True stories - Family

True stories - Family

Family relations in India are different from the rest of the world and often complicated. As doctors in India, we have many-a-times seen the family assisting in the treatment of a patient half-heartedly, just because they don't want to appear disinterested in front of their neighbours/relatives. Mostly the patient senses such emotions and I can't explain what would hurt more, the disease or the loneliness.

So I thought I was facing a similar situation the other day when one of my patients, Rahul, who has just recovered after a stem cell transplant, looked gloomy. "What happened, why do you look sad today?? Is there anything I can help you with?." I asked him. "The cost, sir, I have only now began to realise the amount my family has spent in completing my treatment. I don't know how I will survive, once I am discharged." I did not know what to say. He had Acute myeloid leukaemia, and went through a long a complicated induction chemotherapy which was followed by an unrelated donor transplant. The cost surely would've been high, at least on the north of a million and a half. The patients elder brother, Saurav, was rarely seen during treatment and the responsible person in the family was a cousin. However there was never any hesitation or delay in getting any of the medications or essential ingredients, at any point of time , throughout the  treatment course. Rahul started speaking, "Once dad expired, me and my brother had divided the family land between us. Once we found out about my disease and the cost involved, we understood that we will have to sell my share of the land. My brother was speaking to a land broker a couple of days before I was admitted. They must have got a good price for my land and that's why I could complete my treatment uninterrupted. Now that I am better, I need to find a job to raise my family, before whatever is left from the sales gets over. But now I am worried. All I have done in life is farming, that's all I know. What is there to farm without farmland? To complicate things, Saurav has hardly visited me 2-3 times in the last few months. Why isn't he helping me??" Rahul asked. He was genuinely depressed. I tried to console him, but I did not know what to say. Doctors are trained for treating patients and even lifting up their spirits for fighting the disease. But what after that? How will I explain or console a person whose family seemed like they didn't want to support him??  I realised Rahul's concerns were genuine and I really didn't have a solution. 

So the day before Rahul was due to be discharged, Saurav came to my room to speak about post discharge precautions and advice. I casually asked him about Rahul's work plans. "He will supervise work at his farm, sir. That should be enough to provide for him and his family without having to strive too hard. ", came the reply. I was surprised. "But Rahul told me his share of the farm was sold??", I spluttered. His brother was silent for a moment, then smiled a weak smile. "It was my share of the land that was sold, sir. I realised that if Rahul gets out of the treatment, he would not be able to work hard and would need his farm to feed his family. In case he did not make it through, still his wife and kids would need the farm to keep themselves going. I am young and healthy now, sir. I am now working as a labourer in another farm in the village and that's why I couldn't come to meet him or you often, during the treatment.. "Saurabh said. He continued, "Rahul would've never let me done this, if he had known. So I somehow hid it from him. But I guess he will know soon enough. I have only one sibling, doctor. I can't let him or his family suffer. Money will come and go. I am just glad that he got better." My throat went dry and I was lost for words. I gave Saurav the discharge instructions and somehow told him he had done a great job.  Saurav just smiled. Rahul left the hospital, still a little gloomy, because I never told him the truth. I wanted him to find out from his own blood, when the time was right.

 Today Rahul came for his D+100 visit. He was doing excellent without any trace of the old malignancy in his body. Saurav came with him. They brought me a big box of Apples. "This is from our orchard", Rahul told. "When I realised what Saurav did for me, I realised how foolish I had been to think about property and money. Now we run our farm together and It has prospered in all these days. With hard work and a little luck, soon we will be able to buy back Sauravs land." Both of them beamed as he said this. They left my clinic and walked away. Rahul's right hand was on Sauravs left shoulder, a support he now knows will be there for him, till his very last breath. 

Love works in very strange ways. But one thing is for sure.

Love always wins.

True stories - Brother

True stories - Brother

I was the Tom-boy among all my friends during my childhood. Having 7 brothers definitely helped. I was strong brave and did almost all activities that the boys of my age did. My friends looked up to me and I was their little hero, while I enjoyed the caring love and affection of all my brothers. 

