TheLiverDoc™@theliverdoc
FISHES
My patient, Srijan is visibly in pain. It is not the kind of pain where you ask a patient and they tell you an "yes or a no." It is the kind of pain that you need not ask about, because the pain is visibly palpable. He can barely sit, barely shift positions while seated and needs to think whether he really have to use the bathroom even when his bladder was bursting at the seams. Because getting up from that "least worst" comfortable position required not only physical prepration, but mental strength too, because the low back pain was death itself, but without the liberation.
Srijan's sister Nandini's husband, Sumedh is my patient. He has been, for over three years. When I first saw Sumedh in 2020, he suffered from unstable cirrhosis. With need for repeated fluid removal from the abdomen, to treatment of nearly fatal infections and a disastrous episode of blood vomiting, the cause for cirrhosis was hepatitis C virus (HCV) infection. With the advent of science, the HCV virus, from a dark, undefeatable boogeyman became a Sunday lunch picnic-basket when direct acting antivirals (DAAs) were introduced as new armaments against HCV. With DAAs for only 6 months, Sumedh was cured of the virus and his cirrhosis went back to being stable and meek as a kitten. He survived. Survives.
Sumedh nearly saw death, and the knowledge and rational use of medical science in me & many doctors like me, bring patients at the brink of death, back to their families. I do it, we do it, because we live for it, are trained for it and our duty as healthcare workers embraced by scientific medicine is the only hell-crushing obstacle between patients and death. Nandini hoped that Srijan could be saved too.
But Srijan will die. And the medical science in me will be used for something else, an aspect of clinical medicine that no one really talks about, but should, an aspect of clinical medicine that every doctor must learn and apply at every oppurtunity they get even when it gives you new scars in a corner of the heart every single time - comfort care as palliation.
Srijan was not supposed to die. But he will, because he has stage D liver cancer. The cancer has spread to his spine and hip bones, where, as they eat through the calcium and the marrow, the excrutiating pain will keep him awake at night, deprave him of his sleep and depress him to the core, when at some point, he would find his 52 years of life on Earth meaningless, his family dispensable and thoughts of killing himself would become his friend.
Srijan was not diagnosed with stage 4 liver cancer. In fact, he was diagnosed with stage 2 cancer, but the lack of faith in scientific medicine, the misinformation on chemotherapy and constant exposure to fearmongering through false narratives on social media and from lay folk led him to opt for safer treatments. He chose Homeopathy. And for two months, the Homeopathy practitioner, who has no idea about anatomy or physiology of the liver, no clue about staging and prognosis of liver cancer, no idea about the pathology and immunology of liver cancer and who has never successfully treated any disease other than the ones that go away on their own, gave false promises of a cure. In 2 months, Srijan went from a completely downstageable, curable liver cancer patient, to one where I was going to give comfort care.
The cancer will not kill Srijan. Homeopathy already did that. And I was just the ferryman, going to take him to the otherside, giving him hope & ensuring him that his life was not wasted. That he was loved. He was needed. He will be missed. I have nothing to offer Srijan, a stranger whom I just met. I have nothing to offer, other than the bitter truth which I have to make him accept with kindness and compassion and help him make purposeful choices for the time he has left.
And I will do that, by not demonizing him for the grave mistakes in healthcare choices he made. I will not demonize him by telling him, that every bodily attack that he was going to face from the progressed cancer - from aggressive infections, to vomiting blood and passing black tarry stools with the stench of corpses, to getting repeatedly tapped of the fluid accumulating in his abdomen to help him breathe better and ultimately, the liver coma that is going to take his life, was his fault. It was not his fault. We created him. Our society, with its indoctrination in science-denialism did that. He was the victim.
And I will help him, by comforting him about the fact that he was not the first one, and he wont be the last, but stories like his, will cease to exist one day, because I and others like me, will fight for people like him, who are misled to their deaths, when they had more life and living, to gift their families.
You may ask me, why the fishes? Because watching them move around, comforts me. They look calm and swim free and knowingly, they would not jump out of the water, until someone or something took them out. Srijan would not have knowingly jumped the waters, if he knew that medical science would have truly set him free. To live longer. To cherish every moment with glee.
Srijan will die without seeing his grand children and I will die a little inside, knowing that, he could not.
Post script: Srijan underwent the first (of his many) palliation procedure that will ease the severe pain from the bone metastasis considerably. A recent technological advancement called stereotactic body radiation therapy or SBRT which delivers radiation safely, without conventional side effects. Srijan's first request to me was that he wanted to sleep without pain for at least a few hours at night. And I pormised that he will. And after SBRT, he did, after so many weeks.
