The absurdity called life

A couple of weeks back, something terrible happened to a dear friend. He broke his femur bone while out on a run on what looked like a fine Saturday morning. The incident was so bizarre that it left all of us wondering about the uncertainty  of life. The femur (the bone connecting your hip joint to your knee) happens to be the strongest bone in the body. It is very difficult to break it even if you are in a serious road accident.  My friend while jogging spotted a partially open manhole and swerved to try and avoid it. While doing so, he toppled on the sloped road. That’s really all that happened.

Next thing he knew, he is bed ridden with a huge cast, and a metal rod running through his leg in parallel to his femur with a million uncertainties about when he can begin living life as he knew it. He is by far the most social person I know, an active trekker and an extremely outdoorsy sort of guy.

This incident left me disturbed for several reasons, but primarily for the pain that such a dear friend has to go through. It also bothered me because it seems that the life that we so carefully try and put together is nothing but a bundle of absurdities. From childhood we grow up on a diet that life is some sort of a challenge with increasing difficulty levels. If you play your cards right, consistently do the grunt work, that challenge will start shaping up into a beautiful symmetry.

So since childhood this is what I did. I kept at it, telling myself that I will do better tomorrow. I always had a vision for a purposeful life, a life where I do work that I want to, and am in relationships that are meaningful. Obviously, my life was far from perfect but then there was always this lure that it will turn a corner. Brick by brick, I was putting together a life that was promised to me by important adults (successful people, celebrities, etc.), magazines and movies. And then came the news that rendered all of this meaningless. That made no sense and in a way told me loud and clear who’s the boss.

So today here we are, my friend and I and so many like us who have suddenly been thrown off the track wondering what to do next. I am not suggesting this in a sad or depressing way; far from it. If anything I am amused by it. These few months in my life have helped me unlearn many things I’d learnt about life. Today I just felt like putting together some of it.

1. You can only control as much in life: This is especially significant for control freaks like me. We may sit down to plan things to the minutest details but then one has to remember we are not living in isolation. Our lives exist within larger ecosystems and they all have a say in what will happen to us. We are a generation who are fed on a diet of "if you put your mind to it, you can achieve it". This
may be good for world progress and economic development but forgetting human frailties is stupid.

2. Cultivating acceptance will help us in the longer run: this can begin slowly, but acceptance like many other things is a habit that gets better with more practice. Some may feel it is a passive view of life but I truly believe that in the times we live in, change comes quickly. So the longer we take to accept things, the more it would hurt us. A meaningful life is also a life more accepting of sudden disruptions.

3. Find an anchor, and make friends with it. An anchor is what keeps us grounded, and gives us a sense of safety. It can be a relationship or a practice like meditation or running or playing a musical
instrument that you can go back to in troubled times. There should be something that you can turn to
in such times. It helps.

4. Keep ticking items off your life bucket list on a regular basis: Don't put too many things off until you reach a fictional life milestone (like getting a promotion, completing a degree or some such). Keep doing things that you like on a regular basis. Life cannot be lived in capsules of long weekends and mandatory leaves. Every week or so, there has to be something you do that enriches your life.

5. Make life a balance of now and the future: I read about this interesting research study many years back which said that after a devastating event like a terrorist attack or a natural disaster, people's consumption go up. People fear the uncertainty of life and that motivates them to buy that 50 inch TV that they had long been unsure about. There is a certain comfort in planning the future and
let's face it, not all of us are going to die or will have health scares or accidents. Even for such times, the planning that we so meticulously did earlier comes in handy. Having said that, life needs some
today’s and some tomorrow’s. Certain things can't be shelved for too long or they may never happen.

6. Do Good: Such a simple piece of advice but really we all are interdependent on each other more than we would like to be. We are often so immersed in our own drama that we fail to extend our help to a friend, colleague, acquaintance or a total stranger. I guess the good we do to each other is the single factor holding all this together. So do good, even if you are never going to see its returns. It's the rent we are paying for our time on the planet.

That’s all that I can gather right now. If you are reading this, please say a prayer for my friend’s recovery.
A!

An ode to Tata Memorial Hospital.

I am now done with two chemo sessions and for everyone who’s enquiring about it, I have this to say - So far, so good. I will write about my experience in detail probably after 3 to 5 cycles are done. I expect that by then, the side effects would have manifested quite a bit, and I would have a better sense of how I feel.

