
strategies.
Evidence shows psychological interventions significantly improve the quality
of life among survivors of rare intracranial tumors such as Dural Solitary
Fibrous Tumour.
One afternoon, she told me,
“I started journaling like you.”
“What do you write?” I asked.
“Gratitude lists,” she said. “Today I wrote: ‘I am grateful my brain is
quiet.’”
That sentence remained with me long after clinic hours.
The Library Returns
Six months after surgery, Minseo resumed full-time work.
She organized a reading program for children diagnosed with chronic
illnesses. She called it:
“Stories That Heal.”
When she invited me to visit, I watched her read fairy tales to children
wearing hospital masks and IV bracelets.
Her voice carried warmth shaped by survival.
Afterward, she introduced me to the children.
“This is the doctor who removed my brain monster,” she said playfully.
I felt strangely humbled.
The Global Perspective
During international neurosurgical conferences, discussions about Solitary
Fibrous Tumour of the Dura frequently emphasize surgical technique,
immunohistochemistry, and molecular markers such as NAB2-STAT6 gene fusion.
But rarely do conferences discuss human transformation.
I presented Minseo’s case anonymously during one such conference.
My concluding slide read:
“The greatest prognostic factor is not histology alone. It is the
patient’s will to reconstruct identity after disease.”
The room remained silent.
Not because the data was controversial.
Because it was deeply human.
The Doctor’s Awakening
One evening, nearly seven months after surgery, I reviewed my accumulated
case logs.
I realized something unsettling.
I had documented tumor sizes meticulously.
I had recorded surgical blood loss precisely.
I had tracked recurrence intervals statistically.
But I had never documented laughter frequency.
Nor the emotional rebirth of survivors.
That night, I wrote a new clinical category in my private journal:
“Psychological remission.”
The Conversation About Death
During her eight-month follow-up visit, Minseo asked quietly,
“Doctor… if it comes back someday… will you tell me honestly?”
“Yes.”
“And will you still fight with me?”
“Yes.”
She nodded.
“That is enough.”
Medicine often mistakes cure as the ultimate outcome.
But sometimes, companionship through uncertainty becomes the true
therapeutic endpoint.
The Changing Definition of Time
Minseo began measuring life differently.
Not by years.
But for moments, she almost lost:
• Reading bedtime stories
• Watchingthe rain with her daughters
• Cooking breakfast together
She told me once,
“I used to plan ten years ahead. Now I celebrate ten minutes fully.”
📚 Medical Insight
Post-traumatic growth frequently results in altered time perception among
cancer and rare tumor survivors, increasing present-focused life satisfaction.
The Doctor Who Learned to Pause
I noticed subtle changes in myself.
I began sitting longer with patients.
I asked about families more often.
I allowed silence to exist during consultations.
Minseo unknowingly rewrote my clinical rhythm.
Approaching the One-Year Threshold
Medical literature indicates that the recurrence risk of Dural Solitary
Fibrous Tumour persists long-term, but early postoperative stability beyond
one year significantly improves prognosis.
As Minseo approached her one-year MRI, she appeared calmer than before.
“Doctor,” she said, smiling softly, “If fear is
permanent… maybe peace can be permanent too.”
To be continued!
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