The Anonymous Manifesto™ – Ep. 29 – Leaving the light on for those on their last leg

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DP, 69, originally from India is a retired Medical Oncologist who writes poetry in Hindi in his leisure time. He talks about his childhood trips to the nearest big town, which would take his family from dawn to dusk in bullock carts and two trains. He talks about his chemotherapy practice in a small town in Alabama and what people tell him about how they want to die. Here’s the transcript of my face to face interview with him. 

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Heart: From your childhood in India to your work as an Oncologist in America, what has been the theme of your life?
DP: You know, when you’re growing as a child in India, your family kind of molds you. OK? I was born in ’47. My father was in Government service. We’re two brothers and our father’s desire was that we were well educated. He wanted one of us to become a doctor and one of us to become a lawyer. That was his dream. But he was very busy and he used to travel a lot. We lived in this small town, Netrang, and he was a revenue collector for our district. He was a revenue officer for the farmers. He had to also solve the court cases and disputes. He had a police officer under him and a judge under him. That was what he was in charge of. In those times, in the 50’s, he was assigned to a very remote area where the Adivasis (Tribal indigenous minority population of India) used to live. Those people lived in the forest. They lived a different lifestyle than us Hindus. 

So my dad was sent to that place. He had to go to those villages riding his horse. In those times there was no electricity in my childhood. There was no running water. The only way to get from one place to another was either by bullock cart or horse carriages. Of course, we had trains for long distances. 

I still remember very vividly, Baroda was my mother’s place, it was a big city. It was ruled by a king called Gaikwad. You know the history of India, how different states had different states were ruled by the British? Some kings had retained their kingdoms even though some parts were taken away by the British. The kings didn’t have much power, they were told what to do by the British, they were just like puppets. But Gaikwad, he was from Maharasthra, he was very strong. He had built many universities, libraries, and hospitals. He made sure that children could go to schools, he would send people to homes in those days, when my mother didn’t want girls to go to schools because they were prohibited from going at that time. He would send people to homes to ask where their daughters were and the officers would ask why the little girls were not in school. 

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Heart: Wow. 
DP: And these people would be giving excuses to the officers, and Gaikwad didn’t want that to happen. He was a very forward thinking guy. 

So, anyway, to come to Baroda from our town, which was not very far, right now if we travel in car we can travel in 3 hours. But in those days it would take us the whole day in bullock cart. There was a big farmer who had horses and bullock carts, and my father would leave a message to him asking for his help and we would have these bullock carts and horses arrive at our house in the morning to take us to Baroda. The drivers would be ready for us by 4 in the morning. My father would ride a horse next to our cart and we would be going through these deep forests along the route. There would be streams going underneath us in these forests. Then we would stop at a narrow gauge train station and catch a train to a bigger train station called Ankleshwar. And from there we get into a bigger train to Baroda. And that 20 mile distance would take us from 4 in the morning to 10 in the night. (Laughs) But that’s how we lived back then. 

So, my father wanted one of us to become a doctor and one to become a lawyer. He wanted my older brother to become a doctor. But he had no idea how well he studied. My brother was not good in his studies and he didn’t take Science and Math. So my father couldn’t send him to medical school and told him to be a lawyer. And it was now upto me to become a doctor. 

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Heart: So the pressure’s on you to become a doctor. (Laughs) 
DP: (Laughs) No, I was good in my studies. It was not difficult, I passed my exams and I became a doctor. 

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Heart: What is your profession? 
DP: I am a medical oncologist. 

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Heart: Surgery? 
DP: No, chemotherapy. So, if someone’s been diagnosed with cancer, if they need surgery, a surgeon will do surgery to remove the malignancy. After that they consult with a medical oncologist. Sometimes before a surgery, they might even consult a radiation oncologist if the cancer can be treated by radiation. You treat cancer in three ways. Surgery, radiation, and chemotherapy, you know, but it depends on the case. 

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Heart: What kind of demographics and age groups do you see? 
DP: Mainly old people. In America, cancer’s very common in old people. But, we see breast cancer in young people too. We see leukemia and Hodgkin’s lymphoma in young people. 

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Heart: How do you separate your work from your personal life? 
DP: That’s an interesting question. I mean, you learn to do that. But it still affects you to some degree. Like you see old people and they’re dying of cancer, as long as they are comfortable and they’re not in pain, they’re happy. They’re not afraid of dying. Its very interesting people usually say that “Oh you’re a cancer doctor, it must be very depressing.” No, its not depressing. It depends on how you take it. We have a big room where the patients sit down and we do chemotherapy. 

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Heart: So, all of them at once? 
DP: Yeah, there might be 5 or 6 patients in the room at any given point of time. They sit in these chairs that you can recline, like your lawn chair and they get their chemotherapy drugs in their veins. 

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Heart: Oh, is it intravenous? 
DP: Yeah, its called infusion chemotherapy. We give some premeditation along with it. (His 8 year old grand daughter comes into the room and says, “I’m guessing you’re talking doctor stuff?”) 

