The tale of two ‘cities’ and two sisters

I was at the airport waiting for my flight. A lady came to me and said, “Do you remember me??”

I am petrified of  this question as my memory for names is dreadful and I live in constant fear of someone asking me this question.

I mumbled, “ Your face looks familiar. When did you meet me?”

She said “ I am Mrs. Thakur. You operated on my sister’s husband from Delhi who had pancreatic cancer. I want to tell you that you had said that if you operate and resect the tumour,he might live for 4 years and he lived ONLY for 3 ½ years.”

“Oh” I said, “ It is closer to 4 years but yes all the patients need not have the same  survival and that is the reason we give a range.”

“Listen to this”, she said,  ” My husband was diagnosed with pancreatic cancer around the same time in Mumbai. We came to you and you said it is not resectable”. and when I asked ” How is the survival?”, you said “ Unresectable pancreatic cancer has approximately 12 months of survival”. He had chemotherapy and he is alive for 3 years.

“Well” I said, “Science cannot explain everything. It is fortunate that he responded”, but she was adamant that there has to be a reason for it.

“ I want to know if is he Cured and how long is he going to live”, she demanded.  Very difficult questions indeed.

I was actually travelling back from attending a meeting on Neuroendocrine Tumours and a very similar case was presented at the Conference where a patient diagnosed with ‘pancreatic cancer’ with spread to the liver remained well, not 1-2 years but 12 years, with minimum amount of treatment. These are peculiar tumors with slow growth called Neuroendocrine Tumours.

I had to defend medical science. “May be he had a tumour which had better biologic behavior.”

She said “We went to all Centres (Mayo Clinic, Sloan Kettering Centre) and everyone said he will live only for a year.”

I felt a bit relieved that others agreed with my opinion.

I said “ Well, this is a statistical fact that the ‘median survival’ is only really median and there are always more or less aggressive tumours. Moreover if the diagnosis obtained by a technique called cytology, a relatively less aggressive tumour can look aggressive as each area of tumour is different in growth fraction. This is only a scientific explanation I can give but on the other hand, what really matters is that he is fine, the tumour has responded and he has a good quality of life and is travelling around, so why do you want to know about the future, which none of us can really see or predict.”

She was not completely satisfied but I could see that she was thinking about small blessings.

Predictions can go awfully wrong. Medicine is grey at best and NOT black and white as we would want.

On the same day,  I see patients operated 15years ago and doing fine and just 15 months ago with recurrence.

Each patient and each tumour are different !!

I think the best way to handle cancer is to count the blessings and live each day and not worry about what would happen in the days to come”. Its tough but acceptance is the key.

This is not true just of cancer but perhaps with other ailments and even without any ailment.

 We cannot look into the future and fortunately so!