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Medical Human Story]-Time Hidden Beneath the Skin(Episode 51) Red Blooms on the Peritoneum(3)
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A Record of Adenocarcinoma of the Appendix and Krukenberg Tumour
Part III. Where
the Ocean Ends
She actually went to the ocean. When she walked into the outpatient clinic, her skin
was slightly tanned, and her eyes looked more at peace than they had in a long
time.
"Doctor, the sound of the waves was so
beautiful," she said. I smiled and asked, "Did you walk a lot?" "A little. The kids wrote their names in the
sand."
She
showed me a photo on her phone. Four names written in the
sand, followed by a small heart. I
stared at that photo for a long while. While
the cancer filled her abdominal cavity, her life was still making space for
something else.
But I knew. This tranquility would not last.
Ascites
A month
later, she was admitted through the emergency room. Abdominal distension. Difficulty breathing. I
palpated her abdomen in the ward. A
dull thud.
I
performed an ultrasound. The abdominal cavity was filled with fluid. Ascites.This
is a common stage as peritoneal metastasis from appendix adenocarcinoma
progresses. I stared at the screen and closed my eyes for a
moment.
🩺Medical Insight: Peritoneal Metastasis and Ascites
Peritoneal cancer cells disrupt the
body's fluid balance.
They cause low protein levels and block
lymphatic flow.
This leads to shortness of breath and
abdominal pressure.
Repeated paracentesis (fluid drainage)
is often required.
Paracentesis
The
moment the needle pierced the abdominal wall, a murky yellow liquid began to
flow out slowly. She kept her eyes closed.
"Are
you in pain?" I asked. "I’m
okay. It’s easier to breathe now."
Two liters, three liters. The fluid did not stop. As I watched the liquid, I thought to myself: cancer
isn't just about cells; it is an entity that encroaches upon space.
Pain
She began
to complain of increasing pain. "It hurts all the way to my back." Peritoneal irritation. Tension in the liver capsule. I
started her on narcotic analgesics.
"Will
I get addicted to this?" she asked. "Right now, managing your pain is more
important," I replied.
🩺Medical Insight: Pain Management in End-Stage Peritoneal
Metastasis
Follows the WHO 3-step analgesic ladder.
Uses morphine and fentanyl.
Pain control is a core element of
quality of life.
Failure to control pain is more
dangerous than the risk of addiction.
A
Daughter's Question
In the
ward, her daughter caught my hand. "Is Mommy going to die?" A child’s eyes allow no room for lies.
I knelt to her level. "Mommy is in a lot of pain right now. We are
doing everything we can to make her feel better." "But she promised me..."
I was lost for words. A doctor can explain a prognosis, but they cannot fulfill
a child’s promise.
A
Nighttime Conversation with the Husband
"Doctor,
honestly... how much time does she have left?" I spoke quietly. "We predict
anywhere from a few months to a year. It varies greatly between
individuals."
He lowered his head. "Then I won't waste a single day." I looked at him and said, "The most important
treatment you can provide right now is simply being by her side."
Her
Confession
Late one
night in the ward, she called out to me. "Doctor." "Yes." "I’m getting a little scared now."
I sat by her bed. "What scares you the most?" "The thought of my children living without
me," she said, her voice trembling. "I feel like I’m leaving too soon..."
I paused
for a moment. "You aren't leaving 'too soon.' You have lived your time more fiercely than
anyone." She
closed her eyes. "So...
I fought well, didn't I?" "Yes.
Very well."
🩺Medical Insight: Prognosis and End-of-Life Communication
Explanations should be honest yet leave
room for hope.
Requires "Goal of Care"
discussions with the family.
Advance directives for life-sustaining
treatment are recommended.
Respect the patient's values.
The
Last Trip
She
wanted to be discharged. "I want to go home." We coordinated home palliative care. The ascites returned, and the pain flared up
intermittently.
But one day, her husband sent a photo. All four of them were sitting on the living room
floor, cutting a cake. "It’s Mommy’s birthday party," the message
read. I stood there for a long time, looking at the photo. Cancer had invaded her organs, but it had not
entirely stolen her time.
The
Decisive Night
2:00 AM. An emergency call. Low blood pressure. Decreased consciousness.
I
ran to her room. She
opened her eyes faintly.
"Doctor... you're here." I took her hand. "I'm here." "Can I... rest a little now?"
I couldn't answer. Instead, I squeezed her hand tighter. The heart rate on the monitor was slowing down. Her husband and children were by her bed. She whispered one last time, "The ocean... was
wonderful." Then, the monitor let out a long, steady tone.
The End
of Part III.
I stood there for a while. Doctors see death often, but every time is different. She did not become just another number in a statistic.
She was the mother at
the graduation, the patient in the chemotherapy room, and the person who loved
the ocean. And I became the one
who recorded her story.
[MHS: Medical Human Story – Episode 77] The Vanished Gallstone, Time That Stood Still Prologue | Part 1 | Part 2 | Part 3 | Part 4 | Epilogue Part II: Where the Stone Stopped, the Bowel Began to Speak At 3:18 a.m., the heavy automatic doors of the operating room opened, and the surgeon emerged. The cold air of the corridor settled over his exhausted shoulders. "We found the stone." His words were brief, but the weight behind them was heavier than silence itself. Then came the words that shook my quiet heart once again. "But the condition of the bowel is the problem." I looked directly into his face. His eyes were bloodshot, and the slight tremor in his lips revealed the patient's precarious condition. "How does it look?" He paused to catch his breath before answering calmly. "It's severely distended. Peristalsis is almost completely absent." "What about ischemia?" My question was urgent....
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