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A patient and friend brings her mother in.

Her mother is complaining that her pants keep getting tighter. Increasing abdominal girth. No pain.

We start with labs, which look fine. Her kidney function is good. We do abdominal xrays because they are cheap and could show something. They also have way less radiation exposure than a CT scan. They don't show anything abnormal.

Multiple CT scans can cause cancer. However, this patient is over 80 and anyhow.

The CT is impressive. It shows large retroperitoneal masses. Like, 5 by 8 cm. She is right. Her pants ARE getting tighter.

I call the oncologist. This is a while ago, so our small town and county doesn't have one. We go to the county south.

"Probably lymphoma." says the oncologist over the phone.

I do the referral and he gets her in quickly.

She does have lymphoma. I am all gloomed, but the oncologist is cheerful. "We have some new treatments."

They certainly do. She does not get sick, her hair doesn't fall out, she is cheerful, living alone in her 80s and driving her son and daughter bananas. They both live near her and do not get along that well.

After a few months, follow up CT shows that the masses have shrunk. My patient is pleased. "My pants fit."

She starts having memory issues.

She has lived in her house for over 70 years.

"Oh, God." says her daughter, who is a medical professional. "She is PARANOID. She calls me and whispers 'Someone has stolen the BLUE TEAPOT! THEY REPLACE IT WITH A RED TEAPOT!' She doesn't remember that the blue teapot was smashed 20 years ago and replaced with a red one."

Well. Our patient hides her keys. She won't let people in the house, including her son and daughter. She tells each of them that the other one is stealing things. Her daughter and son have to disable her car because even though I tell her she can't drive and file the DMV form, she drives. She cleans out cupboards and rearranges them and then does not remember doing it. "THIEVES ARE BREAKING IN!"

"She is driving me insane." says her daughter.

Her mother finally passes away right around 90. Her son and daughter have to work hard to keep her in her house, but they manage. No rats and no health department issues, but they deal with 2 am phone calls a lot.

We all don't know whether to be sad or relieved and are both.

"And now I am not sure about the cancer treatment." says her daughter. Well, yes, that has occurred to me too. How do you define success?


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