A Cancer Patient’s Inevitable Dénouement: A Bad Scan Result

Image of painting ‘Fighting for Hope’ Chariklia Kariniotaki.

Mayank Bhatt

Suffering is real. To urge anything that dismisses it as ‘unreal’ is to mock the pain of another.
                                                                                    Does He Know a Mother’s Heart, Arun Shourie

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n the previous two essays in this series on my journey as a cancer patient, (which you may read here and here) I had tried to maintain an overall theme. Thematic consistency lends coherence, but its absence characterizes our lives. For most of us, life is gloriously inconsistent. In this, the third instalment, I have abandoned thematic consistency. I am going to write about many things, not all of them necessarily joined thematically. I hope I am coherent.

I am trying to understand myself – an exercise that should have begun much earlier; but with two bad CT scans, back-to-back, I should no longer delay it. I am facing the inevitable dénouement of a cancer patient.

The October and December scan reports are unsettling. For the first time since the chemotherapy started in July 2020, my cancer treatment has not given positive results. Two stubborn spots on my liver have show marginal increase in size in both the scans. The tumour on the pancreas, which is where it all began, is not visible, and which I am told is a positive development.

After reviewing the October scan, Dr. Sabrina Allegro, my oncologist at the Humber River Hospital, shortened the gap between the scans from every quarter to two months, but the December scan again showed a growth of 2mm on the liver lesions. She has recommended clinical trials. There is a more potent chemotherapy option that she doesn’t think will work for me because of my chronic renal failure (kidney ailment).

Will the alternatives work? Time alone will tell. Is this the beginning of the end for me? It could well be.

The negative scan results have brought the family closer together once again. Not that we had drifted apart. In fact, I haven’t experienced such closeness with Mahrukh, my wife, in the last 26 years. But the last year and a half have taken a toll. Our nerves are frayed. The pressure on Mahrukh is immense, but she manages like a champion, juggling her responsibilities, both at home and work, with a dexterity that I never suspected she had. There are occasional flashes of anger, borne out of despair, but she is always in control.

Che, my son, continues to be the support to his parents that has kept our family sane. The boy is now a man, and he has a car to prove it. He, too, has put his priorities on hold, as he navigates my illness and copes with my constant need for support. He does everything for me, anticipating my needs, being around, serving me food, making hot chocolate, giving me medicines. Then there are the visits late in the night, when I am both tired and awake. We have a conversation. Then, I forget all my woes.

But despite the overwhelming love and care from Mahrukh and Che, I have become increasingly impatient with my condition. The aftereffects of chemotherapy are tiresome both physically and mentally. Mentally, I am active, but chronic insomnia drives me to despondency. Physically, I have begun to deeply resent my debilitation, which sometimes is so severe that I am unable to even perform basic tasks. It has affected my relations with my family. I snap more often and easily and quarrel with my wife, my son, my mother, and my sister. But I equally quickly make up with them because I know they mean well, even though often they seem haranguing me.

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The age-old question: how can such things happen if there is an All-knowing, All-powerful, compassionate God? Either He does not know. Or He knows, and is powerless to do anything about it. Or He knows and has the power to prevent suffering, but cares not to do so.
Does He Know a Mother’s Heart, Arun Shourie

These days Mahrukh and Che often remind me I am stubborn. I hate to admit it but that may be true. My stubbornness has to do with habits of a lifetime that I am unable or unwilling to alter. For instance, working out has never been a part of my daily routine. I know working out will help my mind and body, but I don’t find the motivation to change and acquire a new habit. Every time we speak, my friend, Satish, who is a yoga and wellness enthusiast, recommends I meditate and do yoga every day; I always agree but never do.

I am indifferent about taking medicines for my kidneys and my thyroid on time. Often, if my son doesn’t remind me, I forget to take them altogether. The one change that I have managed successfully is my diet. My food looks Indian but tastes Canadian – mostly, it has no spices. I am happy adapting to this new diet because I can no longer eat spicy food.

When I look back at my habits of a lifetime, I can’t help but wonder that for all of us, life and living go on inexorably, waiting for none and nothing. We are unaccustomed or unwilling to take tough decisions, preferring to go with the flow.

Many of our life decisions are made for us – where we are born, where we grow up, what becomes our home, which school we go to. All these decisions shape our personality. Growing up, then, is a process where we don’t decide anything, and equally, a process that we don’t think about while it is happening.

We do what everyone does – complete our formal education, get a job, earn money, fall in love, get married, (some get divorced and get married again), start a family, buy a home, and before we know it, we are already middle-aged. Around this time, some health issues begin to manifest, and we realize that we have achieved next to nothing in life.

That line from Pink Floyd’s Time suddenly acquires a deep resonance: “And then one day you find, ten years have got behind you, no one told you when to run, you missed the starting gun…” We look at the mirror and don’t recognize the person we see. All seem lost, and yet we resolve to go on, continue to struggle to fulfil goals that are only relevant to us, but are chimerical.