It was in one of those dares my friends threw at me that I decided to climb that walnut tree by the pond. I was 8 years of age, but jumped up to the dare, and threw myself up a difficult branch, but then got stuck. Neither could I reach up to the next branch nor could I climb down to the branch I jumped up from especially with the pond looming below. For a moment I was frightened, I didn't know what to do. The kids below got frightened too as I was at a considerable height. They began shouting in panic and then ran away fearing the wrath of the elders. My mother had appeared at the backdrop but did not come out probably because she had my younger baby sister in her arms. (She later revealed that she didn't come out as she dint see me atop the tree and she had actually thought somebody had jumped into the pond.) I was up at a considerable height, scared and confused and alone. Then I saw somebody running towards the tree. It was my little brother, all but 4 years old, small and skinny. He came below me, looked up with his wide eyes, held out his thin hands and shouted. "Jump, my sister, I will catch you. Don't u worry. I will save you." Tears sprang to my eyes. His bravado, his concern, his love. I still remember that scene vividly. The view from the top, the frightened me, the pond full of water looming below, Amma and the baby and the skinny little kid below me with wide eyes, arms stretched out, calling out to me to jump,a wide reassuring smile in his lips, full of concern and love.

Fast forward 60 years. My brother, because of his concern and love for all, because of his unmatched brilliance and bravado,  grew above all of us, conquered the world. Today is his funeral. I cannot bring myself to look at him today, but I did, somehow. Seeing him brought me back to that day 60 years back. His wide and glowing eyes were shut today, his arms which are not skinny now, are now folded across his body. But that smile, I can still see that reassuring smile in his face. That smile of defeating us all, even in death. That smile, of knowing what lies beyond. That smile, telling us not to cry for him as he is now free from the world of suffering and is now resting in the hands of the Almighty. 

Dear brother, you outdid all of us in all aspects of life but this is one time when I wish you would've let us go ahead into the arms of God. But when I close my eyes, I can still see you, healthy and happy, arms stretched out, eyes wide and the same reassuring smile in your lips. That view is enough for me, till the day i join you, when I'll take that jump into your arms.

Just like that day.

Lots of love,

Oppol.

True Stories - Perspective

True stories - Perspective

Both the good thing and bad thing about CML clinic is that you keep seeing the same cohort of patients every week. Some of them are irritating, but mostly patients are considerate, willing to wait and not noisy. One of my favourite patients was a young lady in her early thirties, just because she seemed to be the happiest in the whole OPD, if not the whole world. She never jumped the queue, insisted the older patients and the wheel chair bound patients to be seen ahead of her and never ever complained about the system, which does not treat its subjects fairly. But what really really set her apart is one character. She is the only patient I have seen, who has the heart to ask at 3:00pm whether I had any lunch or whether she could get me something to drink. In the midst of their troubled lives and bizarre sicknesses, people, quite understandably, forget to think that the doctor seeing them at 4:30pm might not have had anything to eat or drink since morning. Just that one question, showing an extraordinary love for the fellow human being, in spite of her own illness, made her my favourite patient.

But she always came alone. As a policy we hematologists don't ask personal details of our patients unless required, probably because there is enough sadness running around and there is no need for an additional emotional burden. One day she came with her child. The little girl child was the most beautiful thing I have ever seen. Quiet and well behaved like her, with the most beautiful of smiles. Everyone in whole OPD gave the mother and child a second glance, just because of the pure happiness they radiated.
After examining the patient that day and writing her prescriptions I asked the mother, "How come I've never seen your daughter before, did she used to stay at home with her dad??" A moment of darkness crossed the mothers face. But it quickly turned into the perennial smile. "Oh doctor, you don't know. I'm a single mother." That was enough for me, the stupid me had blown off my mouth, yet again. Typical foot in mouth situation. You start the conversation and you don't know what to say. But she did not seem to be bothered and started her story.

