Thursday, November 24, 2016

Torn

There are times in our life that we experience the internal crossroad of doing what feels right in our heart and what external pressures expect us to do.
These challenges aid us in the development of our character.

"No! You are not amputating my hand! I will never allow you to cut off my hand! I need both of my hands! Please, please tell me that you are not going to cut off my hand!"

Silence, tears, and screams . . . she was in a state of disbelief and terrorized by the thought of amputation.

"If you want to take my hand, you'll have to wait until after I am dead! I am not some experimental animal. 
"Please, Dr. Ohno! Tell them not to amputate my hand! Please, please, I beg of you!"

This is a tragic story that I experienced at the same hospital three years later. She was a very young and talented girl with such a kind and friendly personality. She attracted many people, and everyone wanted to be her friend.  She was not only the promising star of her gymnastics team, but she was also a beauty with the heart of an angel.  She was as intelligent as she was lovely.  her parents had high hopes that she would enter medical school and become a doctor someday.  She mastered all of her subjects in school with high honors. Everything in her future seemed bright and promising.  No one could ever imagine that death was lingering beside her like a terrible , dark shadow. 

One day after she turned 15 years old, she began to feel a swelling and a hot spot in her shoulder.  At first she thought this was caused by an insect bite so she ignored it. However, the discomfort continued for over a month. She never complained about the symptoms to her parents or her gymnastics coach.  She was concentrating on her gymnastics competition that was soon to take place, and she didn't want to concern anyone needlessly. 
Although she continued to feel the pain, she ignored it, hoping it would eventually subside.

then, her bright future came to a halt.  It all became apparent during gymnastics practice, when in the middle of doing a routine cartwheel, she experienced a severe pain in her shoulder.  She ignored the pain and continued to practice another cartwheel.  This time the pain intensified and she felt a very strange 'crack' inside her shoulder.  The pain became severe.  It literally took away her breath .  She fell to the floor in excruciating pain, screaming, "Someone help me! I think . . .I think I broke my arm!"

Within moments she fell to the floor unconscious from the pain.  Her gymnastics coach and her friends immediately surrounded her. 
"Call an ambulance! Someone, quickly call an ambulance !"
The gymnastics coach then said, "No one move her!  Wait until the ambulance arrives.  We don't want to take a chance and cause more damage to her shoulder!"

Off and on she would awaken, scream out again in pain, and fall suddenly back into an unconscious state.

At the hospital, her X-rays were read by emergency room doctor, who told her, "Your humerus bone has been fractured. There is also a mass showing up in your X-rays and I feel we should take a closer look at it.  I suggest that we admit you into the hospital fora biopsy as soon as possible."

The next day the biopsy was taken and sent to the pathology department for analysis. When the doctor received the results from the biopsy, he went to the young girl and her family and reviewed the results of her biopsy.  They watched as the doctor opened the envelope containing the pathology report.  As his eyes scanned the report, the look on his face dramatically changed and he became very somber.  After what seemed like an eternity, he read the results to the young girl and her family.

"I am sorry to say that I have some very bad news.  The pathologist's report shows a tumor on the humerus."

Everyone was quiet for a moment.  Her father asked  , " Is the tumor benign . . . or malignant? 

"The tumor is malignant." The doctor added, "It is so far advanced that if we performed an operation to remove the tumor, her chance of living for five years would only be 20 percent. The X-rays also indicate that the cancer has already metastasized to the lung."

Her parents wept upon hearing the devastating news.  The young girl's eyes filled with tears, but she held her emotions. Upon hearing the news, the young girl and her parents went to another hospital to seek a second opinion.  Unfortunately , the prognosis was the same. They then proceeded to go to three more hospitals.  The prognosis from all the hospitals was virtually the same.  Finally, they returned to the University Hospital.

I was among the staff present when the young girl and her parents heard the recommendation from the professor, " We should amputate her arm from the shoulder immediately.  We need to perform the amputation as soon as possible, in order to increase her chances of survival."

