“Well done. So, this presented case has out of whack numbers on that, too. He’s got a real problem here. Your first complicated case.”
The doctor continued reading the reports, attempting to build a picture for a diagnosis. Blood work, combined with the physical, told a partial story, but not the whole story. To be sure, the scans would have to be reviewed, and the physician would have to consult with medical experts, to see where the patient stood.
“What other tests can we do at this facility?” the nurse asked.
“Plenty, but I think between the scans and the blood work, combined with what I think is going on, we can paint a picture. We can always do immunophenotyping, to identify cells based on the types of antigens present. We can do a culture… ah, a sputum cytology, to check his lungs. You know, abnormal cells in his mucus brought up from coughing.”
“Oh, my. He is… coughing a lot.”
“Yes. Oh, and… umm… tumor marker tests. We could do those, too.”
“What are you thinking, Doctor?” the nurse asked.
“Cancer.”
Cancer is when cells develop out of control and attack other human tissues. The cancerous cells become that way due to the accumulation of defects, or alterations, in their DNA cell structure. There are specific alterations in the genetic code that are inherited from biological parents that can increase the risk of cancer, as well as some environmental factors like pollution and heavy metals in drinking water. These certain environmental factors, such as air pollution, excessive sunlight, and certain chemicals, in addition to poor lifestyle choices of tobacco and alcohol, can all lead to cancer.
They walked over to the computer station that displayed the scans on large screens. It took a brief moment for the scans to come up, and the doctor called over the radiologist and endocrinologist from the station next to them. Everyone looked on as they paged through the main scan screens, and then the medical doctors began talking through each of them.
“Your patient has a mass here,” drawing a line on the screen, “to here,” said the radiologist, reading the scan and putting his finger on the touch-type screen, measuring the tumor. “It’s pretty large. Pretty solid. Pancreatic. Been there for a while. You can see it has metastasized to his stomach, lungs, perhaps some other organs and tissue. Went undetected until now, eh? Hmm.”
“What’s your breakdown for TNM categories?” asked the attending doctor.
The TNM categories are used world-wide for the cancer staging system. Doctors describe cancer using this system for cancer reporting, especially when diagnosing for a pathology report. The system will describe it as: T referring to the size and extent of the tumor, the main tumor being referred to as the primary. N is the number of nearby lymph nodes that are embedded with cancer. M is whether the cancer has metastasized, or spread from the primary tumor to other tissue and parts of the body. There are also numbers associated after each letter that indicate more details about the cancer.
“Ahh… let’s see. I give him a T3, as the cancer has grown outside the pancreas into nearby surrounding tissues, but not into major blood vessels or nerves that I can see just yet. But pretty close. The mass is at 5 centimeters. Category N1, as the cancer has spread to nearby lymph nodes. And an M1 because the cancer has spread to distant lymph nodes and most likely distant organs. Overall? Case is a stage 3–4, worsening. Terminal,” replied the endocrinologist.
“Thank you. Yeah, agree. I performed a physical on the patient a few minutes ago and he has pretty good lumps on his neck,” added the doctor.
“Hmm… mmm. I’ve verified it with his blood work,” added the endocrinologist. “Concur. He’s definitely stage 3.5.”
“We just reviewed his blood work, too. Read the CBC report. Ah, what’s this here? Here,” asked the physician attending to the patient, pointing to the screen with his black Sharpie marker.
“That’s his pancreas. Taken completely over by the cancer. That’s why you don’t recognize it. That’s the 5 centimeter mass I measured earlier, but on a different image level than the others,” replied the radiologist.
“Okay. Okay. Thank you, doctor. And ahh…how long do you give him?”
“At best, three months. Maybe four months. But, could be as little as two months, as these are large right here. Here. And here. We can’t see how embedded it is above his neck. We should also CT his upper body again, and his brain,” answered the endocrinologist.
A CT, also known as a CAT scan, are distinct X-ray scans that generate cross-sectional images of the human body using X-rays and a computer. The scans are also known in the medical community as computerized axial tomography, or CAT.
“Can we do anything else to help?” asked the patient’s doctor.
The endocrinologist shook his head, “Nah, not this far along. I’m surprised he can function this well. If he was maybe a bit earlier, we could have performed the Whipple procedure, ah, you know, surgery, but not when it’s caught on like this, and spread,” pointing to the scans. “It’s everywhere. We all know that by the time the patient knows something isn’t right on pancreatic, it’s too late. Soon, he’ll need painkillers. And then a morphine drip. Bed-ridden. Only a matter of time, maybe a four to six weeks, before he’ll need that level of care.”
The doctors looked over the additional scans, scrolling over the screens. They chatted some more looking at the tissue, the slices of the cancer, and where it attacked his body. The initial CAT scan only did a short scan, to see if there was anything present, which there was. The patient would definitely need to be re-scanned, to establish a new baseline, but there was sufficient data presenting itself to be a definite concern.
The doctors shut the screens down before they could see the patient’s name again. It would take about a minute to restart the screens and have them warm up, so the attending physician turned to the nurse standing just behind them.
“Nurse, let’s cut him a prescription for a few bottles of capsules of Tramacet for the pain, and give him a few Zamadol bottles to take with him. Can’t believe he’s not on morphine yet. And, the… ah… the patient… what is this patient’s name and age again?” asked the doctor.
“Let me see. Name. Name…” She picked up her clipboard, turned it sideways to see what was written on the side of the folder and paperwork. “I have it right here.”
“Hello, Ford, how are you, love?” Emily answered at her desk. With her thick British accent, it sounded like “Hah-low, Fooord, ha ah yeh, luv?”
Ford and Emily met when she was working at Harrods Department Store on Brompton Road in London, UK, nearly five years ago this September. Ford was working on the U.S. European Command staff and visiting the U.S. Embassy in London for a briefing with the Defense Air Attaché, when he visited the world famous department store.
Walking through the lower ground floor of the legendary store, he passed the jewelry department from the main aisle, and that was when he spotted a young blonde bombshell standing behind the glass counter in the diamond section. Emily was working part-time at Harrods for some spending money during her college days, and she enjoyed working at the mythical and well-known store. Ford walked right over to her, stuck up a conversation about nothing, and was smitten with her small, petite size, long blonde hair, and attractive British accent.
Little did Ford know that while as an undergraduate taking finance at the University of Westminster, one of her college professors from Global Financial Markets 401 class recruited her for MI6. Emily had the right mix of emotional intelligence required for the job. Her special ability to read other people’s emotions, handle herself with confidence, and her ability to persuade, made her a great fit for Her Majesty’s Intelligence Service. Sprinkle her physical fitness lifestyle into the mix, and Emily was a perfect member of the clandestine team.