Today I want to write about something that has touched me in so many ways. It's about the hospital where I’m undergoing my chemotherapy.

Tata Memorial Hospital (or Tata Memorial as it’s popularly called) is a love story cast in stone akin to the Taj Mahal. In 1932, when Lady Meherbhai Tata died of leukemia after treatment abroad, Sir Dorab Tata decided to establish a similar institution in India. However, he too died soon after, but the trustees carried his mission forward and Tata Memorial Hospital, the Taj Mahal of Medical Sciences was born in 1941. You can read more about it here.

It is rare to find someone in India who hasn’t heard of TMH. In fact, the moment you utter the word cancer, TMH will soon find its way into the conversation with anyone you speak with. My first choice of a hospital to get treated (although strongly recommended by many people) was actually not this one. It was the hospital in my vicinity where I had my lumpectomy.That’s where I stumbled upon my surgical oncologist. Incidentally he spent many years working at TMH before moving to this hospital. I had my surgery done by him and then wished to start my adjuvant treatment under his supervision. My surgery went extremely well and my plastic surgeon completed the reconstruction with the finesse of an artist (another doctor I highly recommend not just for his skills as a surgeon but also for his gentle ways).

Life however had different plans. My tumor was HER2 positive. This meant that aside from chemo, I’d have to take an additional drug (called Herceptin) for several months. This drug is bloody expensive, with each dose costing much more than all the other medication that I’d be consuming. So on one of my appointments, I had a tough and painful discussion with my oncologist to get an estimate on my medical expenses. That is the backstory to how my relationship with TMH began.

While I write this post, I realize how hard it is to summarize my impressions in one single post. There’s so much that happens in TMH on so many levels.

TMH is located in central Mumbai spread across a large area. It has two wings, a general and a private. The treatment and medicines there are very subsidized, much more so in the general ward compared to the private.The first thing I’d noticed when I’d been there the first time was how sprawling and well maintained it is. Also, they’ve really tried to streamline things as much as possible. When you register yourself as a patient there, you first need to get a patient card made. This sort of card is probably what the government of India was aiming at when they launched the Aadhar card scheme.

This card that you make is your debit card and repository of all information about you. Payments can only be made through this card and the card is linked with your patient page that has all your details on their portal. My personalized portal doesn’t just display my basic details. It also has all my reports, my treatment plans, my treatment updates, everything.So when I am shuttling from one department to another, all that the personnel needs to do is to key in my ID number or scan the card and she would get all the details on her screen.

There is no way TMH could have survived without such smart use of technology. It is thronged by people from not just all across the country but the rest of the Indian subcontinent too (Bangladesh, Nepal, etc.). It may as well be called a mini Indian subcontinent for the sheer number of people present here at any given time.

One may wonder how a hospital can maintain its quality when dealing with such large numbers. I did have similar questions and that’s probably why this wasn’t my first choice. Would my doctor give me a patient hearing when she/he has so many patients waiting in line? Would it be too overwhelming to be surrounded my so many cancer patients of all ages, etc?

Let me try and deconstruct the doctor-patient part of my experience here. TMH has different sections for different type of cancers that straight away makes both the patient and the doctors’ job easier. It takes hours for you to reach your doctor as is the case for most of the things that happen at TMH. There would be 2 or 3 oncologists of the type that you are seeking and you could be sent to any based on where your file is.

You will first be seen by the residents who will note your history/ progress/ concerns and then be seen by the senior doctor. The residents remind me of one's I see on House M.D. or Grey's Anatomy as they seem to be bright, concerned and forever mumbling some research study or the other under their breath. When you see the senior doctor for the first time, she will spend some time with you in explaining the current status and the approach they would be taking. I have seen 3-4 doctors at TMH and have barely felt rushed. When you are an old patient and the concern that you came for is not so significant, it is possible the doctors’ impression will be conveyed to you through the resident.

TMH is in no ways is an easy experience to have. The fact that it is one of the few affordable cancer specialty centres means the volume of people seeking its services is forever more than any establishment can handle. One has to wait for everything for hours, from billing to meeting doctor to buying medicines or getting tests done. The access to doctors is not easy. Unlike your doctors in other hospitals, you won't have their numbers. It’s futile to call reception in an attempt to connect with them. Still every patient you interact with has so much gratitude and respect for the hospital they are in.

