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It is not rare for me to see patients presenting with locally advanced breast cancer or metastatic cancer. Many times, I would wonder why they came in late. Till a few years back, I would judge the educated ones more harshly and enquire in my mind what education had done for them. I stopped judging them a few years ago especially after scratching their tough exteriors a bit! Six years ago, this elderly lady, speaking in impeccable English almost stumbled into my office. She was pale and weak and her daughter informed me that she had a bleeding ulcer in her left breast. I examined her and found a 15 cm large bleeding, ulcerated mass in her left breast. Her blood tests showed she was awfully low on Hemoglobin. I quickly arranged for a biopsy and also had a PET CT done, almost certain, that her disease would have spread. Thankfully, I was proved wrong. She was given blood transfusions and chemotherapy was started. She was an epitome of courage and went through her chemotherapy, surgery and radiation with a quiet resilience. During the course of her treatment, I asked her why she had presented so late. What she said shook me!She said she had a paralysed husband to look after and she had been doing that for the past 4 years. She knew about the lump and that it was growing. It is just that her husband’s need was greater. That is when the judging stopped. We may boast of a secure social fabric but many times we see these lone wagers, fighting their own battles. Their health becomes secondary. Life is not easy for many. Bless her!She is well. Her dear husband passed away 3 years ago and she runs an NGO to promote forgotten skills among women in rural Haryana. I am truly proud to have known her!
Cancer is often viewed as the end of the road in many ways, especially for the young afflicted with cancer. While the diagnosis of cancer, in itself, can be devastating for them, the consequences of treatment can actually push them further into a corner. One such situation arising out of treatment is infertility, a topic which was rarely broached with the young and old alike, till the recent past. With due care and sensitivity to these needs of the patients, it is possible to reverse a lot of wrong that treatment can bring in its wake! That brings me to the story of this young Champion I wish to share with you.The main protagonist of this story is a young Doctor diagnosed with breast cancer aged 26 years about 6 years ago. She was devastated! She was engaged to her sweetheart- a young Doctor training to be a surgeon. She was looking forward to a beautiful life when she was struck by breast cancer. This was more than what any girl her age could take. But she was different!She had spunk and was not willing to let go, of the life she had dreamt of. She soon collected herself to ask the right questions of her doctors. She wanted to preserve her fertility and after consulting an infertility specialist, had her ova preserved. She underwent treatment, thereafter and had breast conservation surgery followed by chemotherapy, radiation and 5 years of hormonal treatment, supported by her fiancé who stood by her like a rock.She was married to him soon after treatment. She is on follow up and all is well. The story doesn’t end here. She called me last week to share a piece of good news. She had given birth to a healthy baby boy two months ago. I was besides myself with joy and both of us laughed merrily over the phone. She came over two days ago with her bundle of joy cradled in her arms, her eyes overflowing with the selfless love of a mother. I could imagine what it meant to her. And this had happened naturally!! However bad the situation, life does turn up trumps on many occasions. These Champs give a new meaning to hope and I am wiser for it. If I am optimistic, you know where it comes from!! #health #breast cancer # breast conservation surgery #infertility #Max Hospital #Patparganj
Celebrated World Cancer Day (4th Feb), in advance, at Max Patparganj, today...Celebrated each patient’s fight against cancer. An amazing event, with barely place to stand but plenty of space in the hearts. While there will be reason to be morose and sad, there are many more reasons to be happy and live every day better than the last. My salute to all the Champions!!h
ARE YOU PURSUING A DNB IN SURGICAL, MEDICAL OR RADIATION ONCOLOGY? Are you a surgeon or physician aspiring to be an oncologist? If yes, then this is for you! ‘Max institute of Cancer Care, Patparganj and Vaishali presents C4.... Challenging Case Capsules in Cancer.. The competition , on 18th March 2018, at the Russian centre for Science and Culture, 24, Firozshah Road, New Delhi. This is your opportunity to learn and interact with potential examiners from around the country Know what to say and how much to say in an exam Test your preparedness in the Quiz prelims and stand a chance to play in the Final Quiz- Adrenalin Rush Each of you stands to win a prize! This is as good as it gets with many surprise prizes to win throughout the day and Cash prizes for the winners’ Here is the link to the Event https://youtu.be/vIMkQCpBtBo For free on line registrations please visit https://goo.gl/forms/FAMUNtwh9eyEjfne2