So, what I’m trying to say is old Americans live by themselves and they’re very lonely. When they’re all in the same room with some sort of cancer, they all talk, they talk about each other and about their families. They become like extended families of one another. See how it all goes? One of my patients had finished his course of chemotherapy, and I told him he was done but he calls me back and “Dr. [redacted], can I come and sit in an empty chair in the chemotherapy room? I know I don’t take chemo anymore, but I miss all those people, I miss having anyone to talk to.” 

See how people are. For old people, its not how long they live, its how many people they can talk to. Loneliness is a big problem in America, and we don’t realize that. But in the medical profession we can see that. You see in their houses, they’re very lonely, their kids are somewhere else, they don’t call except Mother’s day or Father’s day. 

So, I don’t get affected or get depressed about cancer. But once in a while, you’ve a young patient and you get close to them and they die, I feel sad, you know. But, that’s part of life. 

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Heart: Can you gauge the life expectancy of a patient based on his records? 
DP: Yes, once you diagnose a cancer you can usually tell how long they will live, with or without chemotherapy. 

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Heart: Do you tell the patient how long they’ll live? 
DP: It depends on the patient. See some patients like to know, and some don’t want to know. So, when a patient comes with cancer, I discuss with them what kind of cancer it is, what stage it is in, that’s very important that they know that, and what kinds of treatment are available, what the side affects are of the treatment, whether the cancer is curable or not curable. I tell them if chemotherapy will prolong their life, or if its going to cure it, all kinds of stuff. 

In America, patients are very knowledgeable, unlike in India, where family members of the patient want to hide everything from the patient. Because the family doesn’t want them to know, because they don’t want the patient to get scared. “Doctor, please don’t tell that my mom that she has cancer.” That’s what they say to me. “Just tell her its a tumor and that you’re trying to cure it with medicine.” I volunteered in hospitals in India after I retired, and I realized that its two different cultures. Of course, its not everyone who does that but I’m speaking generally about the cultural differences. 

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Heart: Is it because India is more family oriented and we want to be more protective of our family? 
DP: Exactly. In America, we’re more of an individualistic society. Everyone’s an individual. In India, family is everything, they make collective decisions. Father and son will come and say, “My mom has cancer, but don’t tell her. She’ll break down.” And you have to go by their wishes. 

Here, old patients come by themselves, they drive themselves, and they want to be told what they have. But there was a time in America, when they didn’t openly talk about cancer. It was the same way it was in India a few years ago. But, now its all open, people Google, and they want to find out more. Even the older people, they know what’s going on. 

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Heart: Are people not listening to their bodies? Why do people get cancer? 
DP: Cancer is a very mysterious disease. Its very silent, and by the time you feel pain, its already spread too far. Let me tell you about my wife. She doesn’t smoke or drink. She had complained about this sore in her mouth. And I took a look at it, but I didn’t see anything. It kept bothering her. And so I took her to a specialist and he looked at it. He did a biopsy and it came back negative. But she kept complaining that there was something there. So we went to another doctor and he said, “I see a small spot on the inside of the right cheek. Its red. It might be nothing, but let’s get a biopsy.” I said, “OK,” we got a biopsy done, and it came back as cancer. Its squamous cell carcinoma of the buccal mucosa on the right cheek.

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That was the diagnosis. You know, I was kind of shocked. “How did this happen?” (Laughs) But, you know she’s lucky. I took her to MD Anderson hospital and they did a radical surgery to take out a part of the mandible, lymph nodes and they did skin grafting to patch up her cheek in the inside. It was an 8 hour surgery and that was 4 years ago. So far she’s cancer free. 

The point is cancer’s very insidious, it grows slowly without making noise. So lot of people don’t know they have cancer and by the time they start complaining of some ache or pain, its already too far gone. That’s why we insist on doing screening tests. Get a mammogram, pap test, colonoscopy, they’re all required to detect cancer early. If you detect cancer early, its curable. 

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Heart: When you talk to your patients do they tell you their dreams or their goals? 
DP: Sure, it depends on the patient. Older patients, they tell us upfront, “Dr. [redacted], I don’t want to suffer. Make me comfortable, make it pain-free.” There was a young lady, she was 30 years old and she was diagnosed with breast cancer stage 4, which means its incurable and she would die within a year or two. But, she had a 6 year old daughter and her goal was “Dr. [redacted], I want to see my daughter graduate from high school.” And I said, “I can’t promise you, I’ll do my best to treat you.” And she did live for 10 years and her daughter was 17 and grown up and graduated from high school. 

So, those are things that people want. But there’s another story. I was asked to consult with a big robust guy, a farmer who was diagnosed with lung cancer. It was far advanced and there was not much to do, and I talked to him, explained him what it is, and what I can treat. And he said, “Dr. [redacted], thank you very much. I appreciate you telling me. I’ll get in touch with you. I’ll make an appointment with you.” And the next thing I heard was that he had gone home and blown up his brain. He got his gun and shot himself in the head. You know, you come across all kinds of people with different kinds of emotions and feelings, and some are very brave and others give up very easily. 

