Fight smart till the last strength.

Joy of Cancer (2002)
Author: Anup Kumar

The book's title sounds oxymoronic. How can one find joy after a diagnosis of cancer? The title itself prompts potential readers to pause and take notice. Many must have found that the book makes great sense, as it has become a recommended reading for those who wish to fight cancer. 

Indeed, it is natural to deny and to ask questions such as ‘Why me?' and ‘What did I do wrong?' while indulging in the blame game. However, these questions will not address the immediate and pressing danger affecting the patient. 

This describes the author's experience of successfully battling Stage IV lung cancer. In 2000, a suspicious shadow was detected on his chest X-ray during a pre-employment screening. Further tests confirmed his serious diagnosis. 

He was at the ebb of life. A highly qualified advertising executive with a postgraduate degree in nuclear physics, he had spent all his life savings on his daughter's wedding, and his previous employer had gone under. Moreover, his outstanding wages from his prior job remained unpaid. This was the main reason he sought new employment in the first place.

First and foremost, perhaps it is the butterfly effect. Life happens. One cannot expect a rational explanation for everything that occurs to us. It offers no guarantee that everything will be all right, either. Once one moves past denial, the quest for blame, and resistance, one can resign to the clear and present danger. In the author's experience, embracing the matter at hand, he made it his point to understand everything about his cancer, for his life actually depended on it. He wanted to be part of the battalion that fights the enemy. He worked alongside his cancer team, inquiring and clarifying his own misconceptions. He had to be completely immersed in the treatment regime. After all, it is his life they are dealing with. 

Friends and relatives mean well, but their eagerness to help sometimes becomes a nuisance. Repeating the already precarious situation time and again to relatives who are sometimes 'concerned’ and other times merely asking out of obligation can be exceptionally irritating, especially when the numbing effects of chemotherapy are in full force. In such situations, reclusiveness may be preferable. 

Scars and hair loss are temporary. Clutching at straws, he held on to whatever he could. Abstaining from noxious substances, eating healthily, and even chanting and listening to calming slokas played their roles. He had been a chronic smoker before. 

The last time I checked, Anup Kumar continues to live after undergoing two complete courses of chemotherapy, approaching each day with ambiguity and hoping it will be better than the one before. Not bad for someone who was given just four months to live in January 2000 when his diagnosis was first made. He advises maintaining a positive outlook from Day 1, investing in the right people, and creating a mind-body continuum to combat the illness, alongside the appropriate support groups. That forms a watertight battle plan. 

This work is licensed under a Creative Commons Attribution 4.0 International License.

Different narratives but the story is the same.

By Danielle Teller



Source: Quartz

21 JUL 2015 - 8:53 AM  UPDATED 21 JUL 2015 - 8:53 AM

Yet another story recently surfaced about how doctors don’t die like everyone else. Doctors die quietly at home, surrounded by family—not in the hospital like most Americans. This difference has been ascribed to knowledge about the limits of modern medicine and experience with the horror of lingering deaths on life support, and there is doubtless truth in those ascriptions. As a physician and writer, I believe that there is also another more subtle but equally important contributor, and that has to do with the stories we tell ourselves about death. 

The language we use about death is illustrative of our attitudes. We speak of fighting and overcoming disease, of courage and bravery, of beating the odds. We also speak of giving up, letting go, losing the battle. It’s as though we believe that death isn’t inevitable, that we have some choice in the matter. We even say to one another, “If I die,” and “If you die,” not “When we die”—as though our probability of dying weren’t exactly 100%. 

Our society has stories about deaths that are admirable and deaths that are not. The narratives aren’t just about people who jump in rivers to save drowning children or who are shot in an attempt at armed robbery. An airplane passenger who dies in a terrorist bombing is considered a hero, but if that same airplane passenger had died of a stroke before the terrorist boarded the plane, he would have just been considered unfortunate. Diseases even get different levels of cool points. Cancer is most often associated with the battle narrative; people who haven’t yet died from complications of their kidney failure don’t get to call themselves “survivors.” Heart attacks are easier to talk about than liver cirrhosis. AIDS was perhaps the most shameful way to die until activists changed the narrative, and now it is a noble disease. Breast cancer underwent the same gilding with pink gold thanks to activism. 

When I was in high school, my English teacher had us read a short story about a man whose brother had been killed by a falling pig. I have often thought about that character, about how complicated grieving can be if your loved one dies in a way that is socially uncomfortable. Death by falling pig is disturbingly comical, but grieving is also complicated for those whose loved ones have died from causes our society considers shameful, such as mental illness or addiction. It should not be so. A child who lost her mother to complications of schizophrenia is just as deserving of our sympathy as a child who lost her mother in the World Trade Center on 9/11. The manner of their deaths should not alter our opinion of the value of those women’s lives or the significance of their daughters’ losses. 

