The Fourth Sun Sign: From A Doctor's Diary

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1. Flame of the Forest

W

inter was weaning away and spring was just round the corner. The reserve forest in front of our home would soon be painted fire-red, with the new bloom of ‘Palash’, the Flame of the Forest. The buds already gave it a misty orangish hue, with promises of more. Soon, it would be red all over!

Spring always brings in joy; flowers, colours, honey bees, fresh soft air and the smell of pollens—a fresh start to new life, a promise of things to come, a renewed belief in the indomitable spirit of life.

The rush in our routine outpatients never seemed to cease—come spring or monsoon. The long queues of uncertainties were ever waiting. In that long queue stood a small family; a father, a mother, a boy, a small girl and one yet to come. Spring was almost over.

Santosh, the father was a worker in a horticultural nursery. Every day he tended seeds to saplings, nurtured them and made them into colourful beauties—the violet pansies, the red salvias, the pink poppies and many more. He was the master maker’s regenerator on earth. He was bringing nature to life, similar to what we were doing too—trying our best as doctors—bringing cure and hope and faith into the world of cancer patients.

Two months back, Nilesh, the son, started having uncontrolled fever—his father reported that on the first day of the outpatients. He had been getting weaker ever since. He became pale day by day, looking fairer by each passing day. A fortnight back, he suddenly had a nose bleed—quite profuse and Santosh had understood clearly that this was heading to something serious.

A local physician was consulted immediately and he asked for a blood test; the report showed very high count of blasts in the blood. Blasts are immature blood cells which do not come in circulation normally. It happens in cancerous infiltration of marrow. Santosh was advised to take Nilesh to the cancer hospital at the earliest.

After the registration, the family had come to meet me. The mother, Shantabai and Nilesh’s sister, were oblivious to Nilesh’s diagnosis. Santosh had hidden the diagnosis and the inevitable sorrow and anxiety that followed it, from the family. In that first consultation, I advised some routine procedural tests.

I said, ‘Santosh, Nilesh is most probably suffering from a serious illness. I need to do some more investigations before we take a decision about the treatment.’

Santosh kept the family waiting outside my outpatients, came in and asked me in a serious tone, ‘Sir, does Nilesh have cancer? Our local doctor said that he has blood cancer, is it true?’

I said, ‘Santosh, the initial basic investigations indicate that there is something grossly wrong with him. It can be cancer. I would like to get the bone marrow biopsy report and then let you know.’

Few weeks went by; Nilesh underwent a bone marrow biopsy and a test from his spinal fluid. A bone marrow biopsy is a test where with the help of a biopsy needle we take out a piece of marrow from the core of a bone, most commonly the pelvic bone. These cancer cells can also seep into the fluid around the spinal cord. Both indicated that Nilesh was suffering from a form of blood cancer called Acute Lymphoblastic Leukaemia.

It was very difficult for me to break the news to Santosh. However, I had to do it. I said, ‘Santosh, the reports say that Nilesh has blood cancer but…’ Before I could say anything further, Santosh broke down and started crying profusely. I offered him some water to drink and continued, ‘You have to control yourself, Santosh. You are the head of the family and the most responsible person in your family to take charge of Nilesh’s treatment right now. By God’s grace, this cancer is treatable and Nilesh might be well after the treatment.’

The family was devastated with the news. Santosh used to stare for hours at the small wooden rocking horse that he had got for Nilesh from his employer’s home. Ghoru had been a gift to Nilesh, when he was a little younger, two years back. The owner’s son had outgrown it. And now Nilesh too had outgrown Ghoru, who was passed on to his little sister. Life went on like this, as far as Ghoru’s ownership implied. Space, time and dimension, changed as well.

The precious family possession passed on from brother to sister, and in a few years would be owned by the little one, who was yet to be born. In the meantime, Santosh had become Nilesh’s live horse. His father’s back became Nilesh’s time of entertainment and bonding. Santosh came back home every evening, and it was an hour-long session of horse riding on Santosh’s back that followed. It was tiresome for Santosh, but he would never like to miss this session as Nilesh would also wait for this through the day.

Nilesh’s treatment started with very aggressive regimens of chemotherapy. It would be a long treatment; chemotherapy followed by radiotherapy, followed by more chemotherapy, as maintenance.