I was brought up in a middle class Malayalee family, extremely open minded about education ( like all Malayalees) but as close minded about display of any form of affection. I used to envy my north Indian friends when their parents would hug and kiss them, completely oblivious to being watched. It came naturally to them. By just watching this momentary expression of affection, I used to be suffused by an inexplicable feeling of warmth and also experience a certain positivity percolating into the environment. This seemingly innocuous expression of many positive emotions... love, kindness, a blessing, a prayer, gratitude, healing... came to be extolled as ‘Jaadoo ki Jhappi’ in Munnabhai MBBS. While I always believed in the magic of Jaadoo ki jhappi, it is my patients whose firm belief in its power to heal, that made my belief stronger. I don’t know when, but it has come to be a usual occurrence for my patients to walk up to me and almost ‘demand’ their Jaadoo ki jhappi. The awkwardness of my childhood has given way to the concerted belief that it does good to both the giver and the recipient. And that brings me to my dear Champion, Mrs C who spends time between Australia and India. She is having her regular checks post breast cancer treatment in Australia.She was here last week and waited for a couple of hours in the Outpatients for her Jaadoo ki Jhappi.And I was only too happy to oblige. If she believed it was healing for her, it was for me too! Isn’t it true, the more you give, the more you get?
Today I complete 22 years of marriage and I thought this an opportune time to look back at my life with satisfaction. My marriage was arranged by my parents through mutual friends. My husband is an engineer and the one time we met before the process began, he had decided and I was still unsure. I was trying to peer into the crystal ball, hoping to figure out how this arrangement would work for me. I was training to be a surgeon, not a choice many sensible women at that time made. The questions kept me awake- would he understand the demands of my profession, the late hours, the middle-of-the-night zipping to hospital to deal with an emergency etc? Would he understand my need to study further, maybe go abroad and work hard to give myself a full fledged career? His being an engineer did not help the cause at all. And then I stopped thinking and gave in to the wishes of my parents. When I look back at those 22 years gone by, I have plenty to be grateful for. For a woman to pursue a full fledged career is never easy anywhere in the world.What you make of it has plenty to do with the support you have. The support I had was truly unconditional. I completed my post graduation after marriage. My in-laws wanted me to carry on, unhindered, with my studies.FRCS soon followed with my parents chipping in to look after my little daughter. I went for a year long fellowship to London, leaving my daughter behind with my husband and mother in law. And did I stop? And did he stop me from pursuing my dreams? Not once! We are all imperfect in our own ways but valuing people for their strengths is what sustains relationships. His presence in my life has been the star and I can only wish him the very best that life has on offer!!
Breast cancer can catch anyone by surprise. Why I say that is because the usual history is a lump felt in the breast over a few weeks to a month or two or more. Apparently innocent as it caused no pain or upset the rhythm of life. It was just there! I identify with this extremely unpleasant feeling of being caught out or cornered or ganged up against, when this innocuous lump is declared cancer, almost everyday. How could a lump which was just there till yesterday change life indelibly? The grief that accompanies the diagnosis is unfathomable in most. The denial that follows and the unfairness of the situation is quite hard hitting. I, as a Clinician, after so many years of being witness to this familiar response, still find it hard to say something sensible to console, especially if the affected is young. It is almost as if I am on their side, a part of their family, going through this heart- wrenching sequence. When I am at a loss, the best I do, is hold their hands and say everything will be alright. I want it that way and no other way, as every doctor would. And it works! I liken the situation to being in quicksand. If you struggle too much with the situation, you get pulled in, the brain gets clouded and wrong decisions are made. If you reach out to a helping hand, gently ease yourself out with coaxing and cajoling coming from your loved ones, you make it! How one handles the situation has a large part to play in what the final outcome would be. We do not choose situations in life and some situations do catch you unawares. What you can choose, is your response to the situation- accepting it, making light of it, taking it in your stride and going through treatment with the desire to heal and bounce back, is usually what winners do!!
Yesterday I visited my niece and was on the phone talking to my patients, sorting things for them. When I finished, she asked me, ‘Isn’t your profession stressful?’ I was quick to say NO. The conviction in my tone has taken many years to come. I recall my early days as an oncologist and in particular, this vivacious young lady who had a relatively advanced colorectal cancer with involvement of her ovaries. She had undergone surgery elsewhere, 4 weeks prior to coming to our unit. Her abdominal wound lay open and was pouring out fecal matter and abrasive intestinal juices, consuming her skin.I could not come to terms with the unfairness of the situation, then. Why was this young lady with the most sparkling, hopeful eyes dealing with this horror? I wanted to pull her out of this mess and diligently did my best to improve her nutrition, take care of her wound and her medication. She and I would talk a lot- her dreams, her aspirations, her twins, her loving husband, her family...we became good friends! Her surgery was planned and executed well. She was recovering well and she wanted to be home to celebrate her twins’ birthday. I assured her she would. And then that day arrived, when she walked. She walked for the first time after 8 weeks. I was thrilled and went home thinking she would be out of the ICU the next day. I was going up to the hospital the next day when I got a call that she had had a cardiac arrest. I thought I had heard wrong. I ran up to the ICU and before I reached, she was gone. Pulmonary embolism had taken her away. I was distraught and I cried, rather howled, like I had lost one of my own.An elderly physician put an arm on my shoulder and said, ’ This is certainly not the last time you will have to deal with this. Don’t get attached to the outcome of what you do. Do your best but remain detached from the outcome’. Those words have stuck and I have grown since. My focus is entirely on what I can do for the person who sits across the table and entrusts his or her life to me. I do my best to understand the problem, execute treatment, handhold them and try and do whatever I can to make the experience as seamless as possible. Cancer outcomes are never a 100%. You do lose some at the end of the day but if I have contributed to making their life easier through their suffering, I have done something worthwhile. While it is easy to be overwhelmed by these difficult situations, I need to remain detached from them so that I can do more for those who need help. I have come a long way since, but it is not as if I am not affected by what happens to my patients, anymore. It is just that I have taken better charge of the emotional me and replaced it, not entirely, with the professional me!
Never too old to make choices Last week, I met this lovely lady, pushing 80 years. I’m reluctant to call her old for her lively demeanour would put the chronologically young to shame. How I met her was because she had been diagnosed with breast cancer. Fortunately for her, she had early breast cancer. This is a delight for a breast surgeon like me, who is used to seeing advanced breast cancer. After going through the investigations, it was decided that she should have surgery. I started discussing the surgical options and just as I would do with all my patients amenable to all the options, I discussed breast conservation surgery, mastectomy ( surgical removal of the breast)and mastectomy with reconstruction. She was quick in making her decision and said she wanted to have a breast conservation surgery. I liked her firmness but her daughter was not so sure. When the time came for her to be admitted, the daughter came up to me and said that she and her brother thought it would be better if she went ahead with mastectomy. It was surely concern for their mother. They wanted her to be disease free and also thought that at her age, it did not matter if she lost her breast. At the same time, they were not sure that breast conservation and mastectomy yielded the same results. I spoke to her again and said that her mother had made a choice, which was scientifically tenable .Ten years ago, my warped mind might have encouraged her to go for mastectomy. Now I know, choice has nothing to do with age.The instances when husbands, brothers, parents, relatives and anyone else( read neighbors!) influencing surgical decisions have been too many and every time, my heart has gone out, especially, to the young ladies who have had no say in the choices imposed on them.Losing a breast is a self esteem, body image issue- the loss and its impact is borne only by the one who loses it.The lovely dame stood by her choice and it was executed. Choices are not about being right or wrong. Choices are about the freedom to make a decision and stick by it. The comfort of having made one’s choice is a confidence booster and can bring about unexpected results. I do know that, for a fact!
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