Looking Beyond X-rays

I looked at her chest x-ray, and knew right there and then that she didn’t have a chance. I have seen bad chest x-rays before, but this time, it was different.

I look at chest x-rays and chest CT scans every day. I review 30 or more each day. It is part of what I do for a living. And it is something that I become good at.

Ever since German physicist Wilhelm Roentgen discovered what he dubbed as “x-radiation” in 1895 we have used this technology in analyzing bones, teeth, and other organs in the human body. It also used to detect cracks in metal in the industry. Now we even use them ubiquitously in all airports for luggage inspections. That’s why bag inspectors know you packed in dried fish without opening your luggage.

But do you know that x-rays can also look into the future? It has nothing to do with radiation-emiting crystal balls.

IMG_3418

It was late August of last year when I went back to the Philippines, not for a vacation but for a medical emergency. The attending physician in the hospital, who knew that I am a doctor myself, led me to the radiology department to show me a chest x-ray of the patient.

It was also here in this same hospital, University of the East Ramon Magsaysay (UERM) Hospital, that 27 years ago, where I picked up a CT scan of the brain of another patient. But at that time I just started medical school. In fact I was only in my first month of my first year of medical school then. Yet even in my untrained eye, I knew that the word “tumor” is not good. Especially if it said it is in the brain.

Now I was back in that hospital, looking at a chest x-ray, one morning that August. I have gained more than 20 years of experience now as a physician. And interpreting chest x-rays has become my expertise.

The chest x-ray the doctor showed me revealed a large tumor, the size of a santol (wild mangosteen) fruit. Not just one, but three! A sign that cancer had spread. A sign of impending doom.

Somehow it felt like I was reading the patient’s obituary, way before her death.

The chest x-ray was my mother’s.

And the CT scan of the head that I picked up 27 years ago? That was my father’s. He died 3 months after I peeked on that head scan.

What is this that I was privileged to see the future through an x-ray, as it gave me an insight of what is to come? Is it a blessing, that I could have prepared for it? Or is it a curse, as I started mourning before everybody else did?

When I broke the news to my mother regarding the results of her chest x-ray, she was not surprised. It was as if she knew it already. She was serene and collected.

My mother was diagnosed with colorectal cancer 5 years ago, and underwent surgery for it. We thought we got rid of it. We thought we kick cancer in the butt (no pun intended)!

But we were wrong. It came back. And with a vengeance.

My mother decided to not pursue any further treatment, like chemotherapy or radiation. For there’s no guarantee anyway that it will matter. Somehow she accepted her fate and was at peace with it.

When we took her home from the hospital she even willed herself even though she was weak to accompany me to the airport in Manila when I flew back here to the US. When I embraced her goodbye, I knew it will be our last embrace. Yet she told me, “Anak hindi ako malungkot. Masaya ako dahil nagkita pa uli tayo” (Son, I’m not sad. I’m happy that we saw each other again). She even added that I need not return for her funeral, it was enough that I saw her alive.

A little more than two months after I saw that foretelling chest x-ray, my mother died.

But there are things that the x-ray did not show. It did not show the inner strength and grace that my mother displayed on her last days. It did not show the peace and faith she had even when facing death. It did not show the confidence and hope that she had, that we will see each other again someday, in a glorious place where there’s no more grief and x-rays.

Fear of Shadows

Are you afraid of your own shadow? Here’s a story for you.

Few days ago, a patient that I took care in the hospital last month, came for follow-up in our outpatient clinic.

She was hospitalized with pneumonia, and her course was complicated with fluid collection (pleural effusion) in the chest cavity around her lungs. I placed a chest tube to drain the fluid, and creamy, yucky (yucky? that’s a medical term!), purulent material came out, a condition called empyema. But even after a couple of days of hooking the chest tube to suction (like a vacuum cleaner), it did not drain completely. The fluid was so thick and was gel-like already. Thicker than condensed milk!

chest x-ray with left pleural effusion (the L indicates the left side)

Finally, I consulted a thoracic surgeon, and our patient underwent surgery to evacuate the crap (crap? that’s another medical term!) and scrape clean the thoracic cavity, a surgery known as decortication. She made swift recovery thereafter and was eventually discharged home.

When I entered the examining room on her follow-up, I sensed anxiety on her face. I asked her if she still feels sick, but she denied it, and in fact she admits that she was really doing well. I told her that her chest x-ray, which was taken earlier that day, looks good and I was satisfied with her progress. To this she said: “But there’s still a large shadow in my chest. There must be still fluid there.”

Obviously she peeked on her chest x-ray, probably in the Radiology Department, prior to coming to our clinic. I was astounded by her remark, as I reviewed the x-ray myself. Are we looking at the same film? Does she know something that I don’t?

I then led her to the computer screen to review the digital film with her. She then pointed on the “shadow” in the middle of her chest x-ray, that was causing her concern.

I tried to contain my smile as I reassured her that the “shadow” was alright, because that shadow is her heart. “Then I am glad that shadow is there,” she declared, as she sheepishly laughed with relief.

normal chest x-ray

We sometimes fear shadows, even our own, when we should be focusing in the light.

“No man sees his shadow who faces the sun.” – Danish proverb

 

* Chest x-rays were not from the actual patient