Most medical professionals (doctors, nurses, technicians) in TMH appear competent. They may not be the most pleasant people you interact with, but one will rarely feel shortchanged. I believe when one is at ease with the quality of treatment, the other things start bothering you less. The other thing that helps puts things in perspective for every patient who visits TMH is the awareness that so many of us are going through a similar experience .When I see patients braving the long waits and even sleeping on the footpaths for accessing the general ward, I feel what those of us in the private wards experience are really first world cribs.

Cancer is a seriously expensive disease. TMH makes it possible for so many people to access high quality and reliable treatment at a very reasonable cost. If this is not philanthropy of the noblest kind, I don't know what is. 

The medical team that works there must be constantly overworked because of the kind of numbers they attend to.I will not make tall claims that I have not met staff who didn't yell at me or weren’t impatient. If I was anywhere else, I don't think I would tolerate it. But at TMH, you empathize with not just your fellow patients, but also your doctors and nurses. They are reaching out to so many people in need, we can surely cut them some slack.

I guess TMH is not just a place where I access my treatment, it is also where I learn to look beyond me. It is a place that has already taught me immense patience and to be grateful in the most imperfect location.

I want to wind up this long article with a heartfelt thank you to the group that has not just given us one of the finest medical institution in our country but made it accessible to so many.

And miles to go before I sleep..

Last ten days have been pretty monumental. I again felt a lump in the reconstructed breast. Went to see my plastc surgeon, we decided to do a sonography and then what followed was nothing different from last time. My Cancer is back. It is in the same reconstructed breast but on the other side. The stage, how it feels, how fast its hradening is all similar to what happened three months back. The first time it happened, my doctor decided to do a partial removal of breast (Lumpectomy) and once all the diseased part was removed, they reconstructed it using muscles from my back. Post that I was advised to start Chmeotherapy etc. which I decided to opt out of. I instead was undergoing an Ayurvedic treatment for last two months.

This time things are different. Since the disease has come back so soon, they feel there is no option but to remove the entire breast (Mastectomy). They will do a complete reconstruction at the time of surgery. Before the surgery, I have been advised to start Chemotherapy, to shrink the tumor and ensure that the cells don't spread. I will be starting with Chenotherapy from next week. 

As one can imagine, there are so many feelings, emotions, thoughts that I am going through at this moment and all moments before this. The first and foremost being the nature of the disease and how I may have to embark on a path that I could never own completely. In the past ten days so many people have asked me that obvious question "But why didn't you do Chemotherapy". Some even had the tone tantamounting to " Are you stupid?". I wish I had an easy answer to that, even if I had, it is highly likely that the message will be lost in translation. I know a lot of you may be curious to know If I regret my decision now?. Honsetly not even one bit also this incident has not weakened my faith in the world of healing that is outside of allopathy. The choices that Cancer patients have infront of them are far from perfect. If you don't do anything you may die, Chemotherapy and Radiotherapy come with their bag full of side effects (side effects varies from individual) but are a patients best bet. The world of alternativee therapy is so vast andso fraught with inconistencies that finding a treatment that suits you and one you can trust is a challenge in itself. What makes these choices even more difficult is the uncertainty involved with all this. Cancel literature is full of people who have been miraculously healed and also who succumbed. There is no surity for anything. You can do nothing and survive and you may do everything and still die. 

I believe our decisions speak a lot about who we are as people. Where are we coming from. Having been disease free most off my life and developing a healthy relationship with my body has given me the confidence of its power to heal itself. I also understand that I must embrace my treatment and acceept it completely for it to work. May be it is time for me to loose my judgements about Chmeotherapy. This is what I need right now and I am hopeful this time I would not lie on the right side of statistic. Even if I do, thats allright. I am reminded of something my friend said to me when I asked her if I will succumb to enormity of this. She said " I know it is going to be difficult, but if I know someone who can rise above all this; it's you". 

So for now, I am making friends with Chemotherapy. Everyone's experience of it is unique and hence I am stepping into it with a clean slate. I know so many of you have been constantly praying for me. Let me tell you, even if does not seem so, it's working. I have never felt so grounded and grateful in my life. Like they say " Whatever doesnt kill you,makes you stronger."