[Medical Human Story-Episode 63]-Her Pain Did Not Fade-Two Surgeries and the Invisible Illness_2

 


 

Part I: The Moment the Invisible Illness is Revealed

 

I dimmed the lights in the reading room. Images always speak more clearly in the dark.

Her name appeared on the monitor.

36-year-old female, chronic pelvic pain, s/p C-section x2. I gripped the mouse. This moment is always tense—not because of the images themselves, but because someone’s life is hanging in the balance.

 

The First Cut — Axial T2

 

 As I scrolled through the images, I stopped.

“...Just as I thought.”

The left pelvis. A fluid signal that seemed to spread out softly. And within it—something was trapped.

 

I zoomed in. Boundaries that looked like thin membranes. A structure intertwined like a spiderweb. And at its center—the ovary.

I whispered to myself, “Spider in a web…”

It was a textbook finding.

 

The Patient’s Voice Resonated Again

 

“It feels like a constant pressure…” Now it made sense. Her pain wasn't just a sensation; it was physical pressure coming from a "trapped structure."

This was pain that could be explained.

And more importantly—pain that could be treated.

 

The Second Cut — DWI

 

I checked the diffusion-weighted imaging (DWI). This step is critical because it distinguishes whether a lesion is malignant or benign.

 

I breathed a sigh of relief. “Good… it’s not that.”

The signals that would indicate a malignant tumor were absent. This was definitively a benign lesion.

 

The Third Cut — Sagittal T2

 

I shifted the perspective to the side. 

The picture was complete. This wasn't a simple cyst. It had boundaries but no fixed shape, spreading freely yet trapped along the peritoneum.

 

The Fourth Cut — Coronal T2

 

Finally, I reviewed the entire area. 


 I leaned back in my chair. It was no longer a suspicion. It was a diagnosis.

“Peritoneal Inclusion Cyst.”

I began typing the report.

Impression: Peritoneal inclusion cyst with ovarian entrapment.


The Diagnosis is over, but the Story is Just Beginning. 


This is where the real challenge lies. Diagnosis is the easy part.

Explanation is the difficult part.

To a patient, this condition often sounds like a riddle:

“It’s not a tumor… but it is a cyst… but it’s hard to remove… and it might come back?”

I have given this explanation countless times, and every time, I feel the gap between medical fact and patient understanding.

 

The Second Meeting

 

A few days later, she walked back into the office. She looked tense.

I spoke quietly to put her at ease.

“To start with the conclusion… it isn't cancer.”

Her shoulders visibly dropped. “Thank God…” she whispered.

I continued, “But we did find the cause.”

 

The Moment of Explanation

 

I turned the monitor toward her. “Do you see this area?”

She nodded.

“This is fluid. But it isn’t just sitting there—it’s trapped because of these structures.”

“Trapped…?”

“Yes. Because of adhesions that formed after your surgery.”

Her eyes flickered with a mix of emotions. “So… was it because of my surgery?”

This is always a delicate question. I answered firmly but gently.

“The surgery itself wasn't done incorrectly. This is simply one of the natural changes that can occur during the healing process afterward.”

 

The Moment of Understanding

 

“So… that’s why it has been hurting all this time…”

Her voice was low but certain. I nodded.

“Yes. It is pain that can be explained.”

She was speechless for a moment. Then, her eyes began to well up.

“I wasn’t crazy…” she said.

That one sentence explained everything. All this time, she had:

✔ Doubted her own pain.

✔ Denied her own reality because she was told she was "normal."

✔ Endured it all in solitude.

I said softly, “No, you weren't. It's just that until now, no one was able to see it clearly.”

[Medical Insight]


━━━━━━━━━━━━━━━━━━━

 

Discussing Treatment

 

“So… how do we treat it?” she asked.

I answered honestly. “There isn't a single treatment that resolves everything perfectly in one go.”

Her expression tightened again. I laid out the options.

Option 1 — Observation: “If the symptoms aren't too severe, we can simply monitor the condition.”

Option 2 — Hormonal Therapy: “By reducing ovarian activity, we can decrease the production of fluid.”

Option 3 — Drainage: “We can drain the fluid, but there is a high chance it will fill back up.”

Option 4 — Surgery: “We can perform surgery to release the adhesions and remove the cyst.” I paused. “However, complete removal is difficult, and recurrence is possible.”

 

Silence

 

A brief silence filled the room. She asked quietly, “Doctor… what would you do if you were me?”

It’s a question that never gets easier. But I never shy away from it.

 

My Answer

 

“Given your current state, I would recommend starting with pain management and hormonal therapy first. If necessary, we can then consider the next steps.”

She nodded.

 

The Start of the Journey

 

This wasn't just a diagnosis. It was the start of a long-term battle.

And I knew that this battle wasn't just against a disease—it was a journey to reclaim her life.

[MEDICAL ADVICE]

 I watched her leave and heard the door click shut.

The story was just beginning. And the most important moment was yet to come.

 

To be continued. "Part II:  The Start of Treatment and the Unforeseen Cracks"

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