Author: Dr. M. Suneetha, Radiation Oncology
Dying and death confront every doctor, particularly if their chosen field is oncology. But nothing had prepared me for the insurmountable tragedies that confronted Sarojini, a 55-year-old patient, diagnosed with breast cancer. A large number of my patients often wonder why were they afflicted with the dreaded disease while in case of Sarojini with all the miseries that were directed at her, malignancy appeared to be a very small obstacle.
The first time I met Sarojini she had come with her entire family – husband, daughter and son. They belonged to an upper middle class family and everyone was quite anxious about her. In spite of being educated, Sarojini had neglected the lump in her breast since she didn’t experience any pain. By the time she consulted me it had increased considerably in size and was painful. Her family physician had recommended a biopsy which confirmed malignancy and then she was referred to us.
The investigations confirmed that she had a local disease. It was a straight forward case of breast cancer. We decided upon breast conservation surgery and only the lump along with a part of the normal breast tissue surrounding the tumour was removed and sent to the laboratory for pathological examination. In the final report it was found that the tumour had spread to the axillary glands which increased the risk of a relapse, hence she was advised to undergo 8 cycles of chemotherapy followed by radiotherapy to the breast. She was found to be a triple receptor negative patient following the test which predicts the sponse of patient to hormonal therapy and therefore hormonal therapy was not advised. Thankfully, she didn’t experience much side effects except for the usual bouts of nausea, vomiting and of course, hair loss.
Since a triple negative patient has high chances of relapse in the first two years, I had asked her to come for regular checkups so that even if the disease returned we would be able to tackle the tumour, immediately. However, it seemed life had kept quite a few hurdles eserved for her. When Sarojini came for her first followup after three months I was taken aback by her wan face instead of the bright smiling one I had come to expect. I was shocked when her husband said their daughter, unable to bear domestic abuse, had committed suicide. She had left behind two daughters. I tried my best to console her but there was hardly anything I could say to alleviate their grief. There cannot be a greater tragedy than parents outliving their children.
The next time I saw Sarojini, it was after two years. Once again, I noticed her pale face and thought perhaps she was still grieving. This time both the husband and wife broke down in front of me. Even I was in a shock when they confided that they had lost their only son in a motorcycle accident. His marriage had been fixed but the wedding was postponed several times because of certain issues. I could not find any words to console them as they cried over their loss. The saving grace was definitely that the marriage had not taken place and the young girl had escaped the trauma of being widowed.
However, Sarojini’s woes were far from over. A year later, she came in along with her sister and this time she did not have to tell me the reason behind her pallid complexion. The empty forehead, without the customary bindi was indicative of the latest tragedy that had befallen her. I just wondered how fate could be so merciless, robbing her of the loved ones, one after another. Her husband who had been a rock solid support throughout her ailment had passed away following a cardiac arrest. Once again I realized how helpless I was to assuage her emotional pain though I could try and alleviate her physical discomforts. But then, I thought she had lost everything she had; there was nothing else to lose.
And how wrong I was! Sarojini came for her next checkup and we discovered she had bone metastasis, in other words, the disease had spread to her bones. I decided upon palliative radiotherapy to her backbone to give relief from pain. She was also given second-line chemotherapy to ease her pain.
Next time, Sarojini came I was surprised to see the smile back on her face. She was accompanied by an unknown gentleman and they seemed to be quite close. Imagine, my surprise when she introduced him as her husband. He was her colleague and had witnessed the tragedies that had overtaken her life. A widower, he had proposed marriage to her even though he was aware of her circumstances, including the spread of her disease. She had initially turned him down but he, along with their common friends, convinced her to take a second chance.
Amazed by the turn of events I looked at her husband and asked, “Is it sympathy for her that led you to propose marriage?” Pity and sympathy are two things which I absolutely detest, particularly when they are directed towards my patients. He replied, “I admire her for her strength. She is a strong woman, much stronger than I am. She faced so many losses in her life while I could not cope with the death of my wife. At our age, marriage is not for sex or for society but only for companionship.”
I asked him what would happen if she died, and he replied: “I will be happy to add life to years and not years to life.” Wordlessly, I saluted the couple in my heart as they left my chamber. They had kept on looking for that rainbow at the end of the dark clouds that had once engulfed their lives and found happiness in each other’s company.