We always keep hearing that doctors make an impact on the lives of their patients. But there are many patients who also make a deep and lasting impact on their treating doctors. This is a story about one such patient.
In those days I was a rookie medical practitioner. Had just joined an organisation as a medical officer at their dispensary. Everything was quite new to me and I was quite ignorant of the unwritten rules, the hierarchies and the politics of the place.
In those days of trying to find my way, at my workplace, I met this patient. He was a upper managerial level executive. Had risen from the ranks of the organisation. A capable officer as I heard from my subordinates. But he was also a headstrong and a brusque administrator. Given to talking tough with his team and quite rough in his day to day interactions with them. He also had a lack of patience and was given to throwing his weight around. All heresy but then that was the info I got. Enough to surmise that he was not a much liked person, except a few who valued his work.
So it happened that one day, he came for a consultation at the dispensary where I was working. Rather than wait for his turn he literally barged in. Being relatively new at this place and not wanting to step on anybody’s toe’s, I didn’t say anything.
He sat down and without any formal pleasantries just started off with describing his problems. His mannerisms were a bit jarring but I brushed them aside and concentrated on my work. He apparently had a swelling in his left armpit. After taking due history and doing a thorough examination I realised that this didn’t look like any routine illness. Wrote down some investigations and referred him to a specialist. At the same time requested him, to keep me in the loop, about the Specialists opinion and plan of treatment. He left and I got involved in my work.
After this meeting, he didn’t turn up for almost fifteen days. And that episode went out of my mind. For a doctor “no news is good news”, meaning usually patients come when they have problems and if they don’t have any problem they won’t come even for a follow up.
After fifteen or twenty days this patient again barged unannounced, into my room. I was annoyed and the indignation on my face must have been visible. For he immediately apologised for barging in out of turn and then with a dead pan face asked me,” doctor do you remember you had referred me to a specialist?” I just nodded my head. He then composed himself and told me in a matter of fact manner, that he had undergone a lot of investigation including a biopsy of the swelling and that he has been diagnosed with Non-Hodgkins lymphoma. Hearing those words I was literally shaken out of my mind. I was stunned. Thought I heard it wrong and requested him to repeat it again. He calmly repeated it. It was a terrible diagnosis. It meant he had a cancer. And a cancer which is not very easy to treat. Would require chemotherapy cycles and multiple rounds of investigations and also admission in a hospital for chemotherapy. It is the worst news to break to a patient, and here this man, my patient was telling me, his doctor, calmly that he had this illness. For a moment I thought that perhaps he had not fully comprehended the implications of his illness. Yes, maybe. That’s the reason why he was so calm and collected. In the moments silence which felt like eternity I collected my self and asked him, “Do you know anything about this illness, has your specialist explained it to you and do you know the treatment required and the possible outcomes ?
His response literally stumped me. He told me that the specialist had explained to him everything and he very well knows that he is suffering from a grave disease, which will require a long treatment with lot of financial expenditure. He further told me that he knew perfectly well, that the prognosis of his illness was not very good. He was very clear that he that had understood everything.
As this talk was going on I had risen from my chair to approach him and stood near him, ready to comfort him at any sign of emotional discomfort. But hearing his last sentence, stopped midway and returned to my chair. Rather just slumped in my chair.
Having just started my medical practice, I was still learning the finer nuances of human relations and emotions, especially in relation to the medical field. And I was really trying to find the right words, to speak to him without causing any emotional distress in him. Very slowly and emphasising every word I asked him, “Have you fully understood your illness and the implications or should I explain them in detail. If you want, you also can go in for a second opinion.” Pat came his reply, ”Don’t worry doctor, I know what is there to know and will be starting my chemo in a couple of days. Don’t worry I will be fine”
Quite unnerved with this unexpected behaviour and finally loosing my composure I asked him, how could he be so calm and composed in this situation. Any other person would have totally collapsed. To that he replied, with a composed look in his eyes, ” Whatever has happened, has happened and what will happen will happen, no point in raking my brains for that, just intend to focus on what I need to do, and that I will be doing, by undergoing chemotherapy”.
