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A Letter from the Family of a Patient with Brain Metastases

Department of Neurosurgery, Xuanwu Hospital

First of all, on behalf of the whole family, I would like to send the sincerest wishes to Xuanwu Hospital, wishing your hospital a prosperous career and greater achievements in the field of medical science!

At this moment, as a family member of a patient with severe brain tumor and cerebral edema, I am excited to express my infinite and heartfelt gratitude to your hospital, especially to Dr. Xiang Sishi, Department of Neurosurgery Gamma Knife. During the time my mother was hospitalized in a critical condition, Dr. Xiang relieved my mother from the pain with her superb medical skills and noble medical ethics. Her words, deeds, and actions interpret the duties and ethics of contemporary young female doctors and the true nature of medical ethics.

On February 17, 2022, my mother suffered from brain metastases from lung adenocarcinoma and extensive brain edema. The left half of her body suddenly became unable to move her hands and feet, and her body was in a state of "paralysis" and unable to take care of herself. After seeing the doctor, we were admitted and admitted to the Department of Neurosurgery of Xuanwu Hospital. At that time, the doctor talked to our family members many times about the risks of the operation and the treatment plan, and explained every aspect very clearly, which relieved the family members of their doubts and pressures. I have been to many hospitals before, and the answer I got is that the patient's condition is too serious and the cerebral edema will be aggravated after Gamma Knife surgery, and the treatment effect will not be very good. At that time, my heart was as heavy as a big stone, and it was not ideal to go to several hospitals for consultation.

My mother is old and her condition is complicated. She still has an aneurysm in her brain. At that time, the situation was very sudden, and our family was at a loss. We were worried that the brain edema would worsen after the operation, and we would remain in a "paralyzed" state. But she was very decisive and firm when she saw the doctor to judge the condition. She was very young, but after watching the film she said: I can do it. She gave the treatment plan succinctly and simply.

After a series of examinations, the Gamma Knife operation was performed in the early morning of February 24. Thanks to Dr. Xiang and the Gamma Knife team for their superb medical skills, during the 40-minute operation, the mother was in good physical condition without any abnormality. The surgery was very successful.

The good news is still to come. What I didn’t expect was that my mother could get out of bed and walk the day after the operation. It’s a miracle! A person who is paralyzed and unable to move is only the second day after surgery! You can walk downstairs! At that time, our family jumped up with joy, it was a miracle! Incredible!

Thinking about how many times we came to Xuanwu Hospital by ambulance, during the conversation with Dr. Xiang, she asked how the patient came to the hospital. I said that the family couldn’t move her, and the main patient could not assist in getting on and off the car. I called an ambulance, and after listening to the doctor, he said that he would not have to take an ambulance for the next review. We didn’t believe it at the time and thought it was a joke. Now I have to admire this young female doctor so daringly in judging the condition and so skilled in medicine, and she is not allowed to be a man in this place where male neurosurgery doctors gather!

I would like to express my admiration again. I watched my mother's improvement day by day after the operation. After the re-examination, the tumor continued to shrink, the cerebral edema was gone, and her thinking was as clear as a normal person. It really pulled my mother back from the hand of death, gave my mother a second life, and gave us a complete home. I am really grateful in my heart.

During the Gamma Knife treatment, there were two female doctors and other medical staff who I don't know their names. It was their unknown dedication that allowed a life to be extended and took back the lives of their relatives from the god of death. Life is grateful. Now there is no pain, and my mother has been discharged from the hospital. Everything is going in a good direction.

Finally, let me say from the bottom of my heart: I wish Dr. Xiang Sishi and her team greater achievements in the field of medical science and a higher level of career, and better achievements in this field will benefit the Human beings, I wish good health, good luck, and happiness to the whole family!

May 30, 2022

Doctor’s reminiscence

One day when I was out of the clinic, a young girl suddenly came in. She was very anxious and asked if I was Dr. Xiang. She said that three days ago, her mother suddenly became paralyzed on one side of her body and could not move. She called an ambulance to the hospital emergency room, and the emergency doctor recommended her to come to me. After inquiries, I found out that it was hemiplegia caused by brain metastases. Seven years of lung cancer, it has been two years since brain metastases were discovered.

The patient's brain metastases have never been cured, because at first, they thought that just taking targeted drugs would eliminate the need for treatment for the brain tumors. After half a year, the tumor in the brain was still growing, and I wanted to treat it. As a result, during the examination, it was found that there was an aneurysm in the internal carotid artery on one side, so many places did not dare to treat her.

Doctors at the Gamma Knife Center of other hospitals felt that there was a brain aneurysm, and they were worried about the risk of bleeding during the treatment process. The medical oncologist felt that taking targeted drugs alone could control brain tumors. It "sustained" for 2 years.

Until three days ago, the patient suddenly became hemiplegia on the left side. The culprit was that the original metastatic tumor had been growing, almost 5cm in diameter, and the edema caused by the tumor. So her daughter came to ask if she could make a gamma knife.

After I read the examination and analyzed it, I felt that although the tumor was large, the edema should be controlled effectively by treating the edema in stages and combined with drugs. After the edema subsided, the limbs should be able to move quickly. So I told her with confidence: I can do it.

However, she hung up an expert account at the same time that day. The expert felt that there was a single intracranial mass with signs of intracranial hypertension, and suggested that she go to a craniotomy first, so she finally chose to follow the expert's advice.

Before the craniotomy, there were some routine cardiopulmonary function tests. The test results showed that the patient was old, 78 years old, bedridden at home for a long time, had problems with coagulation function, poor cardiac function, and had a high risk of surgery. Then they came to me for a consultation. In fact, the patient was finally forced to find me for Gamma Knife.

I did not hesitate. After careful discussion with the family, I gave her Gamma Knife treatment early in the morning, and the patient was discharged in the afternoon. On the third day after she was discharged from the hospital, she texted me that my mother would be able to stand up when she got home.

About two weeks later, the patient walked to the hospital for re-examination. After the MRI, it was found that the tumor had shrunk by 2/3, and the edema had also subsided, so he returned to a normal life. A second treatment was then performed as scheduled.

In fact, it is difficult for patients and their families to make choices, because there is an untimely "bomb" of cerebral aneurysm, other doctors feel that there is a risk after evaluation, and the patient's state can still be maintained through targeted drugs, so family members dare not choose gamma Ma knife. In fact, as a doctoral student of a "bomb disposal expert" outside of neurosurgery, we assessed that the risk of aneurysm rupture during Gamma Knife surgery is relatively low, and brain metastases have seriously endangered the patient's life, so I resolutely recommended the patient for treatment. Thank you to the patient and family for their trust in me, with such a good result.

In daily work and life, there are many cases of "entanglement, complexity, and difficulty in choosing", but in fact, many times, the lack of trust and communication between doctors and patients makes it impossible to continue "cooperation" to fight the risks brought by the disease: doctors Worry that if too many decisions are made for patients, there will be the risk of "doctor-patient conflict" due to unsatisfactory treatment results; and patients are "ignorant" and indecisive about the disease, and most of them will miss the best time to treat the disease. Maybe sometimes doctors have more "confidence" and more "communication" on the basis of professionalism, and increase the "understanding" and "trust" of patients, we may be better!

Thank you for the letter from the patient's family, and hope to join hands with you to overcome it!

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