Our last goodbye

If I had known it was the last time I would speak to my friend Dennis, I would have woken up properly.

His wife had rung me at 3.30am, jerking me out of my slumber.

She said: 'I'm so sorry to call you in the early morning but Dennis insisted I do so!'

Dennis was my patient, a China national who was hospitalised in Shanghai.

He was in distress and gasping for breath. I could barely hear his voice as it was hoarse and weak.

Dennis had a tumour at the back of his throat.

It had grown rapidly over the past few days and was partially blocking his upper air passage.

Weak and unable to properly clear the secretions from the back of his throat, he was struggling to breathe.

His doctors wanted to open a tiny hole in his neck and insert a tube into his windpipe or trachea to relieve his breathing problems.

I had earlier been briefed that his doctors were going to perform the procedure, known as tracheostomy, the next morning.

They had to wait till morning because they could not find any blood platelets for him that night.

As his platelet counts were low, this procedure had to be performed while platelets, which are blood cells that prevent excessive bleeding, were being infused.

This would ensure that the small surgical wound did not bleed excessively during and after the procedure.

I explained this to him over the phone.

'Don't worry,' I assured him as convincingly as I could.

As I hung the phone up, I silently prayed that God would keep him safe through the night.

I texted him: 'Don't worry! Tracheostomy is an easy procedure. Can even be done by the bedside! Five-minute job!'

When I woke up a couple of hours later, I saw a text message on my mobile phone from his son-in-law:

'Dr Ang, Dennis passed away.'

It was a blow that came from the crushing realisation that I had failed to save my friend.

I first met Dennis six months ago when he flew in to Singapore from Shanghai.

He had been diagnosed with cancer spreading from the back of his nose and down the back, right side of his throat.

Looking into his mouth, you could see the big tumour pressing down the roof of his mouth.

Within two days, we confirmed that he had malignant lymphoma, a primary cancer of the lymph nodes.

Although there was evidence that the cancer had already spread, I remained confident that he would fare well as more than 90 per cent of lymphoma patients respond well to treatment.

Dennis coped well during his treatment and the positron emission tomography (PET) scan done after two cycles of chemotherapy showed that the tumour had shrunk but not as much as expected.

I intensified the programme, escalating the doses as well as throwing in an extra drug.

I discussed his case with a colleague, who also has special interest in treating lymphoma.

We came up with another type of chemotherapy, which was more aggressive and more toxic than the first.

The tumour budged a little but still not to our satisfaction.

Dennis' family assembled from all over the globe as the bad news was delivered.

Surrender or try another aggressive new programme, we asked them.

'Carry on!' Dennis decided, even though there was a 10 per cent chance that the aggressive treatment, rather than the disease, would kill him.

He braved the treatment only to be given the disappointing news that the lymphoma did not shrink but grew a little instead.

'I'm sorry but I don't think you should have any further chemotherapy,' I told him one evening.

'Never mind,' he consoled me. 'We tried our best and it's time to go home.'

How could a disease supposedly sensitive to chemotherapy become worse? How did we end up in such a desperate situation?

A biopsy (sample of tumour tissue) taken from Dennis was sent to a research facility in Singapore for evaluation.

The analysis showed that Dennis' lymphoma had three genetic characteristics which are known to make the lymphoma more aggressive and resistant to treatment.

While the information helped to explain the poor clinical behaviour, it did not offer any meaningful solution.

I met with Dennis' family a week after his death.

'He really wanted to talk to you that night. He was calmer after you spoke to him. Less than an hour after the call, he just slipped away peacefully,' recalled his wife.

I am not sure if Dennis had a sense of foreboding but I did know that he really wanted me to know what was happening.

Although we knew each other for only six months, I thoroughly enjoyed the brief acquaintance.

We spoke about his childhood; the death of his father when he was still young; his business struggles in the early years; his love for wine, women and song; the blessing of having great friends and a loving family; and his pride in his three children.

He was more than just a patient to me. He was my friend and I did my best to save him.

I am sorry that my efforts were not good enough.

This article first appeared in "Mind Your Body", a Straits Times Supplement.