“Would you like us to speak in Hindi or English?”
“Hindi would be nice,” she says gratefully, although she speaks adequate English too.
We need to discuss her cancer, although I suspect that when she hears the word “incurable”, she won’t absorb its companion – “manageable”. Nonetheless, I try. Turning the computer screen towards her, I point out the tiny nodules of disease that we will endeavour to keep like that. Her major organs are fine and her fitness will stand her in good stead. Speaking mostly in Hindi interspersed with English, I explain that we will see a lot of each other.
“So, nothing bad is going to happen right now?”
“I really don’t think so.”
“Aaj apna aadmi mila,” she sighs, her whole demeanour exuding gratitude. The literal translation means today, I found my own kind, but it doesn’t do justice to the depth of feeling conveyed.
That was a long time ago, during a chance meeting in clinic. Over the ensuing years, she stayed remarkably well. Nothing moved, nothing spread. She swam, shopped and socialised, and visited me regularly to discover that she was as stable as she felt. It was a pleasure to see someone uncomplicated in disease and person.
One day I walk out to find her in the waiting room trying to catch my attention.
Every Indian mother I know harbours the fear that her adult child cannot cook and that this conspicuous failing threatens the very survival of the next generation. My mother, an exceptional cook, reckons that one cannot be a good oncologist and a capable cook, hence the first question of the day is still, “And what will the children eat?” After many years I have gently conceded the point as her cooking is a win-win for all.
“Doctor, I hope you don’t mind that I made you something,” my patient says.
At her last visit, she had discussed visiting India, which led me to casually mention that my own parents were there on a holiday. It never crossed my mind that an Indian patient would automatically pair “mother away” with “no food” and set about to rectify the problem.
A little mortified, I take charge of hot, immaculately packed foil containers of chicken curry, seasonal vegetables and rice. My first glum thought is, “She doesn’t even trust me to cook rice,” but I cast aside my embarrassment when she explains how much pleasure it brings her to do something for me for a change. She reminds me to store the food in the fridge until I go home, and I thank her profusely for her efforts.
“Choti si baat hai,” she says, beaming. It’s a small matter, she is saying but actually, it speaks volumes about the generosity of strangers. It is amazing how people who should be caught up in their own worries somehow make time for others, and I find myself fervently hoping she will always stay well.
One day I tell her that I am taking leave to study abroad.
“I hope I live long enough to see you back,” she says, frowning.
No false assurances, I think. “I am leaving you in good hands.”
A year later I return to the inevitable reality of loss. Advanced cancer during a pandemic has been an insufferable blow to many; slowly, I call loved ones to express my sympathies. The process of tracking down and “readopting” my living patients takes time so I am pleased to see her name on my list.
On the morning of her visit, the weather turns wild, with heavy rain and damaging winds. A sudden thought strikes me that she will want to come bearing food for our reunion.
Fearing that she might lose her balance carrying containers, I call to warn her but there is no answer. Feeling silly but concerned, I call her son, who immediately recognises my voice. I start by saying that I am looking forward to seeing her but he must dissuade her from bringing any food.
“Doctor, when did you get back?” he asks.
“Then you wouldn’t know – Mum died just days ago.”
It is a maddening failure of modern medicine that it falls to relatives to tell the doctor that a patient has died. Communication from disparate systems, or even from within the same hospital, rarely makes it across, leaving long-term providers in the unenviable situation of being caught on the back foot and at risk of appearing uncaring.
Gulping for air, I throw him under an avalanche of questions. What happened? Whom did she see? How was she before she died? Who was with her? Did anyone predict her decline? What was the cause of death?
“Doctor, I wish you could tell me. I have no idea.”
His raw grief and total helplessness pull me short. I realise that sandwiched between consecutive and exhausting lockdowns, unable to freely visit facilities or consult doctors, he is not the only relative in the dark, and asking him to satisfy my curiosity is painful and counterproductive.
I quickly pivot to reminiscing about his mother and her many acts of kindness. I ask him to remember her agreeable and content days despite the spectre of illness and I praise him for his devotion.
I am flooded with regret at the unceremonious ending to a rich association. But really it feels like just one more regret to be added to a long list accumulated during the pandemic, in whose name so much patient care and communication has been compromised.
To stop to think of the mental toll on patients, carers and providers would be to risk breaking down. I type, “Patient did not attend as she recently died. Called son, offered sympathies.” The note feels farcical but its finality is necessary.
At the end of the day, someone quietly says, “I guess that wasn’t a visit and there is no bill.” In the public hospital, it is rare to be asked about a bill – I take it simply as another expression of the closure we all need.
I think of the hundreds of times I saw her and how nice it would have been to hold her hand one last time.
“That definitely wasn’t a visit,” I agree as I walk out.