But now, I had lost control over the situation. I was feeling sad for him on one hand and on the other hand I was impressed with his mental strength, in facing a life threatening adversity. With a few casual words, we decided to follow up on the chemotherapy and I requested him to contact me, if he faces any problems. He left that day and then onwards began an almost a couple of months long saga of his fight with Non Hodgkin’s lymphoma.
We were in touch on phone. In those days there were no mobiles. He used to drop down almost every alternate day. Talk about his experience of chemotherapy. Slowly over time he had started looking frail and had started loosing hair on his scalp. The side-effects of chemo had started taking their effect.
Then for almost four-five days he didn’t turn up and nor did he call on the dispensary’s landline. I was a bit restless and worried for him. Had even thought about giving him a call on his office telephone. But then decided not to. That would have been an invasion of his privacy. Then one day I received a call from him requesting a home visit, as he was feeling very weak and couldn’t come to the dispensary. I packed my medicine bag and left for his residence immediately. I used to stay on the campus of the organisation I worked for. He also used to reside on the campus. As I reached his house and entered the living room, I could hear a gentle tune being played on a guitar. He was sitting in the living room on the couch. Looking sick, very sick. I started inquiring about his health and the problems he was facing. Did a medical examination. And then we started talking. He had taken chemotherapy a day before and was vomiting continuously . He felt severe tingling and burning sensations all over his body and because of that he couldn’t sleep all night. I inquired if this is happening every time after chemo or only this time. He told me that it happens after every weekly chemo but this time it was increasing. He looked quite distressed, rather distressed is a very mild word, he was in a lot of pain. All the while I was there he kept on repeating only one thing, the tingling and burning sensation. Realised it was going beyond his tolerance.
In between our talk, he told his wife to make a cup of tea for me and to get some snacks. I politely refused. Couldn’t think of having tea around a sick patient, who was not able to eat due to intense vomiting. I wouldn’t have been able to have anything. But he insisted. Said, “ Doctor you have never come to my house before and I will not like it, if my guest is not treated well”. I made a feeble attempt at trying to tell him that, I was not a guest but his doctor and was on a professional visit. But he would have nothing of it. His wife as I could see was a homemaker. A typical Indian homemaker. Very subdued and an benign personality. An individual who held her husband and children’s priorities, way higher than her own. A typical self deprecating and self sacrificing person of the household. She got tea and biscuits. I had the tea, rather gulped down the hot tea as fast as I could. He had nothing due to nausea and couldn’t eat much. In between sipping my tea I inquired about the music being played on the guitar. He told me it was his elder son, who was a teacher in a College. He loved music and was learning to play guitar. We talked for a few more minutes. A general talk. Tried to reassure him, rather was listening to him more than doing the talking. As I was about to take leave, his son who was playing the guitar came in the living room. I complimented him on his skill with the guitar and I could see that he was beaming with my compliments. He started explaining about music and different guitars. And then, in a flash I realised that this chap was blissfully unaware of his fathers situation and pain. A quizzical look must have formed on my face, as my patient immediately rose up and curtly told his son that the doctor is busy and needs to leave. Confused I left the house and came back to the dispensary. For a day or two I didn’t receive any call. Busy in my work I also had very less time to reflect on this patient.
Then in a couple of days I received a call requesting for a home visit again. I was almost eager to go. Was intrigued by this patient and his ways. As usual after the medical examination we started chatting. His wife served hot piping tea and some hot snacks which I don’t remember. After ensuring that nobody was around I asked him, “Haven’t you told your kids.” (He had two sons and a daughter. The one who used to play the guitar was the eldest, younger son was studying in college and a cute daughter the youngest of the lot was studying in school.) To my question he replied in the negative, that he hadn’t told his children. I suggested that he must inform them about his illness. I told him, “You are suffering so much and are in a hell of a pain and they are going on with their lives unawares. They have a right to know. Once they know your situation, they will form a support system which you need, in your critical times. You need emotional support. And you need somebody to look after and at the same time give you more time.”
