Against all odds

Yesterday (12th February) was a special day in the Orthodox Church calendar- Remembrance Day of all who departed from this world. (It almost coincided with Maha Sivaratri of 18th February when Vavu Bali is carried out for the departed souls. Was it a coincidence?!)

?During the sermon, the priest metaphorically mentioned that he could see many more people than those who are physically present. He could see the sprits of ancestors departed from the earth. I couldn’t resist looking around with the hope of “seeing” some of these souls. Suddenly my eyes caught on Joseph (name changed). While the entire congregation were sitting on the floor, he positioned himself on a chair by the wall. I rubbed my eyes and looked whether I’m seeing the real Joseph or his spirit.

?I had a flashback of an event occurred over thirty years ago. It happened in my village during a summer holiday while undergoing the surgical training in the UK. Hearing that there is a foreign trained cancer doctor in the village, a senior family member of the Joseph household came to find out whether anything can be done for the dying Joseph. I profusely apologized stating that I have only started my surgery training and that too in the head and neck surgery, and not qualified to make any recommendations on kidney cancer that Joseph was suffering. My mother who was listening to the conversation wouldn’t accept no for an answer. I didn’t have any no option but to follow the orders. We walked about two kilometers to his house located two hills away from ours; carrying my stethoscope to look professional.?

?On the way I found out more about Joseph. His family recently moved to our village to work in a newly started electronic factory. To establish his loyalty to the village, he was involved in several village social activities. Church became his second home. Every day at the crack of the dawn he would be there to light the candles, cleaned the premises on Saturdays to get the church ready for service the next day. His faith in St Behanan- the patron saint of the church was unshakable.

?Mr Joseph walked into a city hospital with the complain of blood in urine over a year ago and came out in a wheelchair. Joseph had undergone nephrectomy (removal of kidney) for renal cell cancer.

?I was taken to Joseph’s dimly lit room. Could see the frail curled up body of a middle-aged person. I looked through his neatly filed medical records and noted that he had stage-1 renal cell cancer. I made few inquiries about his well-being and any symptoms associated with disease recurrence. Clinical examination that followed revelated no untoward findings.

?The operating surgeon had informed the family that he has done everything possible, and being cancer, unable to predict outcome. Joseph has been mostly lying down in the bed ever since, awaiting his fate. The family accepted the fate, and Joseph became a passive recipient of care. The villagers extended their support caring for the dying cancer patient. Joseph, although not been directly informed the prognosis, assumed that he belonged to the departed souls. And claimed every day as bonus day given by the blessings of the patron saint, St Behanan, who is a healer of incurable diseases.

?Flashback of my general surgery posting in urology wards came through. It certainly did not make any sense. The cure rate of stage-1 renal cell cancer is over 90%.

?I explained my dilemma to the Joseph household. With their permission, I called the surgeon who operated to understand whether there was some error in the documentation. Being the first renal cell cancer surgery, he had done, his memory was vivid. The surgeon appeared to be rather perplexed to learn that Joseph was still alive. Since he couldn’t find any reasonable explanation for survival, he took solace in the supernatural- “It must be my beginners luck”. On his guidance obtained scans, chest x-rays and few blood tests, which all came back normal. Armed with the normal scan reports and other investigations and recently acquired knowledge by reviewing by surgery textbook, I was excited to inform Joseph and family that he didn’t have any evidence of tumor. This happy news was met with blank, melancholic faces. Their thoughts had been entrenched in the belief that cancer is fatal.

?So there I was facing Joseph, alive “against all odds”, and against the belief of everyone, from the doctor who treated him, his family, the community, and above all Joseph himself. ??The challenge here is how to reverse this deep-seated delusion.

?Remembered attending the Cognitive Behavioral Psychotherapy lessons in my medical school. The key is earning trust and anchoring the faith on immutable fact(s). During that one month long summer holidays, decided to test these principles. Afterall nothing worse can happen. I started with explaining the medical facts that stage-1 renal cell cancer is curable, connected him with others in the village who got cured of cancer, demonstrated his physical ability to walk and to do day-to-day chores. Also explained that even if the death is imminent, by worrying it will neither be hastened nor delayed. None of these worked. What finally worked was the advice for him to serve his patron Saint Behanan during the rest of his life. On the last Sunday of my holiday, the frail Joseph made an appearance in the church, to the surprise of the parish. Perhaps because of the special attention that he received, the old habit of being regular to the church came back.

?At the end of the Remembrance Day service I inquired Joseph of his wellbeing. The deep entrenched fear of cancer was still there. “Against all odds” Joseph is still alive. The irony is that its easier to cure cancer that the fear of cancer.