Focus on each mile stone and you will reach the destination


Last week I operated on a complex Pancreatic Cancer. After completing the 6 hour surgery I was very happy that everything went well and the surgery was successful. I came out of the theatre and called the family and said that the surgery is successful, the whole tumour has been removed with all the lymphnodes etc. Instead of being happy, one of the relatives kept asking me about the recurrence. I was a bit frustated. I do understand the reason for anxiety but the patient was not even out of recovery room.

You have to realize that cancer treatment is not like a cough and cold with about 4-5 days of antibiotics. It is long drawn and involves different types of therapy. It is important to remember that this is a journey and our destination is potential cure. The journey has many milestones exactly like your own journey on a road. When we travel we only look at the milestones, perhaps we cannot even see a milestone which is more than ½ km away. But each milestone, once you cross, takes you closer to your destination and that is exactly how we need to approach the treatment of cancer.

First , during surgery there should not be any unpleasant surprises, the disease should be localized so that the surgeon can do a good surgery. So, successful surgery is the first milestone.

Second the patient goes to the intensive care unit for a day or two, so the second milestone is a shift from intensive care to the regular ward which means that all the systems are functioning normally.

Then the third milestone is discharge from the hospital. The surgeon does a lot of plumbing and joining the intestines and tubes and ducts together. Everything takes time to heal and once it heals the patient would resume on a diet and is discharged so that is an important milestone – Discharge from the hospital.

Then comes the pathological reports which are important for staging of the disease, also gives an information on how the further treatment has to be managed. This is when you can have a detailed discussion on the options of treatment, the usual fear about chemotherapy is unfounded. If necessary ‘Yes’ chemotherapy would be needed for preventing or lessening chances of recurrence. Chemotherapy might involve a little longer treatment on a periodic basis, so one should approach this positively. I had written earlier and will write again as to how you can handle chemotherapy if necessary.

Then comes the follow up of periodic examinations and tests. Generally if a period of 2 years is crossed most of the chances for recurrence come down but in some of the tumours recurrence can be as late as 5 years or even longer. But this is all part of the journey.

Yes it is tough. But anyone who embarks on this journey with a positive attitude, willing fight to reach the destination, has a lot more chance of making it to the destination i.e. complete eradication of the disease.

Remember , “Focus on each milestone and then you will reach the destination.”

Elderly parents and NRIs


Sharda Joshi is around 70 years. She was diagnosed as rectal cancer about 3 years ago and underwent surgery with a permanent colostomy. She is a remarkable lady, a literary critic,   managing her stoma and continues to lead a very productive life. She lost her husband nearly 10 years ago. Her only son has moved to California. He did come for the surgery but as many other NRIs, has work pressures and finds it difficult to come to India to see his mother. Obviously he is pressing her to come to California to spend time with the family.

Sharda talked to me and expressed some genuine concerns.   She was worried about long flights and concerned how she would manage the stoma.

“I want to go and see my grandchildren but, everyone is going to be busy with their own lives, school and homework. Weekends also turn out to be a busy time with the activities, additional things to do, groceries and other chores.”

She said, “What am I going to do while they are at work or in school and even when they get back they are going to have their own friend circle. Why should they even bother about an old lady sitting at home. Here I have my friends. I can talk to them, call them over and even go to some cultural activities and plays”.

” If I fall sick in a foreign health care system , I have  no insurance cover.”

So she said, “Doctor, can you give me a certificate stating that I am not fit to travel to California ?” This was rather unusual as many patients ask for ‘fit to travel’ certificate.

The more I thought about it, the more I realised that though there is some emotional guilt on the part of the children, the parents are better off in their own homes and environs. I see a lot of elderly couples or many single elders managing on their own with some help but having more social interaction here in their country.   It is really unfair to uproot them from their familiar surroundings and make them feel isolated in a foreign country with practically no social interaction.

I looked into the factors that really gives you happiness. The socio-cultural interaction becomes an important issue. Yes, we are going to see ageing population and perhaps lonely, and the big challenge is not just to attend to their basic physical needs and medical needs but try and be in touch with them and encourage social interaction.

I know of a family, Mr. Ramakrishnan, whose three sons were senior software professionals in the US, who took turns and  come here in rotation for 3 months. It will be  difficult for many others to do it.

It is fine to allow their parent/s to have a support system and a friend circle.

This is not just a reflection on NRIs but also in many of the families even here in India, the children stay in far away metros and parents stay in their village homes. This is the same story and the same message.

Allow the elderly their space and the freedom to make their choices.

They want their independence and want to be useful.