The young man sat outside the Ashram. It was a beautiful place, incongruously fitting for its purpose – a home for terminally ill cancer patients.
He sat there, oblivious of the beautifully maintained gardens, the exotic plants and the cooling sea breeze on the hot morning in May. A brown paper packet lay in his lap which he fingered absently-mindedly. He had made up his mind; he was just waiting for the sisters to open the gates.
Two small urchins darted across the large imposing Ashram gates. Their shrieks of laughter completely overshadowed their obvious poverty. One of the beaming children was a thin, scrawny, wisp of a girl, totally involved in the fun of the moment…
His mind went back a couple of months where a similar, poverty-stricken, slip of a child was pushed into his Out Patients Department. At first glance she appeared to be about four years old. Her OPD papers revealed that she was nine. In stark contrast to the beaming face outside the ashram, this child’s expression had a distant, resigned look. Her intensely sad eyes were devoid of tears. And, much as he tried to cheer her up she maintained that look throughout his examination.
The reason for her sadness was immediately obvious. There was an ugly tumour growing out of her face. It has completely engulfed the tip of her nose and the left nostril. The unsightly bulge in the left cheek removed any hope the man harboured of the disease being superficial and restricted to only the skin.
A year ago her father had taken her to a doctor in her hometown, where an unsuccessful attempt was made at removing the tumour. As all her previous records were lost the first obvious step was to confirm the diagnosis and to determine the type and aggressiveness of the disease; a biopsy needed to be performed. For this a small sample of the tumour had to be taken under local anaesthesia. The procedure though minor and relatively painless is usually frightening for most small children. Screaming tantrums borne out of fear and apprehension rather than actual pain are usual, and most doctors are prepared for them. In this case, however, he was taken by complete surprise by the child’s reaction.
There was not a murmur from her throughout the procedure that lasted a few minutes. Her stoic, sad face was almost mask-like and the only evidence of the terror and fear bubbling within her was a single tear that forced itself out of the corner of her eye and rolled expressionlessly down her cheeks.
While concentrating on the impersonal chore of assessing the extent of the disease, he longed to do something to bring a smile to the face of the child.
The biopsy report confirmed his worst suspicions of an aggressive, potentially lethal tumour; a high-grade sarcoma. She would require multi-modal treatment consisting of a combination of surgery, chemotherapy and radiotherapy. Even then, the expected chances of survival were not favourable. Coupled with this was the fact that she was poor. Her father, the only earning member of her family, was a simple labourer, who earned just enough to sustain a day to day existence. There was no way he was able to afford to pay for the treatment.
Though the man’s heart went out to the child, he was careful not to show it. He maintained his distant, professional attitude. After all, that was one of the unwritten dictums of medical training— “Be professional and detached, only then can you function efficiently.”
The next few weeks were hectic. Hospital admission had to be arranged. Social workers hearts had to be melted sufficiently to waive hospital fees. The uncharitable city of Mumbai had to be scoured for financial aid.
As the treatment became more aggressive and traumatic his resolve to remain detached wavered. He decided to get the child a gift. A doll he thought, one of those new Barbie dolls I bought my daughter last week should do the trick. Just the thought of buying the child a gift made him feel good. And he often fantasised of her joyful expression when he finally handed over the doll to her.
The girl went through the entire trauma and uncertainty of surgery, plastic surgery and subsequent adjuvant cancer treatment with the same mask-like acceptance of her fate. Though not a tantrum was thrown; not a smile ever crossed her face.
And though his intentions were good, for some reason or other the doll was never bought…
…The brown paper bag slipped from his lap and brought him back to reality with a jolt. He bent down and picked it up. Opening the flap he peered at the gift-wrapped parcel within.
He had specially chosen a similar doll to the sari-clad one he had given his daughter earlier. He turned his gaze back to the ashram building.
His mind’s eye went past the gates and the well-maintained lawns. Past the dedicated nuns with their terminally ill wards. Till he could ‘see’ her lying weakly in bed, unable to even sit up, her frail body ravaged with disease.
He knew she would enjoy the gift. It may even bring a smile to her lips; a smile that for so many months refused to surface. All he had to do was go across and deliver it.
Indecision however, racked his mind. What would people think? It was a totally unprofessional thing to do. On the other hand who will know? All his colleagues say that one should never get involved. Stay professional and dispassionate at all costs, they say, once you start getting involved you will wind up a nervous wreck and you will never be of any good to any of your patients.
Maybe they are right he decided. Impulsively, he beckoned the urchin girl and as she curiously approached, he tossed the paper bag with its precious contents to her. Not waiting to see her amazed reaction he walked dejectedly through the traffic towards his parked car.
The next day the child finally succumbed to her disease. True to form she did it peacefully and no one even realised till someone decided to take her pulse. Even in death her expression remained unchanged –sad, distant, without a smile. As if she knew all along that same people who pride themselves on the time and efforts they spend for their patients were strangely unwilling to offer the simple gesture she needed most.
This story is based on fact. I really did have a patient “a thin slip of a girl” who did have high-grade sarcoma on the face. Her attitude in the beginning was exactly as I described it. It was at this stage that I conceived and wrote this story.
However, this is also where fact deviated from fiction; and for once—favourably!
[At the time of writing this update] it has been about five years since treatment was initiated and on her last visit there was no evidence of recurrence. It is still too early to start celebrating. But every disease-free day that passes brings fresh hope and expectations.
Just for the record, I did buy the doll and give it to her when she was admitted, months after her surgery, for one of her chemotherapy sessions. The change in her expression was worth travelling miles for. Initially there was distrust, the look on her face said “This parcel probably contains some of that dreadful chemotherapy stuff you have been tormenting me with!” When she finally opened the gift wrapping, the smile that lit her face was something else!
We can’t play God. Very often we just have to accept the uncertainty of a particular situation and manage as best we can. At these times it is unbelievable how powerfully a simple gesture can pierce the glare of a busy, impersonal world.