'The Operation Was a Success, but the Patient Died'


The diagnosis was very uncertain. She had been given steroids on the supposition that the skin condition was a severe form of psoriasis. The latter is a common skin condition, and it is another old saying that common diseases occur commonly. But she continued to be ill and eventually was admitted to the Massachusetts General, as law cases are taken finally to the Supreme Court.

The patient underwent an immense number of tests of enormous sophistication, among them repeated skin and lymph node biopsies. Immunological and genetic tests were likewise performed. Eventually a diagnosis was reached: she had a cutaneous kind of lymphoma that has a bad prognosis.

The case report discusses the various possibilities for treatment, none of them guaranteed to work and all of them with serious side effects. The best option seemed to be pegylated liposomal doxorubicin, which had a cure rate between 20 and 60 percent, though it can cause serious damage to the heart. “This agent,” said the report, “was considered but could not be obtained because of a national drug shortage.” Other drug treatments could produce remissions, but short-lasting and at the potential cost of severe complications.

In the end, the patient “received alemtuzumab followed by total-skin electron-beam therapy and a reduced-intensity-regimen stem-cell transplant.” The dermatologist adds that the patient “is currently doing well, 1 year after the transplantation.”

A triumph, then, you might think! But in the next paragraph the pathologist says, “Unfortunately, she died approximately 1 year later of transplant-related coronary artery disease, with the lymphoma in complete remission.”

This rather peculiar juxtaposition of the patient doing well, in the present tense, and of having died at the same time, rather casts doubt on the way in which such case histories are constructed or redacted. The patient is cured, but the patient died. However, it is by such contradictions that medicine makes its strides.


images courtesy shutterstock / Johan Swanepoel / Roblan