"I was 4 months into my arranged marriage when I was diagnosed as CML. My husband left me on the day of diagnosis and I returned to my parents. I was devastated, lost, jobless and penniless. I contemplated suicide. Although the doctors explained to me that the disease would most likely be under control with drugs, I didn't want to be a burden to my parents or to anyone. I cried all day and night. Just before I went to bed, my dad came to me and told. "See you'll be my favourite whatever happens and whoever leaves you. You were such a confident, smart and ambitious girl when you were little. Bring that girl back. Tumhara hi zindagi hai beta, jaise vo bekaar-sa ad mein bolte hein, "Make it Large"....." I didn't sleep a wink that night. In the morning I decided I am going to face my disease with my head held high. I went to my best friend from school, borrowed some money from her and bought a sewing machine. Long story cut short, I own a stitching and designing shop in my hometown. I employ 6 girls now, all either cheated or abused by their husbands. 

Life is never complete without more people to love. Hence with the approval of my dad, I adopted her. Took some real arm twisting with all the paperwork. But now I am her mother and her only parent. It's actually quite funny. I used to get a lot of marriage proposals when I became successful, those have reduced since she came. But I'm not at all sad doctor, I decided that day itself, that I will not venture into anything myself, unless it was on my own terms.

I am surrounded by people who love me unconditionally doctor, and I came to realize that in life, that's all that matters."

She gave me the sweetest of the smiles, picked her daughter and walked out. The daughter waved me a ta-ta over her mom's shoulder. 

I closed my eyes to savour that moment. Oscar Wilde's famous lines came to my mind.. 

"To live is the rarest thing in the world. Most people just exist.".

Happy Women's day.

True stories - Diwali

True stories - Diwali

This happened during rounds today.

Consultant to patient - I am glad you made good progress in the last week. We can discharge you today so that you can celebrate Diwali with your family. 

Patient - Sir, if possible I would like to stay in the ward during Diwali. Can u discharge me day after tomorrow??

Consultant <surprised> - Why would you want to stay in hospital on Diwali day. Don't you want to go home??

Patient <lowering his voice> - Sir as you know, I have not being working for 2 weeks now. If I am discharged today, my family would starve tomorrow on Diwali day. But If I stay here, tomorrow at least I can feed my kids the Diwali special hospital food that they give out for the patients. 

The consultant was too stunned to say anything. He felt his throat going dry, voice getting hoarse. "Sure, we will discharge you on Monday", he managed somehow, before turning away and leaving the ward. 

There was an awkward silence, and the residents walked behind the consultant saying nothing. Before leaving, the consultant took out his purse, grabbed some money and gave it to his SR without counting. "Buy some sweets for all the patients tomorrow, please.", he told before walking away.

As he was walking to his car his mobile beeped. The gifts for the family that he had ordered from Flipkart, Amazon and Myntra had been delivered.

Happy Diwali to all.

True stories - Inspiration

True stories - Inspiration

Every 6 months, among the new residents in Medicine, there are the "runners". These are the guys who are shocked by the amount of work that a first year medicine resident is expected to do, that they quit or move on to lighter specialties. They can't be blamed either, u know. These are probably guys who topped every exam in their life and were probably the only ones to crack the tough entrance exam from their states, that their egos would be dancing among the stars. Such inflated egos can never comprehend the fact that they are expected to pull trolleys, collect reports, arrange files, beg for ct scan dates and what not. 

Hence it was no surprise when our new first year JR dint turn up for blood sampling one fine morning. He messaged, "I can't work among these people" and bunked. He was a prodigy from the apex institute in India, had cracked PGI without batting an eyelid and hence, expected to be treated like a king. One rounds in the morning by the Professor J and a grueling evening rounds by his SR painfully made him realize that, at this point, neither he is efficient in his work, nor does he know the head and tail of medicine. We thought he was gone forever, but somehow he decided to give it all a try again. He returned the next day and started working. When his SR was about to reprimand him, Professor S intervened. He told the SR in private, "Look beta, we have all felt like running away, all of us, you and me. Although bunking without informing is ethically wrong, since he decided to give it a try once again, lets act mature and appreciate his spirit to fight." Turning to the JR, Prof S told, "I'm glad that you are back beta, let me tell you a story.

