[Medical Human Story]-Time Hidden Beneath the Skin(Episode 51) Red Blooms on the Peritoneum(4)

 A Record of Adenocarcinoma of the Appendix and Krukenberg Tumour

 

Part IV. Time Left Behind, Life Carried Forward 

The funeral hall was quiet. The scent of white chrysanthemums filled the air, and in the portrait, she was pictured by the sea. Short hair, a smiling face. It wasn’t the face of a cancer patient, but the face of someone who had lived life to the very end. I stood among the mourners—not as a doctor, but as a human being.

 A Husband’s Greeting

When the husband saw me, he bowed deeply. “Doctor, thank you,” he said. Those words felt heavy to me. “I couldn’t protect her until the end,” I replied. He shook his head. “No. Because of you, we had time to prepare.”

Preparation. That word was weightier than I thought. While cancer shortens time, medicine sometimes grants the time to prepare.

The Daughter’s Letter, Part Two

As the funeral was drawing to a close, the daughter approached me. “Doctor, this is the last letter my mom wrote. Would you like to read it?” I carefully unfolded the paper:

My children, even while I was sick, were happy. Because I had you. The disease was terrifying, but life was beautiful until the very end. So please, don't cry—just live.

I stared at those sentences for a long time. Medicine calculates survival rates, but life leaves its mark in sentences.

Leaving a Record

After returning to the hospital, I opened her chart once more.

  • Diagnosis: Adenocarcinoma of the appendix with peritoneal metastasis
  • Treatment: HIPEC performed; recurrence of liver surface metastasis
  • Outcome: Transition to palliative care; Deceased

The medical summary was a mere four lines. Yet, between those lines lived the sweat of the operating room, the laughter in the chemotherapy ward, the sound of ocean waves, and a daughter’s letter. I sat there for a long while, unable to close the electronic medical record window.

🩺 Medical Insight: Lessons from Appendix Adenocarcinoma and Krukenberg Tumors

  • Appendix Adenocarcinoma: Rare but carries a high risk of peritoneal metastasis.
  • Diagnosis: Often diagnosed at an advanced stage due to difficulty in early detection.
  • HIPEC: Can potentially extend survival.
  • Krukenberg Tumor: A representative form of metastasis to the ovaries.
  • Palliative Care: Not a failure of treatment, but another form of care.

 A Doctor’s Confession

That day, I admitted it for the first time. I hadn’t just been treating her; I had been walking through time with her. Doctors try to remove cancer, but sometimes cancer cannot be removed. Nevertheless, life cannot be removed.

She was a mother until the very end. And she was a wife. Cancer took her organs, but it could not take her identity.

A New Patient

A few days later, another patient entered the consultation room. A thirty-nine-year-old woman is complaining of abdominal pain. The CT scan showed a thickened appendix. I paused for a moment while looking at the monitor. Then, I spoke softly.

“We need a biopsy.” She asked with anxious eyes, “Is it serious?” I nodded and said, “We cannot rule out any possibilities. But we are testing so that we can know for sure.” I was no longer in a rush. Medicine demands speed, but patients demand understanding.

Ways of Remembering

After work, I went up to the hospital rooftop. The night in Cheongju was quiet. Her last words came back to me: “The sea… it was lovely.”

I thought to myself: If I were given that time again, would I explain more statistics to her? Or would I share more moments of silence? It would likely be the latter.

What Cancer Left Behind

Appendix adenocarcinoma is rare. Krukenberg tumors have a poor prognosis. Yet, what this disease left behind was more than just medical data:

  • The importance of early diagnosis
  • The limitations of managing peritoneal metastasis
  • The value of patient-centered decision-making
  • And the meaning of a prepared farewell

She didn't leave her name in a textbook. But she remained within me.

Epilogue — Flowers on the Peritoneum Do Not Wither

I am still a surgeon. I open abdomens every day. And occasionally, when I see mucinous nodules scattered across the peritoneal surface during surgery, I think of her.

Cancer spreads like red flowers. Not beautiful, but fatal. Yet, life also blooms like a flower. Even if it is brief, it is intense.

Her children will grow up. Her husband will live on, holding his memories. And I will hold the hand of another patient. Medicine is not perfect. But we give our best every time. And sometimes, that is enough.

_The end_

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