Fearless Crusaders

 

Last Friday was a great day.

In fact I can name it  as the  ‘Survivors’ Day’.

Nearly 10 patients who are long time survivors of 5-20 years came for review on the same day, by random coincidence. It certainly makes one feel happy to see them leading normal lives without any fear

I was particularly happy when Suhasini, a young lady came in with a broad smile. I was very glad to know that she was operated 6 years ago for Colon cancer.

She asked me, “Doctor, can I start my family now”?

I was thrilled as I know that she was single when she got operated.

I said, “Certainly, I would like to meet   the wonderful young man who accepted and married you”. She said he is on the way. “We were courting before I was diagnosed but he never left my side and continued to be my support. After 5 years he convinced his parents and even my parents that he will be with me forever”. As she was saying this her husband walked in. I am genuinely proud of this young man. There are so many instances where engagements are broken after diagnosis not just in a young person but even in their parents. In a society with so many unfound fears and superstitions, this couple stood like a shining beacon. I assured them that everything is fine and they can have a wonderful family.

I do have many instances of such remarkable couples who not only fought the disease but went on to lead their lives with full vigour.

Hats off to such fearless crusaders.

Battle within…..

In a classic Battle there is a known or unknown enemy somewhere out there and you start firing the weapons at your disposal.

In cancer however, the enemy is within. Within the body, one of our own cells becoming ‘our own enemy’. The battle is within.

The weapons used like chemotherapy hit the body and not just the enemy.

The battle ground is not remote but our own body.

The weapons are fired at self – trying to defend against an enemy hiding in the body.

Imagine the courage and grit needed to fight the big C.

Its truly a ‘mind over body’ battle. There are days and times when the outlook seems bleak, the body cannot endure.

Its then the innermost strength is necessary.

We as doctors can only support by medicines and encourage the ‘mind’ , to maintain and sustain the positive attitude.

Positive attitude is most crucial for winning the battle.

Family is so important and the emotional support by family and friends keeps up the morale.

A pat on the back and encouraging word is all that it takes to keep the battle going.

Never ever sympathise with a friend or relative fighting the big C.

encourage them.

Don’t give sob stories and tell about all that you have heard – it doesn’t matter

Each one has to fight his or her own battle.

I always say that “ I am there for you and lift  the gun which you can fire’

Some times I wonder, why did I choose ‘Cancer surgery ‘

Something easier like plastic surgery (I joined in PGI) would be less stressful.

I don’t think I would have been satisfied in any other branch. Yes, its stressful but

I am making a difference in a brave heart’s life. At least trying to.

Hats off to all those who have fought and won and those who continue to fight.

They are the bravest soldiers

The victory in the battle is worth all the effort and difficulties

The reward is “LIFE’ itself.

Surgery in the morning and counseling in the evening.

Most of my days start at 9am with surgery, which goes upto 4-6 pm, and there is the evening clinic till 8 pm. While I find surgery most relaxing, not at all stressful as you may be imagining. I am in control and focused. There is no noise or distraction. No random thoughts. I do what I enjoy doing. Each surgery is a piece of art, except that the art is hidden under the abdominal scar. The reward is patients’ recovery.

I actually find the evening clinic to be much more stressful. In the evening, more than medical issues, I have to deal with emotional issues. On each day there are husbands who are worried about their wife’s illness and vice versa.

The most difficult question is “How much time do I have ?”. There is no clear answer and even a guess can be very hazardous. I do not think anyone of us has an answer to “How much time is there for anyone of us”. But it is certainly difficult to tell a mother who invariable asks “My children are small and need me to take care of them so at least give me that much of time”. As all mothers, they would rather sacrifice anything just to giet additional time for their children. Men on the other hand, are worried about their work, their finances, how to provide for their families and why should it happen to them and what are the consequences. Invariably the question“Can I go back to work?”

Questions to which I do not have answers.

But still, patients need to be comforted.

“ Yes, things are bad but can get better.”

It is ‘Hope’ that drives the whole human existence and effort.

For a student the hope that he will score well in the exams, for a mother, hope that the children grow up well, for a young man that he will find true love and live happily. May be for someone hoping to become wealthy, someone hoping to become happy.

A cancer patient hopes for ‘cure’ or ‘control’. There is no need for luxuries of life; just LIFE.

In fact TIME is most precious gift….

A few days more to settle the home, work, finances, children and many other issues

Only thing I can give is a bit of hope, to be optimistic, to allow them to gather courage in the face of adversity.

I just say “ I am there for you, the whole medical science is for you”. “Whatever best that can be offered anywhere in the world, we would  offer to you and then hope for the best”. Mostly they are comforted and go back with a feeling that ‘Yes, they can fight the disease’.

The drop-box for worries:

I started keeping a small box near the door and I generally tell them, ” Leave your worries in that box and let me take care of it”.

The least a doctor can do for a patient is to give comfort and hope. Yes, cure of disease may or may not be in our hands but certainly comforting someone in distress is an absolute must in this profession.

I feel privileged that I am able to help at least a few if not all on each day. Though it does make my heart heavy and I need to deal with this heaviness every single day and to be as normal as possible. Recharge for the next day and the days after. …

What keeps me going, week after week and year after year ??…

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!