Two years ago my father-in-law was diagnosed with Renal Cell Carcinoma (RCC). At this time my wife & I were living in Hyderabad and my parents-in-law in Guwahati, in the North-east of India. They had come down to Hyderabad in a hurry: my father-in-law had lost a lot of weight, was running a fever and his sugar was dangerously high, a cause of even greater concern, since he was diabetic.
Over the past several months he had been through a period of poor health: first, he had been diagnosed with spinal tuberculosis, then with a prostrate enlargement and then a urinary tract infection. He had spent many days at the hospital, and was tired of hospitals.
The day he arrived in Hyderabad, he fainted in our house, splitting his lip and breaking a tooth. We rushed him to one of the finest private hospitals in Hyderabad, where over the course of a month he was diagnosed for RCC and operated upon, a partial nephrectomy of the left kidney.
During that time, I spent many evenings with him after work, staying over at the hospital for the night. My two recollections of the time spent in the hospital were: stepping out each evening, with a tinge of guilt, for chai, samosa and biryani at the fantastic Sarvi Bakery opposite the hospital; and watching the Cricket World Cup matches along with my father-in-law in the TV in his hospital room.
I still remember the finals of the world-cup: as we were watching India’s captain Dhoni run down the chase late in the evening, a patient emergency bell started buzzing shrilly in a room somewhere down the hall. After five minutes of incessant start-stop-start-stop of the bell it suddenly fell eerily silent. I stepped out of the room, and the corridor was deserted. The nurse station was empty, the nurses were watching the final of the cricket match somewhere; the Dr. on duty was also absent. Finally, someone came hurriedly, wanting to get back to the match, and I told them about the bell — thankfully, the patient who had rung the bell was fine, and was just buzzing to remind the nurses that it was time for his sugar to be tested.
That incident, compounded by the apathy of the nursing staff and supercilious attitude of the doctors left me feeling less than happy about the hospital. The doctor who was operating was supposed to be one of the finest urologists in the country, and so we stayed on. Finally after a few weeks my father-in-law was released from the hospital, on the road to recovery. The doctor proclaimed the operation a success, and told us that we could relax — the cancer had been excised from the body, and nothing further needed to be done.
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Fourteen months later, my parents-in-law visited us again. We had moved from Hyderabad to Chandigarh, my father-in-law was healthy, completely recovered from the cancer. We decided to get a routine check-up done: he hadn’t had any specific tests done since moving back to Guwahati, the Dr. hadn’t recommended any.
The test results were a rude shock. The cancer was back, and it had spread — left kidney, perhaps the right one too, the muscles on his left and some lesions in the bone. My wife was distraught, and we went through a few days of painful guilt for not having followed up, for not having asked him to get any more tests done.
We didn’t tell my wife’s parents about the test results — we didn’t know what the right thing to do was, whether to inform them or not.The hospital we got the tests done from was a fine private hospital in Chandigarh, and we were asked to meet the urologist there. The meeting with the urologist was very disturbing — his outlook for my father-in-law was dire. He told us that he couldn’t be operated upon, given his diabetes and already weak kidneys. He then told us that there were medications we could consider — but all he spoke about was the price of the medications (very expensive in India), not about their effectiveness.
My wife and I went back home, and after the initial few days of shock and paralysis, we got into action. We decided to consult the best hospitals in India. We wrote back to the hospital in Hyderabad to get the sample of the tissue they had taken — they were supposed to have given it to us, but hadn’t — and then took the sample to one of the finest cancer hospitals in India, in Mumbai, where my parents lived.
My father and I got the test results that identified the cancer, and then waited in the hospital all afternoon for our doctor. The doctor who finally came in was not the Dr. we were supposed to meet, but a junior Dr., who spent five brusque minutes during which he told me that he needed a fresh biopsy and that we should admit the patient before anything else could be done. The meeting was over.
My father and I moved on to the next hospital — the doctor we were meeting was of legendary status, in his eighties and supposedly with a magic touch. The meeting with him was equally brief — he looked us down from his imperial nose and told us, “Medicine is all science, I can’t tell you anything unless the patient is admitted”.
I then went to Delhi, where my wife and I went to a private hospital where a friends father had been treated. The hospital building was big, clean and white, and we met another specialist doctor here. The meeting with him was better: he gave us his time, explained the facts, but in the end, he told us the same thing, that we should admit my father-in-law, they would do a biopsy and then could determine the right course of action.
Four hospitals, and the same advice — it doesn’t look good, admit the patient so we can get a biopsy done and then figure out the next course of action. My wife and I discussed repeatedly about which hospital we should consider, without getting closer to a conclusion. We didn’t feel great about any of these private hospitals, the doctors all seemed very busy and brusque, impersonal and not really involved in the details of the case — they seemed more interested in having my father-in-law admitted to the hospital than in discussing his case with us.
