10/11/2025
“Disangka pening kepala biasa, rupa-rupanya…”
“Doktor… kenapa kepala saya rasa berpusing sampai tak boleh jalan lurus?”
Suara Puan Khadijah bergetar. Wanita berusia 66 tahun itu duduk perlahan-lahan di kerusi, kedua-dua tangannya menggenggam tepi meja saya.
Saya memandangnya. Pandangannya kabur, langkahnya tidak stabil.
“Puan ada demam?”
“Sikit je mula-mula, doktor. Lepas tu dah hilang. Tapi pening… pening ni tak hilang.”
Dia menggeleng. “Saya tak batuk, tak semput, tak turun berat badan. Cuma… badan rasa tak sedap.”
Saya menyusun semula sejarahnya.
Tiada batuk. Tiada sakit dada. Tiada sesak nafas. Tiada simptom dramatik yang biasanya membawa saya terus kepada paru-paru.
Tetapi ada satu perkara yang mencuit perhatian saya.
“Puan ada merokok?”
“Tak pernah, doktor. Tapi…” Dia berhenti seketika. “Saya dulu kerja di pejabat yang sempit. Kawan-kawan saya ramai yang merokok. Hari-hari saya hidu asap tu.”
Passive smoker. Pendedahan bertahun-tahun. Walaupun sudah lama berlalu, paru-paru kadang-kadang menyimpan cerita yang kita tak sangka.
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Babak 1: CT Brain – Permulaan Debaran
Puan Khadijah berjalan perlahan ke bilik CT scan dengan bantuan jururawat. Dari jauh saya melihat tubuh kecilnya hilang di sebalik pintu besi tebal.
“Doktor, hasil CT brain dah keluar.”
Saya mengangkat muka.
Banyak tompokan putih.
Multiple lesions.
Dua kemungkinan muncul serta-merta:
1. Kanser yang sudah merebak ke otak, atau
2. Jangkitan kuman di otak
Saya menarik nafas panjang. Hati terasa berat.
Saya kembali ke bilik rawatan.
“Puan… ada beberapa tompokan di otak puan,” kata saya perlahan.
Mata Puan Khadijah membesar. “Tompokan? Maksud doktor… ketumbuhan?”
“Belum tentu. Kita perlu siasat paru-paru dan organ lain dulu. Kadang-kadang ia jangkitan. Kadang-kadang… ia petanda kanser yang datang dari tempat lain.”
Dia memejamkan mata. Nafasnya perlahan, teratur tapi penuh ketakutan.
“Doktor… saya takut.”
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Babak 2: CT Thorax – Kebenaran Mula Tersingkap
CT thorax, abdomen dan pelvis dilakukan segera.
Ketika imej muncul di skrin, dada saya terasa tenggelam.
Di paru-paru kanan – satu ketulan besar.
Di kelilingnya – penyebaran ke pleura.
Di mediastinum – kelenjar membesar.
Di atas buah pinggang – kelenjar adrenal turut terlibat.
Hampir keseluruhan badan sudah disinggahi oleh sesuatu yang agresif.
Saya menutup mata seketika.
“Ya Allah… kuatkan hati pesakit ini.”
Saya duduk di hadapan Puan Khadijah.
“Puan, ada ketulan di paru-paru. Kita perlu buat bronkoskopi untuk ambil sampel. Kita juga perlu lakukan prosedur untuk mengambil sedikit tisu dari paru-paru.”
Puan Khadijah menggenggam tangan saya.
“Doktor… saya tak pernah sakit apa-apa. Kenapa tiba-tiba macam ni?”
Saya menelan air liur.
“Kadang-kadang, penyakit datang senyap… tanpa memberi banyak tanda.”
Air mata Puan Khadijah menitis.
“Anak-anak saya… macam mana saya na beritahu mereka.”
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Babak 3: Bronkoskopi – Dua Jawapan dalam Satu Prosedur
Di dewan bronkoskopi, saya memasukkan tiub halus perlahan-lahan ke dalam saluran pernafasannya. Ketulan di bronkus kelihatan jelas.
Cecair lavage yang diambil dihantar untuk ujian MTB/RIF PCR.
Hari berlalu perlahan.
“Doktor, keputusan bronkoskopi dah siap.”
Saya membuka fail keputusan.
MTB/RIF PCR – DETECTED
Saya terdiam.
“Ya Allah…”
TB pada masa yang sama?
