I’m an oncologist and I know my patient will die.

5.00 am in the morning. The phone is ringing continuously. Half awake, I answer the phone. On the other side is my assistant saying, ‘Sir your patient with terminal colon cancer has passed away’. ‘Oh!’ I exclaimed, trying my best not to feel the wave of emotions that just hit me. But, the single word ‘oh’ had summed up in it, all of my dismay, frustration and grief. After absorbing all these feelings in a part of my soul, which I wish to hide even from me and ignoring the heart sinking feeling, I went to bed again. Closed my eyes, took a deep breath, tried to sleep and prepared myself for a new battle tomorrow.

Doctors, as people say, have the noblest profession because we save lives. I’m also a doctor. Like any other doctor I fight death for the life of my patients. But I’m different and so is my story. I’m an oncologist. I fight, I struggle and many of the times I lose the battle in the end, but not hope. Yet, I fight the hardest of battles than any other doctor. I say this because firstly, in a time where every doctor specializes in treating a single region or organ, I treat the whole body. At a given time, I treat a number of patients, all of different ages with different diseased regions. Every day I have to learn new techniques, keep my knowledge up-to-date and my skills polished as I don’t know what nature will bring up next in front of me. I can’t show up unprepared. Nature and fate shall test me and my knowledge at every stage and failure isn’t an option for me. Still an oncologist must always be prepared to lose because I lose battles as often as I succeed. The key, though, win or lose, is to never fail. And the only way to fail is not to fight. So, I fight until I can’t fight anymore. Secondly, I’m the hope of my patients in distress. There’s this thing that happens when people find out that you’re a doctor/oncologist. They stop seeing you as a person and begin to see you as something bigger than you are. They have to see me that way to trust me and believe in me. But only do I know, I’m just like everyone else, unsure, flawed and normal. So I act strong, I remain stoic. I hide the fact that we’re all too human because I have to satisfy and give my patients a hope to live. When a patient comes to me, he is completely hopeless, turned down by a number of doctors and his only wish is to hear from me that he’ll survive. Nobody wants to be told that they have cancer. The news of suffering from cancer itself inflicts an enormous mental trauma on the patient and his family. My job is to keep their hopes alive, besides knowing all the bitter realities of the disease that my knowledge has taught me. If my textbook says, that only 10% of a certain type of cancer patients survive, who am I to judge that the patient sitting in front of me is not among 10%. I have no right to take away his hope of living and to declare him dying, while there is still a tiny bit of hope and fight behind. So, I take up the depression and distress of my patient on me and transfer to him my optimism as much as I can. So that when he leaves my clinic, he leaves with hope, with courage and with the determination to fight for his survival along with me.

Adjusting the knot of my tie and the white coat, that marks my identity. I look at the time on my watch as I enter the oncology ward. Wearing my most compassionate smile, I start the rounds. After a hectic hour of checking up on patients and adjusting their further treatment plans, I move towards my office. I hear my assistant calling out that biopsy reports of my new patient have arrived and are placed on my desk. At that moment, I felt an adrenaline rush in my body. As I entered my office, my steps became heavy but rapid. My heart beating hard and fast against my rib cage like a child’s heart would race before his report card is handed over to him. Taking in a deep breath, I opened the file. As I go through the figures mentioned in the report one by one, a little piece of hope dies within me. Finally my gaze becomes fixed on the bone marrow biopsy result stating “Acute Lymphoblastic Leukemia”. Given the extent to which the cancer had advanced, this was no good news. At this instant, I just felt sad. Extremely sad. Had it been diagnosed a little earlier or the patient had come to me a little earlier, I could’ve saved this patient. I could’ve done everything in my power and saved this patient. I couldn’t only buy the patient more time but also give her back her rightful life. But now it was too late and I was helpless. Just as I was about to close the file I caught sight of the patient’s age: 10 years. My heart broke. An image of my daughter popped up in my mind, whom I had just dropped at the school few hours earlier. Her innocent eyes and her naïve moves. What a gem is my daughter to me and here someone is about to lose that gem of their life. As an oncologist, all I could do was provide her the palliative therapy. That would mean making the rest of the time period that she stays alive, free of pain. If I can’t save her then the best I can do is lessen her pain. Make the quality of, what’s left of, her life better. At this point I wouldn’t go for something heroic. Something that might make this journey of hers more difficult and painful for her and the parents. I will just try my best to lessen her pain and buy her as much time as I can. While I was still lost in my thoughts, there was a knock on the door. The assistant informed me that the patient and her parents were here. I signaled to send them inside. Feeling their presence in the office, I lifted up my head. There she was. That little angel. Holding her mother’s hand and half hidden behind her. As they walk towards my desk and seat themselves, I notice my little patient. She is pale and weak now, but in my mind I can imagine how she must have looked like when she was healthy. She had luminous blue eyes. What a perfect personification of innocence and purity was that child. Turning to her parents, I started the routine session. “Hello! I’m Dr. Ali and I’ll be your daughter Sara’s doctor from now on.”

