Pak Fadil Gets Uncleared for Brachytherapy

When doctors talk fast and agree to everything you say, they’re about to refer you to another doctor. When doctors speak slowly and clearly they’re getting ready to give you bad news.

Doctors use all types of ruses to avoid patient concerns including simply ignoring patients when they speak.

But when they need something from you — typically informed consent in connection with an operation — they’re surprisingly good communicators.

“I have some important information for you. This information is based on the decision of the all the doctors who are treating you. It is based on the facts of your case and is made in your best interests. First, we’d like to show you this MRI.”

Anyway, the doctor sure was speaking slow today. The news was that there will be no implant and there won’t be a glossectomy.

I can’t count how many times they’ve gone back and forth on the glossectomy. They try to blame in on the patient: “Not ready to have your tongue removed are you, sir. Well, well. Let’s see what our other options are.” But they’re always a couple of doctors meetings away from knowing if they themselves are ready.

I’m beginning to wonder if the brachytherapy “offer” (doctor’s own words) was half-baked as well. It began with a signed order, and progressed to blood tests, meeting with the anesthesiologist and a meeting with the patient, presumably seeking consent. But never anything like a date. Besides, do they just have small radioactive bits of metal lying around in the desk drawer. Doesn’t that have to be ordered? What does it cost. I don’t really know what to think.

One thing they didn’t ask for was an MRI. That was our idea. They were still referring to a CT scan taken before radiation therapy started and raised the question of cost and suggested maybe another CT scan would be enough. Not only did we end up paying for the MRI we had to scout around town to find a working machine that could take a picture of a tongue because the one at Cipto was going to be out of order for two weeks. (Cipto referred us to Cikini which, it turns out, doesn’t have the right machine.)

The MRI was part of the reason there’s going to be no brachytherapy. In fact — I had her repeat this a couple of times in colloquial Indonesian just to be sure — they’re not going to do anything.

Fine, a lot of times you can’t with cancer. But there’s a certain irony given all the hustle and bustle and talk of options and operations. To end up with “palliative” treatment and — upon inquiring about pain control — a referral to anesthesiology.

And they tell you to be there at 10:00 sharp to get the important information about whether your dad’s tongue is going to be removed. But they can’t be bothered to show up and give you the information. It was almost noon before Mona called in (from Fatmawati where she was helping another cancer patient this morning) and coaxed the doc downstairs by getting her to feel sorry for us.)

For months we’ve been focused on these apparently non-existent options the doctors have supposedly been debating. The brachytherapy isn’t an option because docs “aren’t sure” whether the area visible in the MRI that nearly bisects the tongue at the back is the tumor or what’s left over following radiation and chemo. Putting radioactive spikes in it might be the last straw if it turns it’s former tumor rather than actual tumor.

Somewhat puzzled (then and now) I asked, so why don’t you take a sample and see?

Doctor wills pencil purposively. “We can do that. Would you like to do that?”