The Perfect Treatment. Rebecca Lang

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СКАЧАТЬ may know the saying with regard to making a diagnosis—“When you hear the sound of galloping hooves, think of horses, not zebras.”’

      Abby smiled. ‘Yes, I have heard that. And certainly not unicorns,’ something prompted her to add.

      ‘No, not unicorns.’ He smiled slightly in return. ‘Not that leukemia is difficult to diagnose. We have to be sure of the type, though.’

      Abby nodded.

      Dr Contini turned again to their patient. ‘These immature cells—which never develop to full maturity, Mr Simmons—are unable to perform the functions of the mature cells that they gradually replace…thus the symptoms that you experience, especially the anemia,’ he said.

      ‘Yes.’

      ‘Because you have fewer and fewer normal red blood cells, with less and less hemoglobin as a result, you gradually become unable to carry as much oxygen on your red blood cells…which is why you get breathless on exertion.’

      Their patient nodded. He seemed avid for information, as though that in itself might help him to fight this vicious disease, if only on a psychological level.

      ‘Mr Simmons has been in here for two days, Dr Gibson, waiting for the results of more blood tests. I’m here today to discuss treatment with him. Any questions you want to ask him?’

      ‘Has a bone-marrow biopsy been done?’ she asked.

      ‘Yes,’ Dr Contini said. ‘That, as you know, is the other diagnostic test, which shows up the abnormal bone marrow cells, the immature forms.’

      Although most of the background information was already in the chart, Abby preferred to hear it directly from the patient. He would most likely have a need to talk. ‘What were your initial symptoms, Mr Simmons?’ she asked, moved by his air of abject exhaustion, his outward calm, she suspected, masking a great deal of underlying apprehension.

      ‘Well…I was pretty tired all the time, much more so, I suspected, than was warranted by my age,’ he said, ‘although I lead a hectic life. I teach at the university—political science—and this is a busy time, coming up to the end of the academic year. Even so, I suspected that something was wrong with my health.’

      ‘I see,’ Abby said kindly, encouraging him to go on.

      ‘Also, my skin was very pale and I got breathless easily on the slightest exertion, whereas before I could walk for miles. I felt unwell for a lot of the time and I got several colds, as well as chest infections, which I couldn’t shake off.’

      ‘Do you smoke?’

      ‘No. Never have done.’

      ‘Anything else?’

      ‘I noticed that I bruised easily, and I couldn’t remember having injured myself in any way to cause the bruises,’ the patient went on. ‘Then my dentist noticed that my gums were bleeding more readily than usual, so when I told him my other symptoms he advised me to see my doctor right away. Then when I went to my GP for a check-up he found out I was very anemic…Then things progressed from there.’

      ‘He had some nausea as well, which indicates some involvement of the gastro-intestinal tract—either infection or bleeding, or both,’ Dr Contini said quietly.

      ‘I see.’ Abby nodded. ‘And what is the planned treatment?’

      ‘I’m getting on to that now,’ Dr Contini said. ‘What I’m going to do, Mr Simmons, is build up your general resistance before we start you on a course of chemotherapy. If you agree, that is. Since you’re very anemic, I’m going to give you a blood transfusion of packed cells, plus some fresh plasma which will help the clotting function of your blood, which gets out of whack with this disease.’

      ‘When am I going to get that?’ Mr Simmons asked.

      ‘We’ll start this afternoon. The hematology lab is getting you cross-matched. When we’ve done that, we’ll discuss the treatment further. If we decide on chemotherapy later, you get a combination of drugs over a period of five to ten days—that’s called the “induction therapy”.’

      ‘I’ve read something about that,’ Mr Simmons said ruefully. ‘It kills off all the abnormal cells. Right? Or almost all? I guess it makes you feel pretty awful, as well as making your hair fall out.’

      Blake Contini nodded.

      CHAPTER THREE

      WHEN the consultation was over and the two doctors were out in the wide corridor again, divested of their protective clothing, Blake Contini drew Abby to one side, out of the way of the pedestrian traffic, and queried her about aspects of the disease.

      ‘How would you make the final diagnosis here, Dr Gibson?’ he asked, fixing her with an astute glance from those rather unnerving blue eyes.

      Abby cleared her throat, feeling a little like a student taking an exam. At the same time, she was grateful to have this opportunity for learning—even if her feelings towards her teacher were a little mixed. There was no time now to dwell on that.

      ‘Well,’ she began, ‘there are abnormal cells in the blood and in the bone marrow—tests for those would be decisive. The cells in the bone marrow never mature beyond the myeloblast level.’ Abby met his glance squarely, warming to her subject. ‘And, of course, the proliferating leukemia cells accumulate in the bone marrow, eventually suppressing the production of normal blood cells and the normal bone-marrow elements.’

      ‘Yes.’

      ‘He would have evidence of abnormal blood-clotting function—an elevated prothrombin time and low fibrinogen levels, as well as the clinical findings,’ she added decisively.

      ‘Right.’

      Mr Simmons had manifested two common clinical signs. Abby had felt those distinctly when she had examined him as well—an enlarged spleen and an enlarged liver. They were signs indicative of a blood disease. ‘He has hepatomegaly and splenomegaly,’ she said, ‘two other diagnostic signs.’

      He nodded. ‘Quite right. After the transfusions that we’re going to give him, how would you proceed with treatment, Dr Gibson?’

      ‘Well…’ Abby took a deep breath. ‘I would give him the remission induction chemotherapy that you mentioned—provided we think he’s a good candidate. We hope to induce a complete remission. We would need to really build him up first, including, probably, the giving of broad spectrum antibiotics to try to get rid of residual infection, particularly if he has some gastrointestinal involvement.’

      ‘Yes…good. I can see that you know your stuff Dr Gibson,’ Blake Contini conceded, raising his dark eyebrows at her and giving her a small smile, a gesture that transformed his lean face.

      They had moved well away from the door of room six to discuss their patient, yet Abby glanced at it, feeling a familiar sense of pity. ‘I expect he was generally a very fit man before this,’ she said. ‘He doesn’t smoke, has always exercised regularly.’

      ‘Yes,’ he agreed. ‘We’ll see what the packed cells and the plasma СКАЧАТЬ