"“Sir, a 74 year old male patient, Keshav hailing from Mangaluru, a coolie by occupation, came to the hospital with primary complaint of chronic cough last year. The cough has exaggerated since one week and there have been two episodes of blood in sputum in the past week.” The post graduate was narrating the case and running to catch up with her Doctor. They were doing their rounds. “Sir, he also has a history of smoking, he is a chronic smoker. He has been smoking cigarettes since past 30 years at the rate of 2 pack per day.” The post graduate was almost out of breath because of all the running and talking since the one hour of extensive rounds. They stopped, they had already reached the patient but she could not finish the medical history of the patient. She hoped that her Sir would not screw her for not being quick enough in her work. Apart from the fact that she had a huge crush on him, she was also equally scared of him. But luckily for her, the Doctor started talking to the patient. He got the necessary information that he needed from the patient. He already had the diagnosis in his mind. He just had to confirm it. ‘How are you feeling today?’ Nishanth asked clearly and loudly. His patient was old and naturally had some hearing difficulties. Most of his patients belonged to the elder age group, and because of this the doctor had automatically developed a loud voice. Keshav looked like a typical cancer patient in the terminal stage of the disease. He had lost over 15 Kg over the past two months. Even before the deadly disease started engulfing his body, Keshav was a thin person, he belonged to the low socioeconomic strata. He was a coolie and was paid per day, so he had to work every day in order to survive. But now what remained of him was a mere skeleton with only skin covering him. There was almost no subcutaneous fat present. His eye sockets were clearly visible and deep, his cheek bones were almost protruding through the skin. His mouth was partially open through which the tongue was hanging out and saliva was dripping. He could not breathe with his mouth closed. For one respiration he had to apply all his force, it was like every breath was going to be one of his last. Even without any tests, anyone could make out that he had only a few more days to live. He was almost drowsy but Nishanth’s voice alerted him. Nishanth was happy that his patient was alive. He went straight for the examination. He palpated the chest, quickly moved to the abdomen. He did it just for the sake of it. It did not matter a lot. The history had already given him the diagnosis. Now he had to wait for the tests, to confirm it and start the treatment. But the end result would not change. He auscultated his chest for the breath sounds, he heard wheeze on both sides then he auscultated the heart for heart beats, the heart rate was decreased. He removed the ear piece and put his stethoscope around his neck. He sighed heavily and took a deep breath. He saw Keshav struggling to sit on the bed, the PG assisted him. It was a painful sight to see an elder man in this situation. Nishanth was particularly very fond of elder people but he lost all four of his grandparents early when he was a small child. All of them suffered from Diabetes and succumbed to the complications of the notorious disease. His parents did not have Diabetes but he was certain that he himself would soon be diabetic, so he tried and maintained a healthy lifestyle. He worked out daily, kept himself fit, ate healthy homemade food, he did not drink or smoke. Till now his hard work had been paying off, but he expected the worst to come. Genetics. Finally Keshav sat upright, but he was breathing heavily. Nishanth signaled his PG for the results. She gave him the biopsy reports, scans, etc. It was the squamous cell carcinoma of the lung and it had metastasized to almost all organs of the body. He was going to die for sure, unless some miracle happened. This ward consisted of the worst patients, almost everyone in this ward was suffering from end stage cancer and almost 90% of the ward mates were going to die, not because these cases were not treatable, but because they came late. This ward was reserved for the low socio-economic status people and these people never came for checkups unless they reached a situation where they could not work anymore. It was a difficult situation for them because, they were daily wage earners and if they came for checkup, their day would be wasted, and so would their money. So they came only when their bodies could not perform the duties any more. Since Nishanth was the junior most member of the faculty, he was in-charge of this hectic ward. It was a good experience for him. He cherished this opportunity and made the most of it. He was considered to be one of the upcoming Oncologists in the city, and for that treating such patients was required. Keshav was the last patient of this ward. Nishanth wanted to finish the check-up quickly. After this ward, he had one important patient to see, who did not belong to the low socio-economic status. It was time to tell Keshav his fate. “The test results have come and it shows that you have cancer of the lung.” Keshav did not show any emotions. He was expecting it. He knew it. “The cancer has invaded your blood and other organs. It will be very difficult to cure it.” Nishanth said clearly without any hesitation. “How much time, doctor?” he managed to ask. It was clear that he did not want to suffer for long. His wish was granted.
Start reading this book: