Losing your batch mates is a pain so intense that only those who have lost can relate to. And when you lose them to cancer it becomes all the more insufferable. Yes, one to lung cancer around ten years back and the other to esophageal cancer four years back.
Cancer is the most common diagnosis these days. Where earlier it would strike people more in their older age, it is now killing more young people than old. Early diagnosis and treatment remain the only solution. But in a country where breathing is as injurious as smoking, where food can get as toxic as pesticides, where people talk more about cricket and politics than going for a preventive health checkup, where governments invest more on elections than health, where alternative medicines never learn to accept their limitations and say no, but unscrupulously feed upon the failures of a scientific and logical system of medicine and get away with everything, let me tell you a little story…
She was just a 28-year-old woman wheeled into the emergency in a grave condition or in what is called medically metabolic acidosis. She had been making absolutely no urine for the last five days and all her parameters including her toxic look, laboured breathing showed the signs of failure to excrete metabolites, a sign of failed kidney. It was a shock to find her there. We had barely managed to send her to a cancer hospital through some contacts in the medical fraternity. She was a case of cancer cervix (cervix though being the mouth of the uterus, is a separate entity ) and now she was in an advanced stage with the tumour probably obstructing or spreading to her urinary system as well. The cancer centre, as was the situation with many enthusiastic government hospitals, were either overwhelmed with patients with no beds available or had paucity of other specialized service,in this case it was the lack of urologist and a dialysis unit, leaving patients with not much choice but to wander in search of an equipped and affordable hospital. However, they rarely coexisted. She needed treatment of her kidneys before any kind of therapy could be started for her cancer cervix. Unfortunately, in a well equipped multispecialty private hospital, the cost of staying in an intensive care sometimes became more than an average Indian’s annual income. For those who didn’t have any insurance back up, life didn’t offer them a guardian angel either.
I looked at her worriedly.
‘Please take her to a government hospital. Get a dialysis done and stenting if needed and then go back to your cancer hospital.’
She took off her oxygen mask with an effort that betrayed the fluid accumulating in her lungs and spoke breathlessly, ‘I cannot do rounds of government hospitals anymore, ma’am.’
Her words tore at the heart but did she have any choice?
Her husband had gone for financial counselling. Leaving a message for him to meet in the OPD, I quietly left.
For the last two years, she had been doing the rounds of infertility clinic, desperate for a child. Her preliminary examination which included a PAP smear early on was totally normal. Subsequently, she was caught in vicious cycles of hope and despair which any patient, whom God has deprived of the pleasure to procreate in an otherwise over populous country like ours’, would identify with. She was fast losing up the last vestiges of her sanity. Her husband, a truck driver remained her pillar of support. Yet the cost crunch of endless rounds soon caught up with them and she stopped coming after a few months. But then some three months later she came again with dyspareunia and abnormal discharge. An unhealthy cervix was seen and investigated, soon confirming, much to the horror of everyone, frankly invasive cancer cervix.
Cancer cervix is leading cancer in Indian women and the second most common worldwide, the precancerous changes start early, usually in her twenties, once the women are in a relationship, and if undetected and untreated turns into a full blown cancer by the time the woman is in her 50s.
There are several good things about this cancer. It is cancer that has a known etiology, HPV ( Human Papilloma Virus), with a known mode of spread i.e sexually transmitted though unlike other STIs (sexually transmitted infections) it is not fully protected by condoms. Knowing the etiology, also makes available an effective vaccine. It also has a very good screening test called PAP smear which identifies it some twenty years ahead at a precancerous stage making it amenable to prevention and early treatment.
Living in an era of sexual liberalisation, those into an early initiation of sexual activity or multiple partners, the prostitutes, prison inmates, wife’s of truck drivers, or others in similar professions staying away from home or those attending STI clinics were especially in the high-risk group.
Yet despite the familiarity with the disease, it continues to flourish, unabashed and undeterred making a mockery of modern medicine and all advances. Most of those who suffered rarely made to the hospitals in time. Educated women, even doctors hardly turned up for their PAPs smear in time. Maybe it was a feminine trait, their own health ignored and suffering, buried under the ever increasing pile of housework.
Even among prime-time shows, there was only one portrayal of protective behavior or comment regarding STIs for every 25 instances of sexual behavior shown. This epidemic was one result of our sexually saturated culture and the myth perpetuated by academe, medicine, psychology, and our government that latex, contraception, vaccines and big pharmaceutical companies could make all sexual behavior risk free.
The news was met with frosty resistance. It is when you are faced with a disease as grave as cancer that you realise the apathetic country that we live in especially for those who have little money, no contacts and no insurance. For the first time that we had met, they broke down. Sadly I couldn’t offer them anything beyond a free advice and reassurance. But there were acquaintances in the government hospital with whom we fixed her up with. Her cancer could still be managed at this stage and have a fairly good outcome.
It was a shock that replaced surprise when she was wheeled into the casualty some six months later. All our efforts to put her up in a government cancer centre had gone down the drain for she had decided to go to some self-proclaimed Ayurveda doctor, who assured her of guaranteed cure. She followed their ill-defined medications with a sincerity that was totally out of character. Six months later to her immense joy she turned out to be pregnant. She thanked her stars that she had not given in to getting her uterus along with her ovaries and everything else that made her feel feminine removed at the government hospital. Her worse fears weren’t over and she was now radiant with happiness.
But cancers follow their own whims and no one else’s and have a habit of thrashing all hopes.
Cancer connived with her destiny, and together they rolled out a dangerous plan for her.
Putting a break to her dreams, one day she started to bleed. Her supposedly ayurvedic doctor, used words and blessings more than medicines to treat her and some precious days later, the futility of it all sunk on her and she was forced to visit the hospital again.
A cancer cervix with pregnancy is definitely not desirable, however desperate one might be. She appeared to be around five months pregnant. But an ultrasound begged to differ and simply showed a malignant uterus which had overgrown and aborted her dreams of a successful pregnancy. The treatment of the cancer was now going to be more difficult and prognosis equally bad. But surprising on her part, there was no remorse or regret for missing out on her treatment, neither was there any anger or disappointment directed at the doctor who had promised her a cure.
This Indian psyche of relying on traditional and alternative methods always baffled me. Maybe the allopathic system was expensive but it was scientific and logical. It never promised fake dreams or gave false assurances. Yet it bore the brunt of any failure and treatment, whereas others walked away with accolades despite minimal effort and maximum side effects, in a majority of cases. A few days back there was a patient who had developed a cataract in both eyes following medicine given for asthma in an ashram.
She was still better than this very slim 26-year-old with early pregnancy, who had undergone a surgery for avascular necrosis of both hip joints. Steroids are known to cause this but she denied taking any such treatment. It was on much prodding that she hesitantly admitted that she had always been keen to put on weight and she had visited many hospitals but to no avail. Frustrated she went to a ‘desi’ clinic. They gave her some medicines to gain weight. The improvement in weight was obvious and yes, I didn’t need any tests to confirm that it was steroids that found their way, unethically into her hip joints, permanently destroying them.
Maybe it was their own guilt that prevented people from taking action against such rampant abuse of their faith. As a dear colleague once pointed out it was self-reproach. Steroids were something like ‘burning your house to kill the rat’ yet they were being used injudiciously by quacks causing cataracts, diabetes, decreased immunity, weak bones and muscles, obesity and many other unforeseen complications. However such clinics flourished under the knowing eyes of the lawmakers, sometimes just in the name of tradition to be kept alive rather than developed!
Possibly these alternative medicines started where modern medicine ended. They thrived like hungry parasites on the failure of modern medicine without working on their own. Yet the final destination to all these false havens were not the ashrams but the hospitals in a condition beyond treatment. Yes cured they did, but only the body of all the earthly sins and misdeeds and sent them on their final sojourn.
The sound of somebody sobbing brought me back to the present. Her husband stood with red shot eyes
‘The cost of keeping her here would be beyond my means. Yet how can I let her die?”
‘Why didn’t you take her to the government cancer centre?’
‘ I wanted to ma’am, but she insisted to visit the other doctor. My family had blind faith in this man and supported her.’
‘Who was this doctor?’
‘Actually, I don’t know. She was taken there with a relative.’ He was clearly evasive
There was nothing unusual about this. Till date, these ‘doctors’ enjoyed anonymity whereas in the hospitals, even a well-meaning treatment had gone wrong would get plastered all over the media, easily labelled as money grabbing and greedy.
I sighed deeply.
‘I tried to fix you up at the government centre. I can talk to my friend again.’
‘We went there too, ma’am. But there was no kidney specialist there. So they refused to take us up there.’ He continued with his eyes downcast, ‘ Now, we will have to do rounds of other hospitals again. It will take us so much time, and they mightn’t accept us or beds may not be available.’
‘This is now an emergency. You take her direct to the casualty. I don’t think any good hospital will refuse.’
He suddenly remembered. ‘We had got her card made at this government hospital. Can I take her there?’
The hospital he named had a good urology and dialysis unit. I fervently hoped they had a spare bed in the ICU too.
‘That’s a good idea.’
‘Actually, we had been there earlier, got all papers made too, but then my mother-in-law died, so we couldn’t get her admitted. Later we dropped the idea and started going to this other doctor.’ He admitted hesitantly. Regret was as transparent as the tears that spread in his eyes. Maybe it was the lack of faith in evidence-based medicine that they got so easily lured by the promises of a supposedly traditional system of medicine.
But had he any inkling that cervical cancer was a sexually transmitted disease? It was not good to be judgmental and neither was it easy concluding who brought the disease between the two of them but his profession, as a truck driver definitely put him in the high-risk group. In all probability, he would continue to transmit the disease in future to other women also. Would the realisation make him more guilty? Guilt made a poor companion.
Safe sex is sex with your faithful spouse! If only we were we not slaves of our own behaviour!
A pair of brimming eyes stared back. He was suffering too.
Precious time had been already wasted, and this was neither the time nor place to speculate. Life, whatever was left, offered not many options and he had no other alternative but to shift to a government hospital. I couldn’t do much either, except sympathise with him and help him through my contacts.
He promised to keep in touch. They were soon shifted to another hospital. She was neither the first patient nor the last one to suffer from cancer but she made me sad. It was the loss of such a young life. I wished desperately that we had somehow a system in place that could enforce people to comply with their preventive check -ups and treatment and hold people accountable if they deterred. If only we developed our indigenous systems scientifically and they learned to accept their limitations. If only we knew when we crossed that nefarious line of no return, if only we knew when and where we went all wrong! But then if wishes were horses the beggars might ride.
Photos from the internet.
#WomenWellness #CancerCervix #HPV #STI #WomenHealth #CancerInWomen #PAPSmear #DifferentTruths
Tripti is a practising gynaecologist at BLK Super Speciality Hospital, New Delhi. Many of her writings are influenced by the pain and suffering she sees as a doctor. Her forthcoming book ‘The Chronicles of a Gynaecologist’ is being published by Bloomsbury India. She also has an anthology of poems,‘The Dewdrops..a journey begins’. She contributes poems and stories to many publications.