As I saw them off, all I could think was how cruel and unfair life is. Little Sara was the only child of her parents. She was born to them after 10 years of marriage and now they were losing her. She was slipping through their hands and they, themselves, were helpless at the hands of fate. When I had taken Sara for the general examination, she said she had a question she’d like to ask me. I told her she could ask me whatever she wanted to. Then she asked me, “Am I going to die?” Her words felt like a stabbing knife in my heart. For a moment, I just stood there, looking at her. Then I replied, “No dear, I’ll be making sure that you stay fine. But why do you ask this?” At this she looked up at me with those teary blue eyes and in a very slow, secretive manner she began, ‘Because every night when my mom puts me to bed and thinks I’m asleep. She kisses my forehead, my hands and my cheeks and she cries, she cries a lot. Then she makes long prayers to God. She asks God to give me back to her. To not take me away from her. I know I’m sick and that is making my parents really sad. I don’t want them to be sad because of me, so doctor can you please make me well?” At this I was left stunned and speechless at her deep love for her parents, observation and astuteness at such a small age and her innocent little request. “Yes, I’ll”. But for that you’ll have to help me by following all my instructions, okay?” That’s the moment when I decided to treat her with chemotherapy and delay her departure from her parents as long as I could. Why do I even try when the barriers are so high and the odds are so low? Why don’t I just wind it up and go home. It’d be so much easier. But it’s because in the end there’s no glory in easy and nothing compares to those priceless moments that those parents could get with their kid. Now I’d be seeing Sara after her first chemo session.

Today is Sara’s first follow up after chemo session. She walks in, looking paler and weaker than before. But her eyes more luminous than before. As I examine her and check her reports, she can’t stop telling me about her experience of chemo. Telling me how the medicine felt like pricking pins in her veins. How she vomited several times after the session. How she feels tired now all the time and the new lesions that keep forming in her mouth. And how she is afraid to go for it again. To ease her, I tell her that I will be there next time. Before leaving, she just asks me, ‘Am I going to be okay?’. I reply, “yes, why not.” Not even sure myself of the real answer.

3 chemo sessions and 3 months passed. Sara lost all of her hair, her nails turned black. Her body aches. Her symptoms worsening. All my plans and all my hopes failing. Nothing seems to be helping. As much as I want to help this little patient of mine, I keep losing her. The heartbreaking reality is that I watch that little girl fight a deadly disease like cancer so bravely and I can’t help despite all my knowledge and skill. I assess myself, re-evaluate myself, replay the whole case, to see if there is anything that I could have done and missed out on that. But all in vain. I did all that was possible. All that could have been done. Its 11.00 pm and as I’m about to leave my clinic I get called to the emergency. I rush and to my utmost dismay, the patient is none other than Sara, bleeding out profusely. The surgeon decides to take her to surgery immediately. I decide to go with her. I just can’t let go of my patient like that. Here, in the OR, time seems to stop. I stand here watching the surgeons trying to stop the bleeders and in the end, alas, fail. Here I lost one of my most precious patients, once again. God took away his little angel and eased the pain she was in. Maybe that was the only way it could’ve been.

At the end of some days, shutting off office light, locking the door, crossing the empty parking lot to the chilled dark car. I, the oncologist, who is not a hero but just someone trying to help. Can still feel that exhaustion, that world fatigue, for what I’ve seen, what I’ve done and what I have lost. I take a deep breath, shake off that blank stare and head home to my family, but with the determination and satisfaction that I’ll return to join a new battle another day.

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