REFLECTIONS

Diary of a daughter

Sheetal Pradhan

DOI: https://doi.org/10.20529/IJME.2016.033

Abstract

This is a personal account of my struggle as a young medical student after my mother was diagnosed with an incurable illness; she subsequently passed away. Through this story, I share my experience with the medical profession from the perspective of the daughter of a terminally ill mother.

The diagnosis

June 1997

Impression:
Metastatic carcinoma of poor differentiation
Location of primary tumour unknown

The words hit me like a tight slap across the face.

For a couple of minutes, I stood there stunned, my face as white as the sheet of paper in my hand. Standing there in the midst of a crowd of patients, worried relatives and unconcerned staff, I had to lean against a nearby chair to regain my composure.

I had gone to the Pathology Department of the Citizens’ Hospital, Mumbai to collect my mother’s fine needle aspiration cytology (FNAC) report.

A few days earlier, my mother had noticed some small swellings in her neck. She had been complaining of a lingering cough for several days and had lost some weight as well. Our family doctor had advised us to get an FNAC test done.

As a 20-year-old final year MBBS student, I was fully aware of the possible implications of these symptoms. The odds were definitely skewed towards a diagnosis of cancer. But the innate optimist in me hoped for the best against all odds. I prayed and prayed that it would turn out to be something less sinister.

But fate had other plans.

And there it was before my eyes…the inevitable diagnosis of cancer.

I pulled myself together as best as I could. There was no time to be wasted. With all the courage I could muster, I studied every word in the report in greater detail.

Metastatic – This meant that the cancer had already spread to the cervical lymph nodes…bad prognosis.

Carcinoma – Cancer…the big “C” in medicine that all doctors fear.

Poor differentiation – Poorly differentiated cells signify a bad prognosis.

Location of primary tumour unknown – We do not even know from which part of the body these cancer cells have originated.

All in all, the picture looked bleak, to say the least.

Then came the difficult task of telling my mother what the report said. There she was, waiting outside the Pathology Department. As I stepped up to her, she looked at my ashen face and knew there was bad news. I looked into her questioning eyes and uttered the dreaded words, “Mom, it is cancer.” She stood there for a while, taking in what she had just heard. If she felt any shock or fear, she did not show it.

As a half-baked doctor, I used all my medical knowledge to convince her that we needed to see an oncologist immediately. I tried to tell her that everything would be all right…that once we located the primary tumour, we could get it surgically removed…that chemotherapy and radiotherapy could destroy the remnants of the tumour. Even as I told her all this, I did not really believe it myself.

A quick appraisal of the report indicated that the disease was already in stage 4. How much can surgery help when the cancer has already spread to the cervical lymph nodes? Can radiotherapy or chemotherapy be anything more than palliative in stage 4 of the disease?

July 1997

Mom had always been a pillar of support for the entire family. Her diagnosis affected each family member uniquely. My father, though completely devastated, got busy with hospital visits and doctor’s appointments. My elder sister, unable to express her feelings, immersed herself in taking care of her three-month-old baby. My 85-year-old grandfather, who had come to terms with my grandmother’s death less than a year ago, could not tolerate this new shock. He passed away just two weeks after Mom’s diagnosis.

Then began the cycle of endless hospital visits, blood tests, X-rays, CT scans and MRIs. All pointed to one ominous diagnosis – metastatic adenocarcinoma of the lung, stage 4, inoperable.

The oncologists advised palliative chemotherapy and radiotherapy.

Mom faced her cancer diagnosis bravely. She started her radiotherapy and chemotherapy sessions with optimism.

In the late 1990s, the only medicines available for lung cancer were cytotoxic chemotherapy drugs. These highly toxic medicines killed the cancer cells, but they also damaged other normal cells of the body. This led to several side-effects – fatigue, hair loss, severe vomiting, loss of appetite, mouth ulcers, to name a few. As a budding doctor, I rationalised that the treatment prescribed was the best that could be given at that point, but as a helpless daughter watching her mother suffer, I wondered which was worse – the disease or its treatment.

