Written by Lauren Smith

Chan Pov is a young man who was terrified that he would soon die.  I was also terrified Chan Pov would soon die.  Two years ago, when Chan Pov was 18, he noticed a small, painless, fluid filled lump on his head.  Soon afterwards he experienced a one-day headache that was so painful he could do nothing but vomit.  After that, the bump began to grow.  A week later another bump appeared.  A week later, another.

This is the story that Chan Pov tells me, translated by our head nurse Yinna. The history of his disease is long and confusing.  At least 4 Cambodian hospitals have been involved in Chan Pov’s care. There have been multiple diagnoses; infection, vascular malformation, malignancy.  He was treated with TB medication for 6 months by one doctor.  Others have sent him home with the promise to call when they have the answer, but so far no calls. I ask how much this has cost his family and he says he doesn’t know.  I push the question – has it been hundreds, maybe thousands?  He replies that it has cost his family all their money and half the land they own in Siem Reap.chan head_2

The cost may be much higher than that though.  This disease could cost him his education, his friends, his family, and his future.  Instead of being a young man beginning a degree in architecture with a healthy social life and family close-by, Chan Pov has been at the Children’s Surgical Centre in Phnom Penh for months.  He is far from family (though his mother stays to care for him), and he lost most of his friends when the lumps appeared and the constant search for treatment resulted in him finishing school in year 11.  A recent biopsy specimen sent for histopathology came back as haemangioendothelioma, a very rare vascular tumour which can be benign or malignant. These tumours are so large that they have infiltrated Chan Pov’s skull and compress his brain.

I am a medical student visiting CSC for an 8 week placement.  During my stay I have seen Chan Pov operated on 3 times.  The first was by a team from France and was hastily aborted due to a phenomenal amount of intraoperative bleeding. Our hope rested in Japanese neurovascular surgeon Katsumi Takizawa, “Taki” as he is fondlyScreen Shot 2015-01-23 at 11.53.25 AM referred to by the staff of CSC. Taki took an interest in Chan Pov’s case when it was presented at a neurosurgical conference.  He operated to remove one of the tumors several weeks ago.  Yesterday he returned to remove the remaining two. The operation was long and grueling on both surgeon and patient. Nine units of blood were transfused into our patient to make up for the blood lost during the operation. Quite a lot of that blood could be seen soaking through Taki’s gown and puddling in his shoes.

Samples of the tumor were sent to Japan for analysis. Chan Pov was sent to our post-op room and makeshift intensive care unit to begin a very uncomfortable recovery. Meanwhile we wait for further histopathology to give us some insight into our patient’s future.

When I came into CSC this morning I did not know what condition Chan Pov would be in. Despite our best efforts these tumours may turn out to be malignant.  We may have raised our patient’s hopes and caused a great deal of pain for no real gain. Health professionals the world over grapple with these decisions, but this was the first time I have been involved with such a difficult case. It hit home. I was relieved to find that though he was in pain, and frequently vomiting, his vital signs were stable and he could recognize where he was and what was happening.  It was when Taki came to check on his patient that something special happened, something that confirmed to me we made the right choice in this case.  Chan Pov used all his energy to hold up his hands in the shape of a heart and rasp in English “I love you” to his surgeon.  It was the most heartfelt thanks I have ever witnessed.

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P.O. Box 1060, Phnom Penh, Cambodia