He just listened to my preaching in silence and by the time I had finished my long winding talk he had a faraway look in his eyes. He was silent for a few moments and then he spoke. “ Doctor you have been to my house many times recently, what have you noticed? You have seen my elder son play beautiful melodies on his guitar. He is happy and enjoying his life. My other son who is studying in college is a dynamic guy and working very hard to excel in academics. He is also enjoying his youth and college life. My little daughter is a bundle of innocence and joy. Now, give me one compelling reason, why should I tell them about my illness. Why should I expose them to sorrow and sadness. Right now they are like birds, happily singing on the trees and trying to spread their wings and fly in this beautiful world. What right do I have to snatch their joys from them. And, I very well know the outcome, I have a fifty fifty chance of survival. If I don’t make it, then they will automatically come to know. But not now. Not at this juncture. I would rather delay the arrival of sorrow and pain in their lives. When it arrives, they will have to deal with it and they will. But not now. I don’t want to disturb their blissful lives. And if by gods grace I make it and I am free from cancer, then there will be no need to tell them at all. My suffering will remain my sufferings only. Don’t need to share it with my children.” I was speechless, listening to the outpouring of his emotions and his thoughts.
“What about your wife? Does she know.?”, I asked in exasperation. “No! she also doesn’t know. Look how happy she is that my doctor has come home to meet me. Look at her happiness, in entertaining you. She does her household chores, with complete devotion to the family. Takes good care of me. And you want me to make her sad? Make her cry? No way !!!. She will come to know about my illness if I die. And if I recover then this will be my secret. For all my life.”
I was at a total loss of words. Here I was seeing a man suffering from cancer undergoing chemotherapy which has terrible side effects, right from loss of hair to extreme vomiting, anorexia, headaches, unbearable tingling or burning sensations all over the body, an absolute feeling of unease and sickness and so on. He may make it or may not. And what he really required what we doctors call TLC (tender loving care). A lot of nursing care and a lot of help in his day to day activities. And this man wanted to forgo that in his worst times, just for the sake of not contaminating his families happiness. I was aghast. I couldn’t think of any thing to say. I nodded my head half in appreciation and half in sadness. Appreciation because, I appreciated his thinking and sadness at his plight. For this mans physical suffering’s were immense and he was suffering alone, with nobody around him knowing about it except his doctors. And we could do only so much.
I got up with a heavy heart trying to comprehend what I had heard and seen. Was trying to compare with other similar patients, I was used to seeing. Any normal person would have broken down, but this man was standing tall with his beliefs. His beliefs could be debated but they were sacrosanct to him. He gave a totally new perspective to my understanding of patients and human life. But all this I couldn’t comprehend at that time. Whenever I reflected on that patient later on, I realised that people are not very easy to read. They have different facets to their lives, which are revealed to us, only at the right or opportune moment. In this case I could hardly say at the right time but the exact opposite, at quite a wrong time. I realised one cannot judge people from their behaviour or from heresy. And that there is a lot more to any human being, than what we are used to see and understand in our day to day life. And also that, there is a lot to understand and learn from every individual we come in contact with.
As I traveled back, his words kept ringing in my ears. I just couldn’t take my mind away from the situation I had been into.
Days passed by. Was busy in my work. But whenever I was alone I used to remember that day’s interaction. I used to go for home visits to see him as a doctor. Have tea prepared by his wife. Sometimes used to hear his elder son playing guitar in the adjacent room and sometimes meet his cute and cherubic daughter prancing around, full of life.
Then one day I received a call from his son. His father was was not well. I rushed to his house. For the first time I saw him lying down on the bed. Coughing badly and breathless. After assessing the situation I advised his son to shift him to the hospital immediately. We called the ambulance and he was taken away to the hospital. The next morning I went to see him in the hospital. He was in the ICU and on ventilator. Conscious, but because of the ventilator he couldn’t speak. He very slightly nodded his head at me. I saw, maybe an hint of smile in his eyes or maybe my mind was playing games. I held his hand, tried to speak but was unable to. Stood there looking at him and all the while his gaze never left my face. Then I patted his arms and turned around and left the ICU. That was the last I saw him alive. He breathed his last the next day.
PS : He used to take chemotherapy on Fridays and then rest on Saturday and Sunday. Rest means suffering the side effects of chemotherapy. By Monday he used to be little better and he used to attend office. Nobody at his office knew of his illness. Nobody knew he was undergoing chemotherapy. He kept on with his duties and responsibilities till he was admitted to the ICU. A brave soul.