Helpless...

Cancer is the most dreaded disease I have ever come across . The mere mention of the disease weakens my spirits. As a doctor I am not supposed to have such a feeling and should remain positive to carry on . But this disease invades my good spirit day by day . The most striking feature of the disease is that once it starts growing , it wages a war against the body , weakens its system, attacks its vital centers , suppresses the morale of the patient and sends spies to all parts of the body to ensure that even if the main center is destroyed by the doctor , the deployed troops from distant sites in the body regroup and attack .It is a master disguiser sometimes and a silent killer as well . If God gives me permission to eradicate one disease, I will not think twice to answer . Such is the burden of the disease and the pitiable end the patient is afflicted with. Don't get the idea that all cancers are so . Some of them if detected in early stages can be resected or treated . This is not a documentary on the disease. I would just like to share some of my encounters with this ailment.

As an ENT resident in one of the prime institutes in India , our out patient department is really hectic . Patients crowding around the single door of our consultation room in a steaming summer the last place on earth you would like to be . I would confidently say that more than 50 % of the patients attending the clinic will be suffering from some or other type of cancer . A middle aged lady came from in between the queue claiming that she was an ayurvedic medical practitioner from Uttar Pradesh and she wanted to show one of her patients personally . Usually I hate people who upset the order of the queue and deal with them very harshly . As she personally came to see her patient get the right treatment I appreciated her good will and asked her to bring her patient . It was a middle aged lady with a neck swelling so large that she couldn't move her neck and breath properly . Such large thyroid ( a gland in the neck) cancers are not uncommon in this part of the world but when I asked the doctor what she was thinking of when she was treating I could understand why she personally brought the patient . With a bit of guilt on her face she told me that she had advised the patient to go to higher center long before . I asked her what she expected us to do then . She had no answer . But I appreciated her care and sincerity to bring the patient herself . I took the patient to my professor who right away asked them the same question, what they were doing the whole time . He asked me to get the investigations done at the earliest and proceed . About 60 % of patients with end stage cancer who come to us were already treated by quacks , alternative medicine practitioners and even allopathy doctors . When they reach an advanced stage they resort to us and then we will be left with palliative treatment only.

I always like Sardarjis ( sikh men of Punjab) . It may be because during my childhood ,I had a Major Singh uncle as our neighbour when we lived in Qatar . Steady turban and long beard always humble me with respect . One day a sardarji in his thirties with a smiling face came to my room complaining of an ulcer in the mouth . He told me it was a minor trouble for him but nevertheless wanted to show it. Seeing the ulcer I was quite sure that it was a cancer but of an early stage . I promptly explained the case to him and took special personal interest in working him up early since getting investigations done is a very long process here . In 10 days time he was fully worked up and I took him to the professor for dating for surgery hoping I could persuade him to give an early date . I was heart broken when I saw my professors diary of dates . He just helplessly looked at me and told me if I could show him a slot he would do it . He was right . His dates were full for 4 months and he was going on leave for 1 month in between . He told me to call the patient after 1 month to be listed in another consultants list . Then it was my role to explain to the patient the time lag . As I had already explained to him the investigations should be done on emergency basis , I found it very difficult to tell him to wait for another month . Contrary to my expectations he was a very understanding man and appreciating the efforts I made for him the readily obliged . But his parting question really shook me when he asked me , " doctor Saab , ithne din me ye bad tho nahi ho jayenge " ( Doctor , won't this disease advance by one month ) . Knowing very well the rapidly advancing nature of the disease , I could just tell him , " Let us hope for the best " . Fortunately after one month the disease not only did not advance much , but according to the patient, was the swelling shrank and he was even asking me whether the surgery was necessary or not . I told him that he was just lucky and not to spoil his luck by acting foolishly. I took him to the consultant and by God's graciousness he got operated the next week .

We have a tumour clinic wherein every Friday we discuss difficult cancer cases with radiotherapist , plastic surgeon and other faculties to reach a perfect decision . We take cases in turns . The patient allotted to me was a middle aged man already operated for cancer . We had removed his right eyes and cheek . He had also received maximum dose of radiation therapy and his type of cancer will not respond to chemotherapy . The discussion concluded quickly. He had developed a chest metastasis .The decision was to explain to the patient that we had no options left with us . So all we could provide him with was palliation . In other words ,he was to go home and wait for his end . As the resident in charge of the patient it was my responsibility to explain this to the patient . I was searching for appropriate words to tell him to go home and was nothing else we could do for him. The sad patient kept imploring me to do something . Seeing my dilemma my Senior came to my rescue . She told the patient , " Babaji , Hum bagwan nahi he "( Uncle , We are not Gods) . The patient left silently . She was right . Who are we to prescribe cure for patients when it is God who disposes

During one of our morning rounds my senior complained of mild abdomen pain . She asked me to complete her dressings she was doing in the ward as she was not feeling well . I obliged with no hesitation as she was one of my favourite seniors who taught me the basics of ENT . Next day she left the operation theatre early not feeling well again . During work up she was found to have a cyst in the abdomen either in the mesentry or the ovary . We joked with saying her that the surgeons would say it was from the ovary and the gynaecologist would call it a mesenteric cyst as both of want to evade case . Any way cysts are benign or harmless . After two days in the operation theatre I could not hear the news. It was found she had raised levels of a particular protein in her blood which is usually raised in cancers . It was a big blow to all of us . The usual joyful mood was transformed into melancholic . No one wanted to discuss the matter or to ask for details . Later she was diagnosed to have a borderline .May God help her to overcome her difficulties . Even though we learn , see and explain to people regarding diseases , it was only when someone close to us undergoes trial we really feel the gravity of the disease .

May God help all these people and help me to be of some help in their lives.

By the eldest son