Never Say Die

John S. Banerji, MD,

MCh (urology)

That’s a nice bright checked shirt doctor. Helps us feel chirpy when you dress like that,” quipped my patient. I quickly tried smoothing the nonexistent wrinkles on my neatly ironed shirt and smiled.

Here was an 18-or-so-year-old, bright, vivacious girl sitting up in a hospital bed with a colorful bandana on her head. For a moment, I thought we (my attending and myself) had made a mistake thinking she was a patient. Until Sylvia again broke the silence and said, “Good to see you Dr Chacko, yet again.”

We spoke about mutual interests and cricket (a quintessential sport played by a handful of nations in that part of the world) and about favorite foods and music. And, of course, we discussed the fact that it had rained on the previous day, in this otherwise arid place called Vellore (a sleepy town in the southern part of India), where temperatures during summer soar to around 100ºF and “toasting” has a whole different meaning.

Not once did we mention chemotherapy or cancer—which we were apparently supposed to discuss with her parents. The upbeat mood in her room contrasted sharply with the gray walls and the even grayer hearts of her parents who waited anxiously outside. It then dawned on me that we were about to discuss a last-ditch-effort chemotherapeutic regimen to combat her leiomyosarcoma of the uterus. Yes, this was a young girl whose life had been ravaged by cancer for the past 3 years. Despite the hysterectomy, omentectomy, colostomy, and failing fight, her spirit was unconquered.

She embodied that never-say-die attitude. Her bandana had been hiding a bald pate, where once was a luscious head of beautiful locks. Her boyfriend had given up and abandoned her even faster than her sarcoma had recurred. Yet, she stood tall among the ruins.

My next visit, the following day, was to inform her that my colleagues and I had discussed her case at length during a multidisciplinary meeting. She smiled and then rattled off all the names of possible people who might have attended that meeting—to which I replied in the affirmative. We had discussed more of the “poison medicine,” but only after further debulking of retroperitoneal disease.

She had undergone surgery, and we “successfully” got her retroperitoneum clear. Then she underwent adjuvant chemotherapy. Three months had elapsed since I first met her, but not once did her spirit wane. I invited her to my home, just before she was discharged, after what seemed like eternity to her. Here, she met another strong woman of courage with a never-say-die attitude—my better half. My wife, a neonatal nurse par excellence, had given up her career to be a full-time mom when I began residency. I saw very little of her and my newborn angel. All this took place while she was taking care of her terminally ill mother.

Days and then months rolled by. My daughter grew up, crawled, babbled, and then talked in what seemed like a twinkling of an eye for me. All of this happened before my eyes, but I seemed to miss it all as I was busy caring for sick patients. My wife often sat me down to discuss the fine balance of work and family. I was all ears even while nodding off to sleep most of the time because I was fatigued from days of little or no sleep.

I would often grapple with thoughts within me of how my patients saw more of me than my family. I felt it rather unfair for my loved ones, but I would thank God silently for giving me a “medical” person as a spouse who could understand and sympathize with the life of a resident.

Amidst participating in journal clubs and taking examinations, performing surgeries, and attending didactics, I seemed to have forgotten about Sylvia.

It was nearly Christmas. I could tell as I began to notice all of the cookies and festivity around. One day I received a Christmas card, neatly written and signed by Sylvia. The envelope was addressed to all of us. I was surprised Sylvia had even remembered my daughter’s name and had spelled it correctly. Well, Christmas came and went, and then on a warm March afternoon, I saw a couple of familiar faces outside the resident’s room. They were Sylvia’s parents. I shook hands and seated them, and then noticed the mother’s eyes moisten up. I instantly knew what we had feared all along had come to pass. Sylvia had passed away 3 weeks earlier and her parents had made the 1500 mile journey to inform me personally. They told me that she had written the Christmas card to me while in hospice, in considerable pain, but stoic as ever. Apparently, on the day she passed away, she asked her parents to vow that they would not grieve her death but support the fight against cancer.

It is the stories of such remarkable people that mitigate the sting of cancer. Sylvia knew that she had cancer but never for a moment let the cancer “have her.” She lived life to the fullest, giving hope and encouragement to young doctors like me and to similar patients ravaged by the “C word.”

It’s been 7 years. With more letters after my name and a few gray hairs, I have made many tough decisions, including career choices, which have taken me to the ends of the earth—quite literally. I pursued a fellowship in New Zealand and now am halfway through a uro-oncology fellowship in Seattle.

Through this eventful journey, I have experienced stark contrasts. The frailty of human life and the undying spirit of survivors. I have learned to appreciate the little things life has to offer. The warm sunshine, the smell of the earth before the rains, the feeling of sand through my toes at the beach. Amidst the hustle and bustle of life, I always take a moment to thank my Maker for health and for celebrating another birthday, and try my utmost to embody that positivity I learned through Sylvia early on in my career.