" Around 35 years back when I was doing my senior residency in this very same unit in this ward, my JR came to me one day and announced he is quitting. He had already prepared his letter and booked his train. I was surprised as he seemed a nice guy who was interested in the subject, so I tried to sort out what his problem was. It turned out that, all his troubles were because both his senior residents were allotting him work at the same time. Trying to do everything, he ended up doing neither of the sr's work and was getting scolded everyday. He actually took it upon himself thinking that he was not efficient enough  to continue here. Me and my co-sr sorted out his problem by giving him a combined list of things to do and just that simple step sorted out his problem. He became efficient and showed amazing interest in the subject. He completed his MD, did some period of senior residency, did his DM here itself, as well as some foreign training and went to be an amazing physician. Since he was a very good person by heart, he couldn't ignore the poor, downtrodden and sick in this country and thus got active in social work, in between his busy practice. Last year he was awarded the Padma Shri by the President of India. I was real proud at that moment, because I realized that one small step I took, one moment I spent just listening to somebody, had made a difference. Not just to that resident's life but to thousands of people, patients, their families, and a lot of unfortunate people in this country. 

One can never gauge the potential of a person and the heights a person can reach by a small amount of inspiration at the right time." Professor S concluded, before continuing with his morning rounds.

Good teachers share all they know, they instruct. 

The amazing ones, inspire.

Happy teachers day

True stories - Strength

True stories - Strength

Muthassiamma lived till 96 and moved on last year. What a wonderful wonderful life. No major health issues except for bad knees and poor hearing. Never said a bad word or spread an ill news about anybody. Never scolded any of her 10 kids or 21 grandchildren, not even once, ever. Such a perfect example of virtue, patience calmness and inner peace. Everybody broke down with my dads big brother said "Kandu mathiyayilla"( I want to see her again and again, I have not seen enough of her) before they covered her body one last time. Muthassiamma has gone into the ashes of Thekke Kandam. She lives on, in the hearts of people whom she loved and who loved her. My obituary for her is a story that I heard my dad narrating.

My dad once had a problem with the health minister during his glorious unblemished and achievement studded career. Dad stood for what was right, instead of what was politically RIGHT, to the extent that he had to complain about his minister to the judiciary. The letter he wrote was somehow leaked to the press and all pandemonium began. 

Those were bad days for him, with media frenzy and all, which culminated in the minister resigning and dad being reinstated. Truth won and justice was done in the end, but he was mentally very shaken, to the extent that even my mom couldn't console him.

In the midst of all the frenzy, Dad went to his native place to visit his mom and his brothers, his usual second-Saturday-of-every-month unbroken routine since more than a quarter of a century. He never mentioned anything about his mental turmoil or sadness. Somehow his mother, my Muthassiamma, sensing everything, called him near her and told. "Do not fear anything or anyone. Stand straight for what you think is right. Even if you lose your job. Why do even care, you are an intelligent & educated doctor, you can survive with a pen and a few pieces of paper."

My dad recalled the incident at a later date. When he said about it, his voice cracked. "My amma, mother of 10 children, not formally educated, aged 85, who always stayed behind achan (dad) in the background, never offering an opinion, came forward and said the most sensible thing that could have been said to me at that time, instilling in me confidence about the righteousness of what I am doing, showing her support in my knowledge, my abilities and my patient care. 

After all this while, she said the most amazing words when it was needed the most, and from that day onwards I have not feared anything in my life, ever. Amma did not offer her shoulder to lean on, she made leaning unnecessary.", 

my dad concluded, tears dwelling up in not just his eyes, but in all of ours too.

Motherhood is the place where love begins and ends. 