The young girl responded emphatically, "No! This is my body ! My arm! My life!It's not your life! I will not consider amputating my arm, and I don't care what the consequences are! "

There was a long discussion between the girl and her parents and the professor over the amputation.  The tension in the  room was strong as the professor attempted to persuade her to have the amputation.  Her parents believed that if she went through with the amputation, it would help prolong her life. But the young girl was emphatic about her decision to not go through with the procedure.

"After I die you can amputate my arm for the tests you want to perform, but I will not allow the amputation while I am alive! Even though my mother is crying and trying to persuade me, I cannot agree with her. This is my body, not my mother's body. I am 15 years old and I will decide what is best for my body and my life!"

One last time the professor very sternly told her, " You should have the amputation and it has to be done immediately. If you do not go through with the amputation you will surely die very soon. You must reconsider!"

Once again, I was internally questioning the opinion of the professor.  I knew that her cancer had already metastasized to her lung and there was nothing that amputating her arm would do to help her live longer.  I wondered why he was so emphatic about recommending the amputation. 

I later realized that the professor wanted to perform the amputation because her tumor was very rare.  If the amputation were to be done while the girl was still alive , the tumor would also be alive.  The live tumor was necessary for his personal experiment research. 

The professor continued to pressure her to have the amputation.  However, she still refused.  The professor and her family finally gave up. The the professor offered his only alternative, the new anticancer drug.

The days to follow would present me with a similar scene of watching a patient in torment, as I would again be called upon to administer the anticancer drug to the young girl.  Once again, I was obeying an order from the professor.  An order to give a patient a painful drug that went against my personal and professional judgment. I struggled emotionally and mentally, moment by moment, torn between what i was expected to do and what I knew was the right thing to do. 

Three days after I had started injecting the anticancer drug into the young girl, the nightmare of her agony took hold. She had no appetite ; she experienced ongoing nausea and  vomiting. The fatigue from fighting her suffering was overwhelming. 

"Please, Dr. Ohno, please don't give me any more injections! I can't take the pain of the side effects anymore! My stomach feels like it's pushing its way up through my mouth.  i've had so many seizures!
"Please make this hell stop! Please! Stop giving me this drug!"

She was completely fatigued.  She was collapsing and sobbing. I watched as her face turned pale from the effects of the drug.  I witnessed her tough and fighting spirit fade into a lifeless agony.

She had huge sores in her mouth from the side effects of the drug.  the sores were so bad she could not swallow , let alone eat.  The seizures were intensifying. it was becoming more difficult for her to breathe.  Compounding her misery were other side effects of chronic headaches, fever and infection. medicine to help eliminate these was not  working.

"Help me Dr. Ohno ! I have already lost 20 pounds! I cannot eat anything, because nothing stays in my stomach. No one has any idea how much I am suffering ! Please stop giving me that drug! I know I am dying. I don't want to take this drug anymore!"

If the positive benefits had offset the negative side effects, I might have been more understanding and less resistant.  But this was not the case.  I began to feel that this drug was a monster. I felt that I was not a doctor, but I was being forced against my better judgment to administer this 'Devil's Drug' which was torturing and killing my patients !I would ask myself, "Am I really a doctor, or am I just a prisoner of the medical system?"

Question after question kept entering my mind , How can i stop giving my patients this horrible drug when I know it is torturing them? 
How can I stand by and allow myself to remain a part of this if I know it is wrong?
How can I continue to call myself a doctor when I think myself as a killer?

I knew for my own preservation and peace of mind that I had to do something else to help my patients.  I decided to commit myself to finding another way to help these people and hopefully by doing so, I would heal myself of the personal torment  I was living through.

Struggle can be a blessing in disguise.
There is no room to grow if the Universe does not present challenges. 

Dr. Yoshitaka Ohno. M.D., Ph.D. 


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