AFTER THE ROLL OF THUNDER

Never has there been so decisive & fidgeting a weekend like this before for her,
Reverend Lian Yan-yan, our former pastor & long-lasting old friend.

The pathological examination of excised solitary tumor, about 8 x 10 cm in diameter, is supposed to reveal some preliminary result on next Monday, 12-22.
Benign or malignant?
It hugely influences her who has a 19-year-old only boy with some problem worrying his mother.

The patient choosed to face it alone quietly. We can choose to surround her with overwhelming prayer wherever we are in this weekend. But this is just a beginning. This event, the tumor thing, reminds us our tapering concern & attention about her. Let our care continue beyond the day of release of pathology report.

In 12-10 a cell phone call stunned me. Samuel Chen told me Rev. Lian had been found to have a big tumor in pancreatic tail from some health check-up. It’s just a vague message. As a physician I was driven to get more detailed & specific information, such as her symptoms & signs, diagnostic evidence, kind of examination, accurate location & etc. Given that the most probable examination to confirm a tumor is CT which is better done during hospitalization, the next day I managed to make sure that she was hospitalized in Zhu-wei branch of MMH. That morning I called Dr. Liu Jian-liang (劉建良), who is also an elder, of MMH to ask him if he would like to operate for a good friend of mine. After having heard the name I mentioned he told me he just saw Rev. Lian with her CT images in his OPD in MMH that morning & had arranged the admission into MMH on next Tuesday & operation on Wednesday.

That noon I saw her in ward room, after 1-hour-driving from Ban-qiao to Zhu-wei. Here is the story. She felt epigastric discomfort in July & visited Dr. Right-heart twice with little improvement after taking some oral meds. No abdominal sonography was done. Being very busy she paid little attention to it until this month when she finally visited another GI specialist at Zhu-wei branch of MMH. The latter doctor was more alert so as to promptly arrange an abdominal sonography which surprisingly revealed a huge multicystic lesion near pancreatic tail. That shocked everyone.

Rev. Lian, vexed to have same fate as her husband, Guo-jun, said she didn’t fear death, but did worry to leave her son behind alone. We went to nursery station to see her medical chart. The abdominal sonography photos revealed a multicystic tumor in upper abdomen. The abdominal CT report describes a cystic tumor with size of about 8 x 10 cm, located in upper abdomen, there is margin seen between it & pancreatic tail. The double-contrast LGI series reveal normal colons. But the CEA & CA-199 of fluid got from sono-guided aspiration were high in spite of normal serum CEA & CA-199. So, It seemed there still had no strong evidence to support that the tumor originated from pancreatic tail. It could be a solitary tumor of unknown origin, malignancy could not be ruled out. I discussed with her the indication for abdominal MRI to solve this dilemma.

That afternoon, after having come back to my clinic, I called Dr. Liu again to discuss if MRI was needed. His opinion was that MRI didn’t worth it. The Friday morning I talked with Rev. Lian on the phone. She mentioned the help from colleagues to seek second opinion from a redhot pancreatic surgery specialist in NTUH. But his available OPD visit was on next Wednesday, the arranged operation day. A dilemma again. Finally we got the conclusion: whether benign or malignant, the tumor must be excised; where did the tumor come from only could be answered after the abdomen was opened. She was determined to follow the existent schedule, which afterwards revealing to be a tough, faithful & wise decision .

On Sunday (12-21) I presided at second service in Taiwanese. About Rev. Lian’s condition I said the origin of her tumor might be from pancrease or colon or even some unknown organ & there was still possibility of being benign. In prayer meeting at Thursday (12-25) night Pastor Tsai said my prayer had brought forth change for Rev. Lian’s tumor. Here is my response. I have not changed anything big. I just did do my homework to study thoroughly the data of this case with mind & got these conclusions which made me see more clearly & optimistically.

This Tuesday somehow I knew for sure she had been hospitalized to MMH, so continued to prayed for her & awaited the outcome of operation. On Thursday noon I went to MMH to check her out. She could get up from the bed & sat on chair with an expression of some degree of relief & even a little bit of smile. This was the second day after a major operation.

Let’s wait with her in prayer.

P.S.
During the opearation, which made a long longitudinal incision at mid-abdomen, a solitary tumor of about the size of 8 x 10 cm with 2 tiny nodules attached at its lower pole was removed with dissection of the adhesion with surounding organs. The subsequent pathological report revealed all mucinous cystoadenocarcinoma. The origin of the cancer is still unknown.

Now she's facing the more difficult decision. Whether to take chemotherapty according to her oncologist's suggestion or not. She is seeking more information by visiting more gurus in this field to pray & consider for it.