Happy Mother's Day.

True stories - Lesson

True stories - Lesson

He was totally aghast, he felt numb and his insides burned. He wished he could scream out loud or just run away to escape from it all. One of his first patients in his dream Hematology course, the young guy who had improved so much in front of his eyes, was leaving the ward. He had relapsed and relapsed in a bad way, so bad that it was impossible to treat him further. The family, already heavily in debt, had to be counselled to take him home for palliative care, to which after much deliberation, they agreed. 

The patient M, the 19 yr old, did not know about his death sentence. The resident stood against the wall as his cousin brothers rolled M out on a wheel chair. As M was approaching, flashes of memories flooded the residents mind. 

-  The first week when M arrived, when M was not in his full sensorium, when he used to pat M's hand and tell out loud (more to himself than to anyone else) that M is going to be alright. 

- After M improved, how M had asked whether he will ever be able to play 'Kabbadi' with his bros again. And he had told M, that not only will he be able to play Kabbadi, that he himself will travel down to Ms village to watch him play. The ear to ear grin of M was still fresh in the residents mind.

- How, one day when he came for rounds, he heard Punjabi folk song being played out loud. M was enjoying the music terribly that he asked what sort of music is this. M replied, 'Chamkila...I love Chamkila' and everybody laughed. He had to Google the word to find out that it was the name of the Music director. From then on he began addressing M as Chamki....and M was visibly embarrassed at the fun being made of him. 

M smiled and waved as he passed the resident on his wheelchair. The resident waved back. Just before he turned the corner, M shouted, "Don't forget to come to the Kabbadi tournament 2 weeks from now, OK? I will be participating."  The resident did not know what to say, he just nodded. He leaned back on the wall and closed his eyes for a moment, fighting the tears. 

"Hey....", a soft voice, startled him. "You alright??" The resident was surprised to see his head of the dept, Prof S, standing near him. 'When did sir come here, how come I didn't notice!!', a visibly embarrassed resident thought. "Sorry sir, I was just a little disappointed at what happened to M.", the resident told as he tried to scramble back to work.

" Relax Beta," Prof. S told, his hand on the residents shoulder, "let me tell you a story".

"Around 30 years back, a elderly Sardar brought his only son to me. I was just starting to get interested in Hematology and this guy had an Acute Leukemia. Since the treatments of that form of Leuk were in experimental stages then, I knew that the patient was not going to survive. I called the old man to one side and in private told him that his only son was going to die. And there is no point in spending all the money that he had on the kid. "How many years does my son have?", the old man asked. I shook my head, "Months", I replied, "Not years". The man was shattered, had a denial and anger phase and finally came to the acceptance phase. "Pls give my son the best treatment possible, I understand what you said and I'll never have unrealistic expectations from you people.", the baba told. We gave him whatever we had in our hands at that point, and somehow the miracle happened and the guy responded. Remarkably. He somehow tolerated all the chemo and after around 9 months we could not find any trace of cancer in his body. 2 weeks after the son was declared cured, the baba died peacefully in his sleep, possibly an MI. The son took 2 years of maintenance and still comes to see me with his own kids, twice an year. "

"The guy whom I predicted had months to live, still comes to see me after 30 years and his dad, who was a healthy hardworking Sardar with no diabetes or hypertension had a heart attack within one year. I stopped taking the statistics part of medicine to heart from that day onwards, they just predict and predictions aren't always true. For a particular patient you do not get to judge or be God based on these statistics, they r just soft pointers.

Do u really believe whatever that u do or don't do or can't do is responsible for what happens to  the patient??

The day u start believing that you are actually the Tool and not the Hand that controls the tool, that day, u will start believing in what you do. You become mature and you find your peace. ""

Prof S ended his story, patted his resident again on the shoulder and walked away. 

The resident found a strange happiness inside him from that day onwards. Maybe it was because he had found the purpose of his life. 

The purpose of life was to serve and the joy of life was in giving.

 Nothing else mattered.

E