I felt pain

The least favorable feeling in the world, and the one I get so often is seeing somebody agonising in pain, yet what you could do is just stare at him as helplessly as a baby.

I stumbled across a patient who presented with lower back pain that persisted for 4 months today in the clinic itself. He was in his twenties and apparently what came to my mind was muscle strain as there was no history of fall or trauma. He was pale, the face was obviously lacking of intensity and brightness. One of his hand was on his back, telling the doctor about the wrenching pain that diminished his quality of life. He complained of weakness and numbness and pain radiating down on both of his legs.

"Could it be a PID ( Prolapse Intervertebral Disc) since the patient presented with sciatica" I whispered.

To have a closer look at him, Dr Kama ordered him to take off his shirt.

"What can you see Calvin, this is an interesting one"

" Scoliosis, but he is only 28, no history of trauma or fall, no mechanical stress exerted along the spine either.Scoliosis?"

The whole thing is like a puzzle, waiting for me to put all the pieces together so that I can at least figure out what is wrong with him. I was indeed puzzled. Scoliosis is a medical condition where the spine is curved from side to side, forming an S shape.

What causes the spine to curve? Did he lift up heavy things?

I recall that scoliosis is usually associated with loss of density of the vertebrae, sometimes found in osteoporotic patients in which the micro architecture of the bone is impaired.

"Don't tell me he has osteoporosis at the age of 28" I laughed, not knowing what is coming ahead of me.

"If there is no history of fall and trauma, the only thing that I can think of is actually infiltration" uttered Dr Kama.

"Infiltration? You mean malignancies? Cancer?" I said dubiously.

"I'm afraid so" said the doctor while laying his hands on the patient's spine.

In medicine, doctors are the detectives. We observe, we make our hypothesis and then we rule in or rule out the possible causes. Every decision is dealt with professionalism, a wrong move and you put the patient's well being at stake.

I scrutinised his body, looking for any abnormalities. What I found was that his shoulders are uneven, probably due to the fact that he has to compensate for his posture to keep himself balanced with the curved spine.

He was skinny, pale as a corpse, and the muscles above his cheek bone as well as the first dorsal interossei was wasted. I compared it with my hand. It was obvious.

It all fits.Vertebral compression occur either due to mineral loss of the bone in osteoporosis, or due to vertebral destruction in benign or malignant tumors. He smokes, and it all points to lung cancer. The curved spine impinged on his lumbar nerve roots causing him immense pain, forcing him to stop working. Every step he takes hurt, every move, everything he does causes emotional distress.

I am pretty sure It was lung cancer. He was scheduled for an X-ray and is supposed to come back tomorrow. At this point, I somehow felt his pain. Watching him take every step at one time, groaning in pain hurts me. I know NSAID ( Non Steroidal Anti-Inflammatory Drugs ) and simple analgesics would not have any therapeutic effects on this kind of pain. When you cannot do anything but to wait. It hurts.

He walked out of the door, looking at his back and his abnormal posture, I prayed. Yes, I prayed.