Shantabai too now slowly understood the gravity of the situation. She was educated by the continuous inputs that she got from the other mothers of the paediatric oncology ward.

I have never seen Shantabai talk much. She would always have her little daughter clinging onto her. Nilesh was a bit more self-sufficient. The passing months had suddenly made him more mature, more self-reliant, a tad bit early maybe because of the disease.

Santosh used to work all day in the nursery and would come every evening to the hospital. By now Nilesh was spending more time at the hospital, as the sessions of chemotherapy gradually progressed. Santosh continued ‘acting horse’ with Nilesh; perhaps, those were the only few times one could spot genuine joy on Nilesh’s tired face. Even the other children would look forward to this father-son playtime.

In my late evening rounds, many times I would see the couple sitting at the farthest corner of the waiting hall; sharing moments of togetherness. I do not know, what they discussed with smiling faces and tearful eyes. Crisis always brings out our innermost strengths and theirs’ was no different.

It was autumn, after summer and monsoon passed by. The dark sky slowly gave way to a spotless blue sky with occasional white cotton clouds. The dazzling blue, at times hurt the eyes. The tall grasses ‘kaash’ started to bloom with their flowers and painted the horizon white. The season smelt of the upcoming festivals and the anticipated joy that accompanied it.

Nilesh had finished his induction chemotherapy and achieved a CR, a complete response in his marrow and spinal fluid. Now, he would be going in for the radiotherapy course to his brain. He was much better by then and gained weight too. He looked like a little Buddhist monk, sans his robe.

Shantabai, by then was quiet heavy with her pregnancy. So, carrying around Durga, Nilesh’s sister all day was getting too tiresome for her. Durga started spending longer hours with Nilesh as a result. What the duo spoke and giggled about, I never knew. Their happy faces would inevitably bring a smile to my face, as I went around the ward, in the course of my day.

One fine morning, to celebrate the complete response, Santosh had brought me a small sapling of bottle brush from his nursery. Santosh said, ‘Sir, by the grace of God and your treatment, Nilesh has responded quite fast. I never thought that this day will ever come. You know sir, the word ‘cancer’ is so terrifying that I thought Nilesh will die. Shantabai has not studied much, so she does not understand all this. I had no one with whom I could share this sorrow. I am a poor man, so could not get you a good gift. This small plant is from my nursery. I will be very happy if you accept this small gift.’

I said, ‘Santosh, this is a wonderful gift. We love plants and I am sure this plant will keep on reminding me of you and Nilesh. Thank you so very much. This is a gift of love and it is worth more than anything to me. It is priceless.’

Santosh was visibly very happy. His eyes filled up with tears of happiness at my acceptance of his gift. He said, ‘Sir, I am so lucky that you have accepted such a small gift from us. You have given life back to our son; I can give my life for you. Sir, we are poor but our love is pure and true.’

I said, ‘Santosh, to me all patients are the same—rich or poor. Cancer too, is no different in them. I am very happy that I could do something good for Nilesh and add happiness to your family.’ I took the bottle brush plant home and replanted it in a porcelain pot with a lot of care.

The usher of early winter came with nature’s signature of falling leaves. A year had passed by and lest we forget, nature reminded us. Shantabai was now in her term and within few days, their family would see a new addition. Santosh met me often and kept me updated about Nilesh and his family.

Santosh used to accompany Nilesh for his maintenance course regularly. Nilesh’s disease was in full control by then. He had to finish his maintenance therapy and after that, be on a follow up. He was planning to join school in the next session.

I could see a few buds on the bottle brush plant. The leaves have turned dense green, sparkling in the morning sun. Spring was here and how. The foliage burst forth with new life, shaking the winter hibernation off with impatience.

I did not see Shantabai for a few months. Nilesh and Santosh would come on the appointment days and would leave after the treatment was done. I saw them in day care, from time to time. The therapy was going on even keel and there were more serious cases to be immersed in.

I got engrossed in my routine medical practice. Gradually, Nilesh and Santosh faded in memory.

It was a late summer evening, hot but with a little breeze picking up. I was always late in leaving the hospital after the administration work and evening rounds. While driving away from the parking lot, I saw a lady standing in the darkness with something in her hands.

