Cancer landscape and its hidden charms
Medical consultation has a contour and time frame of its own. A person with ailment sets up an appointment, and s/he is usually accompanied by family, relatives, and friends to meet the doctor, more so in our Indian social milieu. Over the years, I have gained some insight. She had reached to see me early morning, much before the hospital had started bustling with patients and health workers. As we finished, she got up from the chair and I moved around to open the door. Before that, she held my hand and put her head over my shoulder. “I did not get a good sleep last night. Your shoulder and neck feel comfortingly warm.” Then she slowly locked her arm on her husband’s elbow, gave the smile with her eyes open, before leaving the consultation room. I and my younger colleague had all the information on the desktop, in front of us. After all the treatments were over, the cancer had come back and spread over her body. We both were overwhelmed by her grace. Unquestioning about the failure of treatments, she and her husband showed to us the power of a human touch.
Medical Consultation
Towards the end of the day, I sat down with a cup of coffee and looked around for any unfinished task before leaving the hospital. Out of nowhere, the event in the morning had a thread running back to join another one which occurred nearly thirty years ago. The world of health care has its own mind games.
Sister Gowry entered my room, “Basavanna wants to see you. His son had testicular tumor and was treated by us.” Four years after working at Kidwai Memorial Institute of Oncology, Bangalore (Bengaluru now), I still faced the professional challenge of talking to patients and their family caregivers. The twice weekly evening bus rides to learn Kannada, at a learning centre of Bangalore University campus near the Majestic Circle, had made me comfortable to listen and understand, without any reasonable progress to ‘read, write and talk’. Communication, bilateral and multilateral in nature, is integral to the delivery of healthcare in any corner of the world. Suddenly, the presentiment of a disaster gripped me before Basavanna came inside. Has his young son of 25 years got sick again? I pointed at the chair across the small steel-framed desk, “Dayavittu kulitukolli “. In his farmer’s panche (the unstitched rectangular white cloth which covers the lower body waist down) and the bush shirt, both faded yellow after repeated washings, he put his cloth shoulder bag down on the chair,” Namaskara Saar” and then closed the door slowly. As I watched his movements, he put his right hand inside the bag. Instinctively, I blurted out, “Nanage Beda Swamy”. Basavanna took out and kept two bananas on the desk. “Nama hittalinalida balehannugalu, togalli daktar”. These bananas are from my backyard, I got for you. Early in career, you learn certain dos and don’ts. During the internship, soon after passing the MBBS, I could make out that sweet boxes, gifts etc. become the objects of gratification; and a doctor has no reason to be a greedy child for her/his entire life. Yet, the two bananas from the backyard of Basavanna were precious professional recognition of a cure for his son, and I accepted bowing to his desire.
Going through the evening traffic of Delhi and reflecting on a cure and connecting it with a failure, gave me a sense of balance for the day. As the vehicles slowed down on a stretch of road from Subroto Park towards Munirka, I looked upwards through the car window at the beams of a flyover under construction. Desraj, the driver on the wheel got restless, “Teen saal ho gaya, kab kaam khatam karenge?” They are constructing this for last 3 years, when will they finish?
Cancer care in India has drawn attention since 1960s
Those of us who have been in the middle of cancer care can understand its progress through war, by accident, and through serendipity! From the 1980s, in a period of less than 40 years, the intermingling and interdisciplinary developments of several biomedical specialties have given to the mankind slow incremental benefits. From the low cure rate of less than twenty-five percent, at the present more than fifty percent are becoming long term cancer survivors after the successful diagnosis and treatment. The cancer survivorship is far beyond a new lease of life.
Cancer survivors are human assets
Matchmaking, despite the thriving business built up on the vast platforms of matrimonial columns in newspapers, marriage bureaus and matrimonial website portals, is a unique social phenomenon in India. After I had explained that all the tests of his daughter were normal and she had become disease-free two years after the treatments for lymphoma, the father towered over me in a lingering manner. “Are you telling that our daughter can get married? Her mother is anxious.” She was twenty-seven and the father, an impressive man with a soft voice, was a Professor at Delhi University. Invariably, a tall heavy built man with a timbre voice can strike a chord in your heart. I stepped out of the room, with the Professor in tow, into the out-patient waiting area of the cancer centre at AIIMS, Delhi teeming with patients and their caregivers at the noon time. It was a foggy and cold day, and I pointed at a young man sitting quietly with his mother at the corner of a bench facing the window. A brief exchange passed between the two of us. His daughter Nisha, a master in science, may find Sudeep, a software developer and a childhood cancer survivor, a suitable match for marriage. A few months later, the soft-spoken Professor and his wife sought me out to attend the wedding of their daughter at a banquet hall in Faridabad. After the Jodi took the phera, it was a different matter that the bride’s family members had to push my little Maruti 800 out of the submerged roadside. It was past ten in the night, it had rained, and I drove back on a nearly deserted road from Faridabad to Delhi a little valorously. A couple of years later, Nisha entered my tiny office room with a baby in arms and the husband fussing over both of them. They were on a short holiday from USA.
From Rudolf Virchow’s description of the origin of cancer cell in 1863; over a century and half of relentless studies have gone into multidisciplinary areas. The natural history of the tumors, surgery, chemotherapy, radiotherapy, medical imaging, molecular biology, cancer genetics, immunotherapy, and palliative care have progressed in slow incremental steps. The landscape of cancer is merciful on scores of health workers, who on a daily basis take the steps irrespective of a failure or a success. I can never qualify as a Roman gladiator to fight cancer, yet I can play the role of a matchmaker for the soul-mates.
Declaration: Author states that the content has no conflict of interest and no financial disclosure. The names of patients are changed to conceal the identities for ethical reasons.
Author: Bidhu K Mohanti is an Oncologist, who worked as a Professor at AIIMS, Delhi; and is presently a Consultant at Manipal Hospital, Dwarka, Delhi.
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