Somewhere I belong

It's been over a month since I quit my job. Exams, higher studies and all that. But my ties with my old work place and some of the wonderful people I've met there have stood rooted. I am still in touch with a few patients here and there who send me loving "miss you" messages that make my day.

One of my patient's daughter put up a Facebook status asking for financial help. They were never poor. They weren't rich either. They got by. It has somehow affected me deeply. Does cancer push someone to such a place? I cannot even imagine what state they must be in.

Every single day, I would see dozens of patients who were struggling. Physically, emotionally, psychologically, and financially. They were struggling to come to terms with reality. To understand that some of them didn't have very long to live. It's gut wrenching to live in such kind of fear. The fear of knowing that the end is approaching. I saw so many people who desperately wanted to live longer. This is precisely why the suicide of a 15 year old girl from my sister school angered me. It made me so very angry to know that while there are people who are dying to live, there were people living to die. Life is a gift that is too damn precious to throw away. Not every soul is blessed with a human life. And those who are, shouldn't throw it away willingly. If you want to die, come and visit a cancer Center. Your life may fall into perspective.

In the face of adversity, people have stood tall. I'll forever remember Mrs V who told me I was like her daughter and if I believe she can pull through, she believes the same. I won't ever forget Mrs Y who would ask me to hold her hand and come see her every now and then. She loved coming to our hospital because she found us warm. I vividly remember standing and talking to Mrs A. I saw something amiss. Unmistakably, it was the sparkle in her eyes.

We can deny angels exist, convince ourselves they can't be real. But they show up anyway, at strange places and at strange times. They can speak through any character we can imagine. They'll shout through demons if they have to. Daring us, challenging us to fight.

The Romance of Introspection

I was listening to "Hotel California" by Eagles as I was reading about different types of vomit. My feet were neatly resting on the red oxide floor that my nearly half a century old house bears.

Do you remember red oxide floors? The flooring that was there in your grandparents' house probably. The ones you wrote all over with tiny pieces of chalks. The very same you rolled all over when you were 3. You'd get chided by your mother for spilling buttermilk on those floors because they left behind a nasty stain that took time to wear off. Those floors you sat on and played board games with your grandmother every summer. Sunny afternoons you spent mindlessly playing with cowries, the clunking noise they made when they kissed the ground. The floor that did bear your first foot steps and saw your shoe size grow from baby size 3 to adult size 6.  

Sometimes I wonder if we have lost the ability to see perfection in the little things around us. We have definitely lost the old world charm. And  I sorely miss it. 

Doctor Diaries : Part 1

He looked at me intently, wide eyed. No, I wasn't going to touch him if he didn't want me to. It wasn't fright or anger, mere curiosity. I didn't know what to make of it. I was trying to comprehend his mood. Suddenly, I was going back in time to the day when I first met him..... 

..... He came to us with a subconjunctival hemorrhage and a few blue patches on his back. His blood was brimming with leucocytes, cells that fight infection. Only, in his case, they were bad cells growing uncontrollably and not performing their function. In addition, they were even spilling out, fragmenting and would potentially start blocking his kidneys which could be life threatening. His hemoglobin and platelets were dwindling in the meanwhile, causing him to bleed into his skin and eyes. Under the microscope were seen blast cells, a dreaded finding for haemat-oncologists. He was suffering from a form of Acute Leukemia. The parents were shattered on learning the diagnosis. The castles they'd built in air for their family came crashing down in a few seconds. Given his age, the kind of leukemia he was suffering from was expected to be aggressive. 

He underwent his first lumbar puncture. My consultant likes to do the first lumbar puncture himself. As he says, it is extremely important to not puncture any blood vessels in the process. That would mean we have introduced the bad white cells from the blood into the CSF which cushions the brain. The procedure not only requires immense experience, but also profound faith in your own abilities.

We started immediate basic therapy for him. By evening, he had progressed from bad to worse. His cancer cells were already starting to choke his kidneys, a term we doctors like to call 'tumor lysis syndrome'. We used a drug called Rasburicase to antagonize the effect of it. Each shot of that drug costs about 15,000/- as it is a relatively new drug in the field. So much so that my consultant confessed that this was his first time as well.....

All of 8 months, he kicked and gurgled, spitting some fresh saliva into the air, and went back to sucking his thumb, completely oblivious to his disease, poor prognosis and the pain written all over his parents' faces.  

HAPPY DEEPAVALI INDEED

For the longest time I can remember, Deepavali always meant lots of savouries, free goodies, joy, crackers and new clothes. This Deepavali was a wee bit different. Of course, gifts, sweets and new clothes were a part of the festivities this year too. But this time, I celebrated mine working on all 3 days. I spent my time talking to my patients, sharing their happiness, joys and fears. I celebrated it by sharing my sweets with a cute little 3 yr old suffering from an acute form of leukemia, who has now been in the hospital for over 2 weeks. All he gets this Deepavali are beautiful visuals of the light studded sky from the window of his hospital room. 

It is sometimes frustrating that we work tirelessly day and night. Personal life, loved ones, parties, family gatherings and sometimes even important exams may take a backseat. But it disappears when you have even one person coming and thanking you, making you realise that every little minute you spent for them was worth it.

The festival this year has been extra special because we have also done an autologous bone marrow transplantation for a patient suffering from multiple myeloma. It would give her a chance to live disease free for 2-3 years. For people whose expiry date is more or less known, even one extra week makes such a difference. These procedures are huge for the hospital (also in terms of income. He he.) These people are extremely prone to infections post transplantation and have the risk of high morbidity and also mortality in about 5% of the cases. That may seem like a small percentage only. But even one patient we lose is a big loss to us and their families. Hoping that she breezes through the next 20 days safely. 