The lone lady did not linger in memory, as I drove home. The bottle brush buds started maturing over time and we could see the red core, playing hide and seek.

However, every evening, while getting into my car, I spotted the lady, standing in the same place, in the gathering darkness. It was only after this happened for a few days that I realised that she was waiting for me and wanted to tell me something. As a doctor, it was not unusual to have off the line requests from patients, their families and friends.

It was a Friday evening; the sky was overcast with clouds of a nor-wester. Cool, damp breeze was wrapping up around me. The smell of rain, wafted in from somewhere far. It had been an extra tiring week. I was looking forward to a relatively peaceful weekend. I was planning to leave early.

In the parking lot, again the same lady was standing, with something in her arms, trying to say something to me. As I had left my chamber a little early, I was not rushing off to home. I finally thought of talking to her.

I went closer to her and saw a much known face, with the same empty looks, laced with gratitude. In her arms was a cloth wrap, with small soft hands and legs, playing and swinging in the wet air.

The lady was none other than Shantabai. Shantabai was still looking at me, slowly extending her arms, with the baby. I thought Shantabai wanted to show me her new-born baby. The little baby in Shantabai’s hand attracted my attention instantly. It was dark and I could not see it well. I said, ‘Is this your new-born baby? Come and meet me one day, I have some gifts for your baby.’ It is our custom, that when the seniors meet a new-born for the first time, they bless the baby with some money or gift. I started to move towards my car. But Shantabai stood still. I thought she has yet to tell me something. I turned and asked her, ‘Shantabai? You want to tell me something? I have seen you standing here for many evenings now.’

Shantabai shook her head in affirmation. Little raindrops started falling.

I said, ‘Tell me, Shantabai. Is Nilesh fine?’ Since, it was getting darker and the raindrops becoming larger, I wanted to rush to home.

Suddenly, I heard Shantabai speak for the first time. It was Hindi in a local dialect, ‘Saheb, this is Gauri. Nilesh is good now; started going to school. We wanted to gift Gauri to you. Please bring her up the way you want, make her a doctor like you.’

It started raining quite heavily, Shantabai ran to take a shelter under a shed, to save Gauri from getting wet.

I stood there, silent, for a few moments, paralyzed. It was the simplest yet most difficult form of thanks that came from a patient’s family. A gift of her child to the world of medicine. To add force to what we as doctors were tirelessly trying to accomplish every day and night, in every country. It was a mother’s selfless gift to the fight against cancer. What could I have said? As I slowly walked back to my car, I realised that I was soaked to the skin. I headed home with the simple plea ringing in my ears.

The bottle brush at home was in full bloom. It was red all over.

2. Genesis

T

he monsoon was in full swing. The sky was overcast with dark clouds, layer after layer, waiting to rejuvenate the summer-parched earth. The small hillock in front of my house had turned yellow by then. Every time after the first rain, suddenly it turns green with new grass, as downy and soft as a puppy’s coat.

With every monsoon, a small waterfall springs into life for a few days. It comes down, gurgling happily, over the rough rock-face, ending into the Gorewada Lake. It’s short-lived, but for the few days that it’s alive, our little spring lives every moment, not wasting a single thought on tomorrow. The continuous sound of flowing water was always mesmerising to my ears.

The lake would overflow at the end of the monsoon, submerging the vegetation on its bank. The water would turn muddy, affluent in flora and fauna. The fresh generation of spawn made the water murkier with their infinite swimming competitions.

Rain always brought joy to me. The smell after the first shower, the earthy smell wafting up from the parched earth, always made my senses come to life—almost like first love. It always happens in my line of practice, that of an oncologist—one blunts their senses and emotions. Hence, these moments of raw emotion offer a much needed respite.

In one of those cloudy days, came a small girl to my outpatients section; she had a swelling in her neck. It was still raining heavily, and Prathama, my patient, was nearly half drenched. Her father tried his best to cover her, but the strong breeze was not forgiving. Prathama, the winner or the first lady, as her name translated to, was her father’s pride.

A transistor, somewhere far away, with the world news on air, was reporting the 5.6 Richter scale earthquakes in Algeria