Bagi pesakit lain, ini sudah berita besar. Tetapi saya tahu perjalanan Puan Khadijah belum habis di sini.
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Babak 4: Biopsi Paru – Jawapan Paling Berat
CT-guided lung biopsy dilakukan.
Beberapa hari kemudian, keputusan histopatologi tiba:
Moderately differentiated Adenocarcinoma
Kanser paru-paru.
Jenis yang paling biasa bagi pesakit bukan perokok.
Jenis yang sering dikaitkan dengan passive smoking.
Dan tahapnya?
Sudah menjadi Stage 4 kerana:
• merebak ke otak
• merebak ke pleura
• merebak ke kelenjar dada
• merebak ke adrenal
TB p**a mengiringi
Saya memanggil keluarga dan Puan Khadijah ke bilik konsultasi.
“Puan… kita dah dapat keputusan penuh.”
Saya berhenti seketika, memastikan suara saya tidak bergetar.
“Ada kanser di paru-paru puan. Kanser jenis adenocarcinoma. Ia telah merebak.”
Puan Khadijah memandang ke lantai. Tidak menangis. Tidak menjerit. Hanya diam.
Diam yang menyakitkan.
Anaknya yang sulung memegang bahu ibunya.
“Mak… kami ada kat sini. Kita hadapi sama-sama.”
Saya menyambung, “Selain itu, ada jangkitan TB paru-paru. Kita akan mulakan rawatan TB segera. Untuk kanser, ada rawatan sasaran tertentu yang mungkin sesuai berdasarkan ujian genetik tumor. Kita akan cuba bantu puan sehabis baik.”
Puan Khadijah akhirnya bersuara perlahan, hampir berbisik.
“Doktor… saya masih nak hidup untuk tengok cucu-cucu membesar.”
Saya menggenggam tangannya.
“Kita akan berjuang, puan. Hari ini bukan titik noktah.”
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Babak 5: Pengajaran dari Kisah Puan Khadijah
1. Kanser paru-paru bukan hanya berlaku pada perokok.
Passive smoking bertahun-tahun boleh meninggalkan parut yang tidak kelihatan hingga saat terakhir.
2. Tidak semua pesakit ada batuk, sesak nafas atau turun berat badan.
Ada yang datang dengan simptom yang sangat “biasa”, seperti pening kepala.
3. Diagnosis awal memberi peluang rawatan yang lebih baik.
Datanglah berjumpa doktor apabila ada sesuatu yang “tidak biasa” pada badan.
4. Ketabahan seorang ibu adalah luar biasa.
Walaupun menerima dua diagnosis berat serentak – kanser paru-paru tahap 4 dan TB – Puan Khadijah tetap memikirkan keluarga lebih daripada dirinya.
5. Pemeriksaan kesihatan berkala sangat penting, terutama bagi mereka yang mempunyai pendedahan asap rokok di tempat kerja atau di rumah.
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Saya melihat Puan Khadijah melambai perlahan semasa dia meninggalkan bilik rawatan pada hari itu.
Langkahnya masih goyah. Tetapi ada sedikit cahaya di matanya.
Harapan.
Dan selagi ada harapan, kita terus berjuang.
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CT scan menunjukkan ketumbuhan di paru-paru kanan
Untuk konsultasi kesihatan paru-paru:
https://encoremed.io/smcv /154
——————
“Thought It Was Just Ordinary Dizziness, But It Was Actually…”
“Doctor… why does my head feel like it’s spinning? I can’t even walk straight.”
Puan Khadijah’s voice trembled. The 66-year-old woman eased herself into the chair, both hands gripping the side of my table.
I studied her closely. Her gaze was unfocused; her steps had been unsteady.
“Do you have fever?”
“A little bit at the start, doctor. Then it went away. But this dizziness… it never leaves.”
She shook her head.
“No cough, no breathlessness. No weight loss. Just… this awful feeling in my body.”
I reviewed her history again.
No cough.
No chest pain.
No shortness of breath.
No dramatic symptoms that usually steer me immediately toward the lungs.
But one detail stood out.
“Did you ever smoke?”
“Never, doctor. But…” She paused. “I used to work in a small office. My colleagues smoked all the time. I inhaled that smoke every single day.”
Passive smoker. Years of exposure. Even long after the smoke has cleared, the lungs sometimes hold stories we never expect.