At this time, I had also written to my cousins husband, who is an oncologist in the US, and he had sent us a fantastic document that explained renal cell carcinoma in detail, the different medications and courses of options we had. He also suggested that we consult with a doctor at PGIMER — the Post Graduate Institute of Medical Education and Research — right in our backyard in Chandigarh.
Now, PGI is a public hospital, and public hospitals in India have the reputation of being good, but also crowded, with serpentine queues and notoriously long waits. We were wary, but we had heard of PGI more than once, that it was a teaching and research hospital, a public hospital that didn’t have any financial motivations, and we thought “What the heck, let’s give this too a shot.”
The signs on our first visit to PGI didn’t look positive. We had to wait in a crowded hall, where there were about two hundred people and maybe fifty seats. Many people, mostly poor (since public hospitals in India are mostly free or highly subsidized), were squatting on the sides of room, and there were even some patients in stretchers on the side. We had to wait a couple of hours, till we finally pushed our way into a small room — perhaps 50 square feet — where there were two junior doctors on either side of a table and about ten waiting patients in the room.
However, our conversation with the doctors was really good — despite the other patients in the room, the doctor we met gave us his full attention and time, reading through the entire medical history of my father-in-law before suggesting that we meet the senior doctor in the adjoining room, an even more crowded room.
We met the senior doctor, and I was amazed at his ability to pay attention to us as though we were the only people in the room, a complete presence to my father-in-laws case, as though this was the most important one in the world.
This doctor, about forty perhaps, of quiet voice and a small smile, made us feel very comfortable. He smiled, and said, “So, you are well educated, both of you — you must have read up all about this on the Internet, what do you think we should do? Should we start him on Sunitinib or Pazopanib?”. He asked us for the earlier biopsy report from the hospital in Hyderabad, examined that, told us that we should get another biopsy done, but that in all likelihood my father-in-law would be started on a course of medication. He asked us if we had told my wife’s parents — we still hadn’t — and he told us the right thing to do was to tell them immediately, and asked us to bring in my wife’s father so he could speak to him.
This doctor seemed to have an ocean of calm, and in just that single meeting the decision was done. My wife and I didn’t have to say a word to each other, but we both knew: we would go to PGI.
We went home that day, tired, but relieved — finally, we had decided on the hospital, and we sat my wife’s parents down and told them about the medical reports, and what we had found over the last several weeks. Later that week we took my father-in-law to meet the Dr., and after another long wait, we got to meet the Dr.
He spoke to my father-in-law: “You know what you have, don’t you? You have cancer of the kidney. We are going to treat you for it, and there will be side-effects of the medications. You need to stay strong, exercise and stay positive, this will help the treatment.” My father-in-law nodded, taking the news well, given the circumstances.
Just like that — the conversation was simple and plain, no talk of admitting him to the hospital, no talk of the cost of the medicines, no talk about the urgency of the situation — just the plain facts, told in a simple way and with calm.
We got the biopsy done, and then started my father-in-law on the treatment. Over the next several months, we had the opportunity to meet this Dr. many times, and I never once saw him hurried with any patient, despite the crowd in his office, the never-ending queue of patients and interruptions from patients (usually rich and with connections) who wanted preferential treatment. I became a fan of this doctor.
I also became a fan of PGI: it was crowded and the waits were long, this was true. However, it was also very human, not silent and sanitized like the private hospitals, but filled with a bustling life. Here, in PGI, death seemed natural, not something that was hidden away and spoken about in hushed voices, but something in plain open sight and a part of life.
Every Dr. I met here, it was the same — tired, dark circles under their eyes, unending lines of patients, but a simple and plain approach: factual, scientific, rational, and also caring, calm and an individual attention to each case. The patients too were a revelation — a majority of them poor and from the villages, each waiting with dignity and calm, in quiet respect and simple faith of the doctor, despite the crowd and long waits. The worst offenders were the rich — in a hurry, wanting quick-fixes, breaking the line to get ahead, questioning the doctors decisions and in general being a nuisance.
For me, PGI has been an eye-opener: I have always been a fan of private enterprise, free-markets and capitalism, but in taking care of my father-in-law, I have glimpsed it’s dark side: sanitized of humanness, based on fear and money-minded at it’s core.
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It has now been about twenty-four months since the initial examination in Hyderabad. My father-in-law is doing better, on his course of medication and treatment. We are hopeful for his recovery, but we have also learnt to come to terms with his illness. PGI has taught us to not live in fear of the illness, to trust in facts, science and a rational approach, rather than being swayed by tags of “best hospital”, “celebrated doctor” or “alternative therapy”.
In a country known for it’s Godmen and miracle-workers, and known for it’s sprawling bureaucracy of “public servants”, for me our heroes, our finest miracle workers and truest public servants are our Dr.’s who work tirelessly in our public hospitals — especially that one Dr., who with his calm attention and presence makes us feel like the most important people in the world.
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