Down the rabbit hole : Cancer Research, Statistics, and Treatment

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Down the rabbit hole

Cherulil, Sreedhar Jayakrishnan

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Cancer Research, Statistics, and Treatment: Jul–Sep 2022 - Volume 5 - Issue 3 - p 533-534
doi: 10.4103/crst.crst_211_22
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It is now almost 3 months into this new journey. Three months in an alien world which I have always looked at from the outside with a sense of bewildered wonderment. Perhaps it was some manifestation of that almost infantile longing for the new and the shiny that attracted me to Oncology, or perhaps it was an innate sense of curiosity that has gotten me into far too many spots of bother to keep track of. My flirtations with the field were few and far between, and those experiences were hilariously inadequate for me to have even an inkling of what to expect once I ceased to be an outsider.

Malignancy, carcinogenesis, and genes—too many to remember or list—that pretty much summed up what I knew about Oncology from my undergraduate days; mere words, and hardly words that made much sense to the younger me. Then it was 3 years of General Medicine, that headfirst dive into the whirlwind that is our post-graduate residency. Countless sleepless nights, and innumerable dressing downs later, I walked out bruised and battered, but all the better for those experiences. The growth in confidence, the slow but obvious change in approach from the battering ram-like approach to treatment in my internship days, to a semi-refined “art of medicine” were the end results of the months spent in the intensive care unit (ICU), the countless patients seen in the outpatient departments, the highs and the lows. Yet throughout these experiences, from the tremulous uncertain hand that required help holding the needle for his first dialysis catheter insertion to being the hand that steadied another younger one on their first day in nephrology, from looking up in wonderment at the rapidity of decision-making in the ICU to being the one tasked with the same, I grew as a doctor and a person, yet there remained this gaping chasm in my knowledge, the great unknown. Oncology was limited to the textbooks. The rounds with our oncologist were always scenarios wherein we were privy to the smallness of our knowledge once again, the severe deficiency in our understanding of the process of diagnosis. The treatment of malignancies was a smarting wound that was hardly ever addressed during those 3 years. We did have the occasional tryst with the malady, brief sojourns into this unexplored avenue, bustling about in ways not too dissimilar to the blind men with the elephant in the fable. And as is often the case, mystery merely adds to the allure, and I was drawn toward the subject. At this juncture, a special mention is warranted of the one book which I can truly attest to as being life-changing in my regard. “The Emperor of all Maladies” by Sidhhartha Mukherjee. I had picked up the book a few months into my post-graduate life, but it had been left by the wayside as the waves of residency crashed into the shores of my life. During a rare peaceful interlude, I did manage to pick it up again and that was my first trip down the rabbit hole. The prose, the vivid imagery of a constant battle against a disease that has managed to trump our most herculean efforts time and again, the collective race against this unrelenting brutal force of nature, had me drinking in his words. A grudging respect grew in some corner of my intellect for this disease, for its unquenchable drive to survive. And it was perhaps thus that the seed was sown within my mind, that this was one fight I wanted to play my own small part in.

Fast forward to the present day; a book, and some woefully inadequate reading have finally put me on course to be an oncologist. And the budding oncologist is doing his ward rounds; the mad rush which had initially been a maelstrom of questions to which I had no answers has now become a haze I trudge through, swamped at the outset by an influx of information that threatens to send me spiraling into an all systems shut down, to the point that now patterns are emerging. Though far from being a facsimile reproduction of my erstwhile ICU days, I held on to the last remaining shreds of familiarity I could find and centered myself on those. But as time marched on, the words became more familiar, the “mabs” were seeming less like neologisms and more like recognizable medications, though the fact that there was always a newer one around the corner was not doing a novice like me any favors. Old words had begun to take on new meanings: MONALEESA was not just a lady in a painting with a quaint smile anymore, and CLEOPATRA was the queen of Egypt only on second thought, but it did not stop there—there was more unlearning and relearning to be done. The attention to detail required was taken up several notches and the speed of response was not something that afforded time for second guessing. As I fumbled through various protocols and lost sleep over neutropenic sepsis, there was a crucial cog in my education that I had forgotten and was rudely reminded of: the patients. Unlike any group of patients I had dealt with up to this point, the motley collection of human beings who confronted me had been fighting a battle that many knew within themselves to be one that would be eventually futile. Unlike any set of patients I had come across thus, hope was for a few better days, and maybe months in many; for them it was not just pain relief, for them it was the clarity of thought for another day.

It was another day in the slipstream of the hospital machinery, and as time sped on, the routine race against the clock to have seen all the patients was underway, and when it seemed like the patient was being stubborn, there was a curt reply in response. For me, that was but an innocuous incident. But to the man who was to receive the gravest prognostication, my curt reply was another blow to an already battered psyche. It was only much later, as the last vestiges of the day’s workload settled, and I could begin my second, and much less hectic rounds, that I saw the son of the same man, a man of about my age, with tears streaming down his cheeks, tears that he held back as I approached, and a conversation ensued, more of a man alone in a strange place venting his distress out than a caregiver with their doctor. It was during the course of that conversation that he conveyed to me that his father’s disease had progressed and there was no further treatment that could be offered to him. It was at that moment that I stood still, perhaps for the first time in the last 3 years. My earlier conversation with this man flashed through my mind, and the ever-present roar and din of the hospital ward dissolved into a silence that engulfed me. A single thought seared through my consciousness: to me he was a diagnosis, but the person behind the diagnosis was a man who had lived through years of treatment, a man who had seen his disease gnaw through him, who knew before our lab work did of what it would show. I had forgotten about him. And I might never have gotten a chance to apologize either. It was a restless night for me; yes, I did get caught up in the whirlwind of chores that will always catch up with you, but a lesson was learned: here, there might not be second chances.

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