I don't know how the transition happened - dolls to people, playing doctor to being a real one, a real stethoscope replacing the toy one I used to pocket all the children in the neighbourhood. But I am glad it happened and I know I would do it all over again if I had to. 

WHERE THERE IS A WILL, THERE IS A WAY...

"I had amenorrhea for 2 years. I never bothered to pay attention to it because I was so busy taking care of my family. When I finally visited my gynaecologist, she recommended that I undergo a scan, which was suggestive of chocolate cysts, a relatively benign condition. She told me that a laparoscopic surgery can resolve my problem. The operating surgeon, on the contrary found cauliflower like growth all over. She was shocked. She immediately closed me up and informed my husband. It was 1992. I was diagnosed with stage 3 ovarian carcinoma. My girl was 10 and boy was 4. Eventually a debulking surgery was performed. I was given high doses of endoxan (a chemotherapy drug) which made me lose my hair. I fell sick often. I would endlessly retch and vomit. Those were dark days. But I was almost cured of it. I travelled all the way till Apollo Hyderabad for my follow ups. All was fine, till it resurfaced in 2001. My daughter was a medical student. My abdomen had to bear the brunt of another surgery. Coincidentally, I met the gynaecologist who had operated on me for the first time. I couldn't help but stare at the wig she was wearing. She seemed to have read my thoughts and promptly told me how she was diagnosed with breast cancer and had to undergo mastectomy. I was speechless.

Post second surgery, I went to the hospital for a follow up. That's when I learnt she went into coma and passed away in the same hospital. What a cruel twist of fate. The lady who gave me a second chance in life lay there motionless.

Soon, my daughter moved to another country and I lost my husband. I've changed a few doctors. I've had near miss events happening in my life. A lot of people and things left me, but this damn cancer doesn't seem to. But I am not going to quit fighting. I am a survivor.... "

I hope this incredible woman who has tirelessly fought cancer for the last 2 decades serves as an inspiration to every single person out there in the world because out of difficulties grow miracles!

THE POWER OF TOUCH

I have comfortably slid into my daily routine of seeing sick people and trying to nurse them back to  health all in good time. Most people look at us either as God or monsters, but the fact really is that we are human beings like everyone else .Today was a little different. Appreciation for your work makes you work harder. When it comes from your patient, it makes you realise why you got into this profession in the first place.

We have a patient who has been with us for over half a decade now. She explained to me the importance of "touch" in our profession. She explained to me how a very small thing like me patting her shoulder gave her so much of satisfaction and more importantly, courage to go about doing her daily chores.

Patients who carry the burden of a disease which is still considered stigma today are always looking for more love, in addition to care. These little things are never taught to us in med school. They are a mere reflection of our personality. She narrated to me how her previous oncologist always wore a mask face and would never answer queries, leave alone anything else. She, being a doctor herself,also spoke to me about how times and health care have drastically changed in the last 2 decades, when she was first diagnosed with cancer. 

Before I left her room, she thanked me for spending some time listening to what she had to say and did something that caught me by surprise - she held my hands and kissed them. That's when I truly understood what she was trying to say. 

...BECAUSE EVERY DAY IS A SECOND CHANCE

"According to Elizabeth Kubler-Ross, when we are dying or have suffered a catastrophic loss, we all move through five distinct stages of grief. We go into denial, because the loss is so unthinkable, we can't imagine it's true. We become angry with everyone - angry with survivors, angry with ourselves. Then we bargain. We offer everything we have. We offer up our souls in exchange for just one more day. When the bargaining has failed and the anger is too hard to maintain, we fall into depression, despair, until finally we have to accept that we have done everything we can. We let go. We let go and move into acceptance."

We take our lives way too casually. Suddenly, one day you realise you're sick. It dawns upon you that you have very little time to do everything you wished to/planned to. You wish you could freeze time. And then it's too late. And just like that, you're gone.....

Hello everyone. I work in the department of Haem-Oncology at Columbia Asia hospital. In a matter of a week, I have seen a lot of different kind of cancers, head to toe. Right from the more common breast and lung cancers to pretty rare ones like mantle cell lymphoma. Though the cancers have varied, the response to a person's diagnosis when they heard it for the first time hasn't. Sometimes it hits you that despite being a doctor, there is no way to possibly alleviate everyone's suffering. 

Back in the 90s, cancer was still unheard of. Diagnostic tests were minimal. Chemotherapy was expensive as hell. There were so many people who died even without being diagnosed. Come, the new millenium, things took a turn. Today, we have treatment for so many different types of cancers and we have new revelations and path-breaking research happening every single day. Yet, the stigma of having cancer is almost as bad as it used to be for tuberculosis if not worse. What we need to understand is that cancer is a diagnosis just like diabetes or hypertension. The number of people who die because of complications of diabetes and hypertension far outweigh those who die of cancer. Cancer does not mean the end of life. It just means that it needs to detected, treated and accepted in the right manner. We do have patients who have lived for 2 decades after initial diagnosis and who continue to maintain well. We should never stop believing in hope because miracles do happen every day! 

Today, a 50 year old lady walked in to our chemotherapy unit. She was diagnosed with early stages of breast cancer. She was shocked and then she was suddenly crying. It dawned upon me that knowledge is not the most important thing about my job. Knowing how to console a person and believing that they can come out of their illness, or training them to be mentally strong about it in terminal cases, is perhaps the single thing that differentiates a "good" doctor from a "mediocre" one.

I feel so lucky to be working in a setup where I am not only learning to effectively communicate with my patients but also learning to be a better person in general. That's my learning curve.


“The things you do for yourself are gone when you are gone, but the things you do for others remain as your legacy.”