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Scene 1: CT Brain – The Beginning of the Unraveling
Puan Khadijah walked slowly toward the CT scan room, assisted by a nurse. From afar, I watched her small frame disappear behind the heavy steel door.
“Doctor, the CT brain results are out.”
I looked up immediately.
There were multiple white patches.
Multiple lesions.
Two possibilities surfaced at once:
1. Cancer that had spread to the brain, or
2. A brain infection
I took a slow breath. My chest felt heavy.
I returned to the consultation room.
“Puan… there are several spots in your brain,” I said gently.
Her eyes widened. “Spots? Doctor… you mean tumors?”
“Not necessarily. We need to check your lungs and other organs. Sometimes it’s infection. Sometimes… it’s a sign that cancer has spread from elsewhere.”
She closed her eyes. Her breath was slow and steady, but filled with fear.
“Doctor… I’m scared.”
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Scene 2: CT Thorax – The Truth Begins to Reveal Itself
We proceeded with the CT of the thorax, abdomen, and pelvis.
When the images appeared on the screen, my heart sank.
In the right lung — a large mass.
Around it — spread to the pleura.
In the mediastinum — enlarged lymph nodes.
Above the kidneys — adrenal involvement.
The disease had reached almost every corner of her body.
I closed my eyes briefly.
“O God… give strength to this patient.”
I sat across from her.
“Puan, there is a mass in your lung. We need to do a bronchoscopy to take samples. We also need a needle biopsy.”
She gripped my hand.
“Doctor… I’ve never had any serious illness. Why now? Why so sudden?”
I swallowed hard.
“Sometimes, disease grows quietly… without any warning.”
Her tears fell silently.
“My children… they don’t even know I came to the hospital today.”
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Scene 3: Bronchoscopy – Two Answers in One Procedure
Inside the bronchoscopy suite, I slowly guided a thin tube into her airway. The tumor was clearly visible.
The lavage fluid was sent for MTB/RIF PCR testing.
Hours passed slowly.
“Doctor, the bronchoscopy result is ready.”
I opened the report.
MTB/RIF PCR – DETECTED
I froze.
“Oh God…”
TB as well?
For another patient, that diagnosis alone would have been overwhelming.
But for Puan Khadijah… I knew this wasn’t the end.
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Scene 4: Lung Biopsy – The Heaviest Truth
The CT-guided lung biopsy was performed.
A few days later, the histopathology report arrived:
Moderately differentiated Adenocarcinoma
Lung cancer.
The most common type in non-smokers.
Often associated with passive smoke exposure.
And the stage?
It was already Stage 4, because:
• it had spread to the brain
• spread to the pleura
• spread to mediastinal nodes
• spread to the adrenal glands
• and TB infection was also present
I called the family into the consultation room.
“Puan… we have the full results now.”
I paused, making sure my voice remained steady.
“There is cancer in your lung. Adenocarcinoma. And it has spread.”
Puan Khadijah lowered her gaze. She didn’t cry. She didn’t shout.
She just stayed silent.
A silence that carried the weight of a thousand emotions.
Her eldest child placed a hand on her shoulder.
“Mak… we’re here. We’ll go through this together.”
I continued, “There is also TB in your lung. We will start TB treatment immediately. For the cancer, we will run genetic testing to see if targeted therapy is suitable. We will help you however we can.”
At last, she whispered, barely audible.
“Doctor… I still want to live long enough to see my grandchildren grow up.”
I held her hand gently.
“We will fight, puan. Today is not the end.”
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Scene 5: Lessons from Puan Khadijah’s Story
1. Lung cancer does not only happen to smokers.
Years of passive smoking can be dangerous even without touching a cigarette.
2. Some patients have no cough, no breathlessness, no weight loss.
Some present with something as “simple” as dizziness.
3. Early detection offers better treatment options.
Seek medical attention when something feels “not right.”
4. The strength of a mother is extraordinary.
Even with two heavy diagnoses—Stage 4 lung cancer and TB—Puan Khadijah thought of her family first.
5. Regular health checks are essential, especially for those with prolonged exposure to cigarette smoke at work or at home.
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I watched her wave as she left the clinic that day.
Her steps were still unsteady.
But in her eyes… there was a glimmer of light.
Hope.
And as long as there is hope, we continue to fight.
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CT scan is showing growth in right lung
For lung health consultations:
https://encoremed.io/smcv /154