The narratives our society uses for death are not just a problem for surviving family members, they are perhaps an even greater problem for the dying. We want to believe that death is optional, so we don’t talk about it, and we don’t make plans for our deaths. When diagnosed with terminal illness, we focus on the fight, not on making our exit from the world as graceful as possible. When our family members are on their deathbeds, we show our love for them by lauding their courage, by not “giving up,” and by exhorting physicians to “do everything.” 

The secret doctors know is that the stories aren’t true. There’s nothing more noble about dying from cancer than from alcoholism. There isn’t a battle against death to be fought, just treatments to endure when the disease is treatable and symptoms to endure when the treatments are futile. Death has always been inevitable, but once their deaths are imminent, doctors just want to be comfortable and to spend the last days with family. It turns out that this is what most of us want, and we can have it if we can just bring ourselves to let go of narratives that don’t make sense and get more comfortable with the truth.

This article was originally published on Quartz. © All rights reserved. Distributed by Tribune Content Agency.

The uncertain journey of life..

Time warps for a young surgeon with metastatic lung cancer

By Paul Kalanithi
Photography by Gregg Segal

In residency, there’s a saying: The days are long, but the years are short. In neurosurgical training, the day usually began a little before 6 a.m., and lasted until the operating was done, which depended, in part, on how quick you were in the OR.

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Paul Kalanithi

Time at home. Time well spent

A resident’s surgical skill is judged by his technique and his speed. You can’t be sloppy and you can’t be slow. From your first wound closure onward, spend too much time being precise and the scrub tech will announce, “Looks like we’ve got a plastic surgeon on our hands!” Or say: “I get your strategy — by the time you finish sewing the top half of the wound, the bottom will have healed on its own. Half the work — smart!” A chief resident will advise a junior: “Learn to be fast now — you can learn to be good later.” Everyone’s eyes are always on the clock. For the patient’s sake: How long has the patient been under anesthesia? During long procedures, nerves can get damaged, muscles can break down, even causing kidney failure. For everyone else’s sake: What time are we getting out of here tonight?

There are two strategies to cutting the time short, like the tortoise and the hare. The hare moves as fast as possible, hands a blur, instruments clattering, falling to the floor; the skin slips open like a curtain, the skull flap is on the tray before the bone dust settles. But the opening might need to be expanded a centimeter here or there because it’s not optimally placed. The tortoise proceeds deliberately, with no wasted movements, measuring twice, cutting once. No step of the operation needs revisiting; everything proceeds in orderly fashion. If the hare makes too many minor missteps and has to keep adjusting, the tortoise wins. If the tortoise spends too much time planning each step, the hare wins.

The funny thing about time in the OR, whether you frenetically race or steadily proceed, is that you have no sense of it passing. If boredom is, as Heidegger argued, the awareness of time passing, this is the opposite: The intense focus makes the arms of the clock seem arbitrarily placed. Two hours can feel like a minute. Once the final stitch is placed and the wound is dressed, normal time suddenly restarts. You can almost hear an audible whoosh. Then you start wondering: How long till the patient wakes up? How long till the next case gets started? How many patients do I need to see before then? What time will I get home tonight?

It’s not until the last case finishes that you feel the length of the day, the drag in your step. Those last few administrative tasks before leaving the hospital, however far post-meridian you stood, felt like anvils. Could they wait till tomorrow? No. A sigh, and Earth continued to rotate back toward the sun.

But the years did, as promised, fly by. Six years passed in a flash, but then, heading into chief residency, I developed a classic constellation of symptoms — weight loss, fevers, night sweats, unremitting back pain, cough — indicating a diagnosis quickly confirmed: metastatic lung cancer. The gears of time ground down. While able to limp through the end of residency on treatment, I relapsed, underwent chemo and endured a prolonged hospitalization.

I emerged from the hospital weakened, with thin limbs and thinned hair. Now unable to work, I was left at home to convalesce. Getting up from a chair or lifting a glass of water took concentration and effort. If time dilates when one moves at high speeds, does it contract when one moves barely at all? It must: The day shortened considerably. A full day’s activity might be a medical appointment, or a visit from a friend. The rest of the time was rest.

With little to distinguish one day from the next, time began to feel static. In English, we use the word time in different ways, “the time is 2:45” versus “I’m going through a tough time.” Time began to feel less like the ticking clock, and more like the state of being. Languor settled in. Focused in the OR, the position of the clock’s hands might seem arbitrary, but never meaningless. Now the time of day meant nothing, the day of the week scarcely more so.

Yet there is dynamism in our house. Our daughter was born days after I was released from the hospital. Week to week, she blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks of her progress over time.

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Paul Kalanithi savors moments with his daughter, Cady.

