Spleen or what?

"Aling Maria" is an 81-yr old spinster who came in because of cough and difficulty of breathing. She said the cough has been there for 2 months. She took Guiafenesin and Lagundi tablets which gave her temporary relief. Two days prior to consult she developed fever with difficulty of breathing. On examination, she had crackles on her lower lung fields and a low grade fever. Incidentally, I noted a large mass on the left upper quadrant of her abdomen which I thought was an enlarged spleen. That day I treated her as a case of Community Acquired Pneumonia with strict advise to have an ultrasound and a blood chemistry done. She followed up 3 days after.

The ultrasound showed a complex mass measuring 11x9x14 cm on the left upper quadrant of the abdomen and multiple cholecystolithiases. Her fever subsided however, cough was still present. Her chest xray showed suspicious densities and apical infiltrates which may be suggestive of pulmonary tuberculosis. She had bibasal pneumonitis too. I had to request for an abdominal CT scan. Pending the results, I am still in the process of finding out what she really have. Could it be malignancy? Extrapulmonary TB? Colonic mass? (but she doesn't have GI symptoms!)

Masses in the left side of the abdomen are quite uncommon. Many times in the cases that we see in the clinics, we are faced with diagnostic dilemmas. However while awaiting CT scan results, I advised "Aling Maria" to take phytonutrient supplements because she has lost her appetite. I also gave her cough medicine and antibiotics. Many emotional and personal concerns confound her illness. The economic burden too is putting a toll on her. Until now, because of financial constraint, no CT scan was done. However, she continued to take the supplements I gave her. She has improved with her appetite though. She no longer complains of cough.

At this very moment, aside from checking on her vital signs and physical well- being, I keep on praying for her. Sometimes, as a doctor, because of the complexity of some diseases, I have to pray a lot too for the patients I see. She lives with a sister who is also elderly and frail. Both of them are spinsters and 2 of their siblings have chronic diseases too. They don't have children or nieces or nephews who could help them. When her sister, in tears, asked me, " What will happen to me Dr, if my sister dies?". I could not find words to answer so I embraced her and told her I will always be there to talk to whenever she needs someone.

I ask you, if your were in my shoes, how will you answer her question?