Lessons that shaped my life

Over the years, I learned many lessons from patients, my parents and others. Some of what I learned had a profound influence on my future life.  One such lesson was in 1969 when I was in final year of medical school in Hyderabad, India.

I was posted to eye hospital as a part of the regular curriculum. One day during an outpatient clinic, a man in his 50s showed up with a towel covering his right eye. Attending ophthalmologist removed the towel from his face only to see the eye very swollen and almost popping out of the socket. As an inexperienced medical student, it was scary for me to look at it.   He appeared some what malnourished with wearing clothes with holes in his shirt reflecting his poor financial status.  He came from a village 30 miles from the eye hospital .

Cataract is a condition where the lens in the eye becomes opaque and as such interferes with vision. Once the opaque lens is removed, one can see better. This patient  was losing vision due to cataract. He was either unaware of the availability of government funded free eye  hospital or more likely couldn’t afford the expense to travel to the city.

Instead, he  went to local barber who has a quick fix for restoring eye sight.  Barber charged equivalent of a dollar for the procedure. He inserted a fine needle in the eye to push the opaque lens to the back of the eye with expectation to improve vision. This procedure has been banned long time ago by the British when they were ruling India. It is punishable by law .

Unfortunately, the needle often is dirty and can cause infection. That’s exactly what happened to this man. Whole of the right eye was swollen due to infection.  Attending doctor told the patient that the only option is to remove the eye.  I was a silent spectator through out the entire conversation.

Attending doctor asked the patient for the identity of the man who performed this  illegal procedure so that he can get compensation..

The response from the patient will live with me for ever.

The patient, in spite of his visible poverty said “I will not tell his name. Though I do not know him well, I do know that he has 2 children. If I tell his name he will go to jail and no one to take care of his wife and 2 children. I can see with one eye just well as 2 eyes”.

I will never forget his expression. He was not only  not angry, but appeared calm and meant exactly what he said. Of course he was not thinking of the negative consequences of not revealing the culprit’s name.

I learned that day the power of caring for fellow human being. It is the greatest feeling.

Redefining Hope in cancer

I spent 37 years caring for cancer patients. Cancer is a frightening diagnosis. Advances in surgery, radiation, chemotherapy, immune therapy and more recently targeted treatments ( designer therapy) not only increased cures but also increased survival rates for cancer patients.

Understandably, the definition of hope for those afflicted with cancer is cure. Unfortunately not every one with cancer can be cured. Does this mean they have no hope? Yes, they do have hope.

My definition of hope in those whose cancer has spread is “prolongation of quality and quantity of life”. This can be accomplished in many types of cancers with newer treatments. This message has to be shared by oncologists with their patients. A typical example of such hope is a woman I saw in 2005 with breast cancer. At the time of her diagnosis cancer already spread to liver and bones. Treatment resulted in disappearance of cancer in liver and changes in bones consistent with healing process, both documented in her scans. She maintained her job, maintained normal activity, watch her children finish college. As I write this, she has very tiny spots come back in liver and on a different treatment. She continues to be free of any symptoms.

How about in patients who have exhausted all treatments for their cancer. Is there any hope for them. Again my answer is Yes. At this stage of their illness definition of hope is “how to keep them comfortable”. Comfort can be accomplished by various methods including hospice, pain control, acupuncture and many more.