Clinical Story丨Grandma Hao was discharged safely from the hospital (—)!

Life is precious. The 80-year-old Grandma Hao was discharged safely from the hospital, and the medical team of the oncology department was very happy. After more than a month of hard work, Grandma Hao went from being seriously ill and ready to "welcome death" when she first came to the hospital to gradually recovering to a normal diet, walking on the ground, and being discharged from the hospital. Behind this is the hard work of the "Oncology Team". Grandma happily said to her family: "I'm fine, thank you to the medical staff of the oncology department, they are all good people, they take good care of me, and I will be able to go home soon!"

1. First impression upon admission

On September 30 last year, Grandma Hao was sent to our department by her family for hospitalization. The reason why she was hospitalized on the last day before the National Day holiday was that she was seriously ill and could not bear it at home. Grandma Hao suffered from endometrial cancer and had surgery in the gynecology department in February this year. The surgery went smoothly and she recovered well. But three months ago, Grandma Hao's belly began to grow bigger and worse. Her family did not know why and asked to take her to the hospital for examination. Grandma Hao was introverted and afraid of going to the hospital. She refused to agree no matter what. In this way, her belly grew bigger and bigger, and her legs swelled up. She could not get out of bed, and she could not eat. She had no strength at all, and she was in a gloomy mood. In the end, she could not even eat rice. Grandma Hao silently waited for "death to come" at home. Grandma Hao's husband and children could not bear it anymore, so they contacted the oncology department and completed the nucleic acid, chest CT and other examinations required for admission to the hospital. The chest CT report indicated bilateral lung nodules and metastasis was considered. Grandma's husband said with red eyes: "I hope you can help prolong her life as much as possible. It would be great if we could be discharged from the hospital and go home to live a family life. I know this may be a luxury." When Grandma Hao was first admitted to the hospital, she was very indifferent. She didn't speak actively and would only answer one question when asked. Maybe she was nervous and afraid, or maybe the physical discomfort made her unable to cope. We couldn't help but comfort her again and again, "Don't worry, Grandma Hao, everything will be fine."

2. Work overtime, collaborate across multiple departments, and get the best support

We examined Grandma Hao and conducted emergency tests: she was apathetic, emaciated, had a blood pressure of 110/60 mmHg, dry lips and skin, sunken eye sockets, a heart rate of 90 beats/min, normal breath sounds in both lungs, a distended abdomen, positive shifting dullness, and severe edema in both lower limbs. The test indicators were also very poor: hypokalemia, hyponatremia, hypoproteinemia, and white blood cells greater than 10.0*109/L, and procalcitonin as high as 7.31 ng/ml. Considering that Grandma Hao had a large amount of abdominal effusion, coupled with long-term poor feeding, severe body fluid deficiency, and some early symptoms of shock, she was immediately given close monitoring, opened intravenous access, and supplemented with fluids, electrolytes, and human albumin. Because white blood cells and procalcitonin were significantly elevated, infection could not be ruled out, and an infection consultation was requested. Colleagues in the infectious department quickly consulted and gave antibacterial treatment recommendations. Grandma's abdominal distension was quite serious, so we contacted the ultrasound department, did the abdominal bedside ascites positioning, and closely monitored the blood pressure. When it was stable, the doctor in charge performed closed abdominal drainage for Grandma Hao. After draining out the light yellow and clear ascites, everyone breathed a sigh of relief (worried about bloody ascites). On the same day, 1000ml of ascites was intermittently drained. The ascites was sent for testing and pathology. The National Day holiday was coming soon, and everyone was worried about Grandma Hao's condition. The doctor in charge made a detailed handover, asking Grandma Hao about her abdominal distension every day, and trying to drain ascites every other day to improve the symptoms of abdominal distension. Don't drain the ascites completely during the "National Day" holiday, because after the holiday, the ascites will continue to be sent to the pathology department to find cancer cells. During the "National Day" period, the doctor on duty every day was required to closely monitor Grandma Hao's blood pressure, heart rate, urine volume, and drainage volume, and adjust the infusion volume. Grandma Hao's eating was still very poor, and she was given intravenous nutrition during the National Day.

3. Carefully craft and develop the best solution

After close monitoring, intravenous nutrition, anti-infection and ascites drainage to improve symptoms, Grandma Hao's condition has improved significantly. She is much more energetic than before, her complexion has gradually become ruddy, her mood has gradually become cheerful, her abdominal distension has improved, and the swelling of both lower limbs has disappeared. All test indicators have improved. After the National Day, the ascites pathology reported that adenocarcinoma cells were found, and endometrial cancer metastasis was considered based on histochemistry. Adenocarcinoma cells were found in the patient's ascites, and we explained the condition to the family for the second time. Malignant ascites is clear, and we gave her a plan of intraperitoneal infusion of cisplatin. She was also arranged to have an abdominal and pelvic enhanced CT scan after the ascites was drained, and peritoneal and omental metastases were reported. The third communication with the family about the condition was clear, and the patient's diagnosis of stage IV endometrial cancer with omental and peritoneal metastases and lung metastases was confirmed. The family members all understood the condition. Grandma Hao's husband repeatedly said, "Doctor, we understand the condition. The only hope is to find an anti-tumor treatment method suitable for her to treat it and control the tumor progression." According to the NCCN guidelines, carboplatin combined with paclitaxel is the preferred chemotherapy regimen for the treatment of advanced, metastatic or recurrent endometrial cancer. Other commonly used regimens include docetaxel combined with carboplatin, doxorubicin combined with cisplatin, carboplatin combined with paclitaxel + bevacizumab, albumin-bound paclitaxel, topotecan, etc. After careful analysis, the team finally selected intravenous albumin paclitaxel + bevacizumab + intraperitoneal cisplatin regimen considering Grandma Hao's advanced age and poor physical condition.

4. A pennant, a token of gratitude

As Grandma Hao was discharged from the hospital, the old man happily presented a banner with the words "Excellent medical skills and noble medical ethics". A banner, a token of gratitude, hung on the light green wall of the oncology department's corridor, is not only a recognition of the medical work, but also a reminder for the medical staff to fulfill their duties. It is the belief of "never forgetting the original intention and keeping the mission in mind", and the professional spirit of medical and health care of "protecting life, saving the dying and the wounded, being willing to make sacrifices, and having boundless love". It always reminds us to do our job well, relieve the pain of patients with sincerity and love, and win the recognition of the majority of patients.