Verb conjugation became muddled. Which was correct? “I am a neurosurgeon,” “I was a neurosurgeon,” “I had been a neurosurgeon before and will be again”? Graham Greene felt life was lived in the first 20 years and the remainder was just reflection. What tense was I living in? Had I proceeded, like a burned-out Greene character, beyond the present tense and into the past perfect? The future tense seemed vacant and, on others’ lips, jarring. I recently celebrated my 15th college reunion; it seemed rude to respond to parting promises from old friends, “We’ll see you at the 25th!” with “Probably not!”

Yet there is dynamism in our house. Our daughter was born days after I was released from the hospital. Week to week, she blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks of her progress over time. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing, an incandescence lights the room.

Time for me is double-edged: Every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence — and eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time, it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. But even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder, some days I simply persist.

Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.

Yet one thing cannot be robbed of her futurity: my daughter, Cady. I hope I’ll live long enough that she has some memory of me. Words have a longevity I do not. I had thought I could leave her a series of letters — but what would they really say? I don’t know what this girl will be like when she is 15; I don’t even know if she’ll take to the nickname we’ve given her. There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.

That message is simple: When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.

[Editor's note: Paul Kalanithi died March 9, 2015, at age 37. Here is our obituary.]



DAYS ARE LONG, YEARS ARE SHORT

Paul Kalanithi opens up about his battle with advanced lung cancer and how he is facing his mortality. Photograph by Norbert von der Groeben 

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44:08

Last Kiss

What do you tell a full grown man who is wailing? How do you console him for his loss? The loss of the apple of his eye, upon whose shoulders of all his unrelinquished dream, rested on. The loss of a 31 years young son who just reached the pinnacle of his youth with a whole brand new life laid downed before him to savour. The loss of a son who was just an anecdotal statistic in the doctor's file as an atypical presentation of cancer.

What do you tell a man who went beyond the call of duty as a parent to scout for the best of the proven and unproven modalities of treatment to annihilate the tentacles of the spreading crab? And spent his lifetime and retirement savings doing it...

Just when the tides were turning in his favour, the enemy struck back in vengeance in full throttle. He fought a good fight but lost the war and the battle.
What do you tell his parents to soothe the pain? That their son is now free of pain in a better place? That their son is so good that the Maker wants the whole of him? That the Maker likes him more? That the Maker knows best? That it is fate? That whatever happened for a good reason!#*@? That he would want a good farewell, rather than doom and gloom surrounding his departure?

"Why did it happen," the father asks. "Where did I go wrong? Did I not do something right? Have I not been a good person? Have I not paid my dues in alms? Have I not did my penance? Is it a punishment? What about my regular prostrations at the lotus feet of the Almighty for pleas of continued blessings and peace on Earth and my family? Is it a curse or is it karma?"
There seem to be more questions than answers. The departed may not be around in person. The memories of his existence on Earth would linger on forever. His physical body may be gone but not the moments that were spent with the loved ones.

With so many unanswered questions, he bends down to kiss the cheeks of his beloved son for the last time before the cortege leaves... on a long journey back...

When doves cry

A friend's 20 something son who has his bright future laid in front of his eyes and a female companion dying to share his life with, was bogged down by what was thought to be a minor ailment. It turned out to be not a minor disturbance at all. Beneath the triviality of its symptoms, lay the possibility of crab like tentacles of the big 'C'!
The mood around my friend's household understandably turned sombre overnight. 'Sombre' may be an understatement. Tears seem to be flowing freely, irrespective of age and gender. It is indeed disheartening to see a grown man of any age crying.
Why the crying you may ask?
Is it the fear of the imminent demise of the love one, the baby with whom many a precious moment was spent arguing? The arguing was well intended, though. The older wiser one, with his weather beaten bags full of experiences trying to impart what he had acquired after getting lost in the maze of life. The cry, is it because of the inability to ever, ever to connect, to touch, to grow old together is lost altogether?
After the initial denial, devastation, soul searching and final acceptance, the family, after rejecting mumbo-jumbo kind of shaman advised by well meaning relatives, has decided to go on full throttle crusade against the proliferating intruder with the strongest armamentarium known to mankind - Modern Medicine.

crab...

Thursday, July 24, 2008

July 24. One week after turning 45. Time to reflect on things again…

Bayan Baru auntie, I guess, must have been diagnosed with Ca Ovary Stage3B! Now undergoing chemotherapy. 3 years ago, she was complaining of tummy upset, planned for laparotomy but decided otherwise. A provisional diagnosis of cancer was there. The notion then was, once you put the knive on cancer, it spreads fast, so try alternative therapy. Cleansing, detoxifying traditional treatment so on so forth...
What we saw was an 85kg, 5ft 6in, lady with a big frame who had shrivelled up to 50kg!

Now on chemo...