There was a lady with breast cancer and my goodness, she loved to swim and was a competitive swimmer and she was very good at it. She would get chemo and go participate in a competition. You just never saw her depressed. Whenever she came to my office, she was always upbeat and it made you wonder, “What’s she doing here?” And her family situation was awful. She was married to a guy who never came to any visit with her. She was working as a secretary in a church, and she had some problems with her legs, but she would always swim. Her father was also diagnosed with cancer. But she never had any self pity. She was always smiling, nicely dressed and I would know when she was there in the office, because she had this perfume on. And she would give me a hug, and when I would go back home, my wife would say, “Oh, looks like Diane came in today.” (We both laugh) 

But, you know when she died? When her cancer went to her brain. When she was swimming one day, she had convulsions and she almost drowned. They had to pull her out of the water and that’s when she found out. 

You see, each person has a different personality, their own way of handling stress, and to me the medical profession is one of the greatest professions. I don’t think I would have gone into any other profession. Maybe, I would have been a musician, I don’t know. That would be fun. 

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Heart: Is it because you feel like you’re making an impact? 
DP: Yes. And not only that, when you’re with a patient, you forget everything else. If you like your job, its like you worship what you do. You forget the world, because you enjoy it so much. That’s why everyone should do what they enjoy, instead of looking at how much they’ll make or whatever. 

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Heart: What are some of the side affects of chemotherapy? 
DP: There are a lot of side affects, it depends on the drugs we are using. But the general side affects are, hair loss, they can break out, especially around their mouth, your white blood count can go down, you can get infections easily, because your immunity goes down. Because when you try to kill the cancer cells with chemotherapy, it also kills your normal cells, like your white blood cells. So, we have to be on the look out. 

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Heart: It’s hard not to get emotional listening to all this. What in the end really matters? 
DP: Everyone should realize what their goals are based on their own limitations. It depends on how you look at life, how you interact with your friends, family and surroundings. You might be one individual but you’re surrounded by all these things. Your culture and your surroundings can mold you in a good way or a bad way. Religion creates friction and bloodshed. But you’ve to treat humanity as one. 

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Heart: I just want to go back to the chemotherapy room once again. It doesn’t feel like a hospital, it has a human feel to it somehow. 
DP: You know, we used to have a chemo room in the hospital also, but lot of people prefer to go to chemo rooms of doctors who have their own practice. Also, using a chemo room in the hospital is very expensive, they charge 4 times more than private doctors. Now, the hospitals are moving towards using these private chemo rooms, because the government knows it has to pay more money to hospitals. 

So when I see someone in my office, I have a room where we meet, and everything gets done quickly. In the hospital, it takes a long time for things to move with the paper work and everything. At my office, we check the patient’s blood count and we start the treatment. We already have an outline of how early he has to come, and you keep talking to the patient once in a while about how he’s feeling while he is getting treated. The room has TVs and they can watch shows, there’re magazines to read and there is coffee and snacks. A lot of people just relax, some bring their own books to read, some people chat and some people watch TV. Its like a small little club. If they go home and if they have a problem, they call me in the middle of the night sometimes, you know. 

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Heart: I’ve read this book last year which I absolutely love, its called When breathe becomes air. Have you read it?  
DP: No, but I’ve heard about it. Have you read the book by Siddharth Mukherjee, its called Emperor of Maladies? 

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Heart: Yes, its a big book, but I’ve read it. 
DP: Its a great book. He has written another book called The Gene, have you heard of it. 

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Heart: No. As a matter of fact, just this morning a friend had recommended it to me. I’ll check it out, thanks. So, what do you do in your free time? 
DP: I write poetry, I listen to music, I play tennis. We visit places, we just came back from Wimbledon (, London) to watch the game. 

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Heart: Yeah, I saw you on TV, that’s why you look familiar. 
DP: (Laughs) 

So, I have three children and two of them are doctors. My older daughter who’s married to an American has a PhD in Computer science. She works for Google from home.

My 2nd daughter is an M.D., board certified in Internal medicine and Palliative care and my son-in-law is an entrepreneur and he has an MBA from Carnegie Mellon. 

My son’s a surgeon and his wife is a pediatric neurologist. They’re moving to [redacted], Alabama because he’s got a job as an assistant professor of surgery at [redacted] and she’s going to be the assistant professor of pediatric neurology. 

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Heart: So, they won’t practice anymore, will they only teach? 
DP: They will teach academically and practice medicine in the hospital. They’ll do both. My daughter-in-law is going more into the research field. 

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Heart: What top three apps do you use every day? 
DP: I use Facebook, YouTube, and use email. And I read Google news. 

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Heart: Thanks so much, we started from your bullock cart days to now curing cancer. This is great. 
DP: Such a Long Journey. Have you read that book? There’s a book by Rohinton Mistry by that name. (Smiles) 

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The End. 

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Note: Before you rate this episode, please consider if you would’ve been so open and authentic about your own life. Earlier episodes available at The Anonymous Manifesto™.

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