My reflections 1:

Despair

Isn’t there anything better in allopathy?
Can somebody advise us about ayurveda? Homeopathy?

Something? Anything?
I am willing to try everything…
Is anyone up there listening?

Is there any hope? Or only despair?
Is anybody even sitting up there?

August 1997

The follow-up visits to the cancer hospital were a nightmare. The outpatient department was forever crowded; the waiting lists were miles long; and the doctors were extremely busy and often had very little time per patient.

After the initial chemotherapy sessions, I visited the medical oncologist with Mom’s follow-up reports.

My reflections 2:

Just another case…

The City Institute of Cancer Research,
The best of its kind,
Where people come from far and near
With hope in their mind,
A cure for deadly cancer
These poor souls hope to find.

I was among those poor souls,
Visiting the hospital that day…
Hoping that the chemo
Would have cleared the cancer away.

I stood in endless queues,
Through a long waiting list…
For that five-minute follow-up meeting
With the medical oncologist.

And when I finally met him
He glanced at the scan and said…
“At the most, six months…”
Then he turned and said, “Next.”

And there it was before me
The final verdict of doom…
I knew this was to happen
But surely not so soon.

I rushed out of the room…
Just like a soul possessed.
If you’ve never been through such a scene,
Believe me, you are blessed.

A request to fellow doctors
With due regard and respect…
To be a bit more sensitive
While announcing impending death.

You are talking to a human being
Not a nameless face.
It is someone’s dying dear one…
Not just another case…!

September 1997

Even though she went through all the prescribed therapy sessions regularly, Mom’s condition deteriorated steadily. The weight loss became acutely visible and more pronounced with each passing day. Then breathlessness set in. Symptomatic treatment and oxygen therapy gave her no relief. Mom would spend sleepless nights, sitting up in bed, unable to sleep due to breathlessness. This was followed by pain, which is often associated with terminal cancer.

Mom faced her disease with stoicism and courage. When asked how she was feeling, she would say, “I am okay.”

“How can a person be okay in this situation?” I would ask myself.

But Mom never complained about her condition or her pain or the struggle that she was going through.

She never even asked, “Why me?”

Then came that fateful night of September 26, 1997. Mom refused to eat that night. She said she just could not tolerate it. I brought her a glass of milkshake but she only had one sip. Little did I know then that it was to be her last meal.

She passed away peacefully in her sleep that night.

The end of an agonising battle against cancer…
An untimely demise at the age of 51…
A brave life lost…
A loving mother seized from her daughters by the cruel arms of death…!
Fondly remembered, loved and missed by your daughters every single day…
Always smiling…just like your name…
May your beautiful soul rest in peace, Mom!

Life after Mom

Mom’s untimely demise left a deep void in my life that could never be filled.

I struggled to cope with life after Mom. Relatives, friends and well-wishers extended their support for a while. But finally, each one of us has to fight our own battle.

At that time, my father was living and working in Rasayani, a small industrial town about two hours away from Mumbai. So I had to move to my medical college hostel.

I would stay in the hostel through the week and return home every weekend.

My reflections 3:

Grief

I put my key into the lock,
The door creaked open; the room was dark.
The windows shut and the curtains drawn,
One couldn’t be sure if it was evening or morn.

Just one little object cast a faint light,
Like a twinkling star in a pitch dark night.
It was a picture so warm and sunny,
The smiling face of my dear Mummy.

Smiling at me through all the gloom,
The radiance of her face lighting up the room.
Teaching me now as she did in life
To smile always, come joy or strife.

With tears in my eyes but a smile on my face,
I fondly recall those bright sunny days…
Filled with happiness and cheer, which in a time so brief,
Have given way to the darkness of grief.

Although I felt my world had collapsed, I had to pull myself together and move on with my life.

Having lived a secure and protected life so far, I was totally unprepared to deal with this new challenge that life had thrown at me. I learnt very soon that I was on my own. It was up to me to either struggle and survive or give up and perish. The choice was obvious…I chose to survive.