I wanted to be a writer but life intervened. I published my first novel when I was in my fifties. For three decades, I was busy earning money, and that, too, not a lot of it, just enough. When I look back, my biggest achievement has been to emigrate. Immigration takes a lot of courage when one is in one’s mid-forties. It has taken a lot of effort to settle a family in a foreign land. And, when I thought I had finally arrived, cancer hit me.

In the last year-and-a-half, I have often wondered whether I should have left India at all. The 13 years in Canada have been an uphill struggle, where I have done things to survive that I couldn’t possibly have imagined when I was in India. Could the many and unending struggles have caused the cancer? But I shake off that despondency as quickly as my mind begins to have such thoughts. There is no room for ‘What ifs’ in life.

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Is the statement – ‘On no soul do We place a burden that is greater than it can bear’ – a statement of fact? Is the assurance not a mere tautology? Does the fact that the Jews who were being driven into the gas chambers did not commit suicide, does the fact that a person suffering from leukemia does not commit suicide mean that the burden which has been inflicted on them is not greater than they can bear? For they do ‘bear it’ till they are extinguished, do they not?
Does He Know a Mother’s Heart, Arun Shourie

If I live till then, I will be sixty in March 2022, and I am staring at death in the face. It is at once amusing and frustrating.  Amusing because I am still unable to take my imminent death seriously. I find it strange that my life is about to end soon. I can detach myself without effort and examine my condition objectively, as an outsider, as another person. Frustrating, because even as I accept the inevitable dénouement, I don’t want to die right now. There is so much that I still want to do in my life, and I need time for that. I want to give my family time. Mixed with this frustration is the realization that there is no such thing as a right time to die, it is right that we don’t decide when we are born or when we die.

These days, I often think about fate. How did I get pancreatic cancer? Why did my kidneys fail? Family lore has it that as an infant, I had a severe, near-fatal bout of illness when I had pneumonia, and inexplicably, a massive inflammation on my kidneys. Doctors treating me had given up hope, and my mother says it was a miracle I survived.

During this illness, I was administered strong doses of antibiotics. I wonder whether the antibiotics also had a severe and everlasting impact on my health. I have never been able to know the reason I didn’t have teeth after my milk teeth fell off. At 13, I was wearing partial dentures. It affected me in ways that I have never completely understood or acknowledged.

In my mid-fifties, it was discovered that my kidneys are small and that for several years, hadn’t worked efficiently. In medical terms, my condition is known as Glomerulonephritis. It is inflammation of the tiny filters in the kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from the bloodstream and pass them into the urine. At present, my kidneys work at 25 to 28 percent, and if they fall below 10 percent, I will need regular dialysis. My oncologist informed me that chemotherapy and dialysis cannot be done together.

Why is my liver so weak? I was not an alcoholic. Growing up, I did have a few wild years in my youth, when alcohol flowed freely, but I was never addicted, and I never had enough money that I could drink myself silly. I remember, as a teenager, I would have frequent swelling on my liver, which gave me a mild fever on some evenings. Then, it stopped, and so it was forgotten.

My death will cause emotional trauma and economic distress to Mahrukh and Che. Had I known that I would develop these ailments, would I have started a family? Should I have been allowed to start one? Today, I can claim that I didn’t know my life’s trajectory when I made my choices.

But soon, science will have progressed enough to determine the lifespan of a newborn, and what ailments s/he would suffer from during her/his lifetime. Even if we have scientific answers available to all our health questions, the moral questions will still need answers. This cannot be an individual’s choice, if the society has to pay for it eventually.

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The doctrine of karma asserts that a person receives birth in accordance with his karma in previous lives. This is how differences in natural endowments, in predispositions, and in circumstances are explained. But at the moment of creation, there had been no previous lives. Hence, how did differences in natural endowments and circumstances arise at that point? How did those who were to subsequently sink commit the first evil deed? How did those who were to subsequently ascend higher commit the first good deed which then engendered predispositions in them to go on committing good deeds in the subsequent rounds?
Does He Know a Mother’s Heart, Arun Shourie

I think constantly about friendships and relationships. Among the few things that we do on our own when we are growing up is to make friends. At least that is how it was when I was growing up. Of course, our home and our school still decide who our friends are. As William Saroyan (1908 – 1981) says in Sons Come and Go Mothers Hang in Forever (1976), “There is no explaining why out of three dozen boys in a neighbourhood, one becomes a friend and others are forever acquaintances, or rivals and even enemies.”

‘Best friend’ is a childhood phenomenon that ends abruptly. The bonds that we create with our friends when we are young are unique. But as we grow older, these friendships fade and whither away. We are never able to make friends that share the same bond when we grow older. At least that is my experience.

All professional relationships are transactional. I believe, even non-professional relationships – what we choose to describe as friendships – acquire a transactional quality as we grow older; these ties are inherently competitive; we are constantly comparing ourselves to our friends, and always feeling insecure. Such relationships are intense when mutual needs are strong. The intensity diminishes as the mutual need is fulfilled, and the relationship is either forgotten or ends. Such relationships end easily, without regret or rancour.

I also believe that even the most personal of our relationships are transactional, too – arising out of mutual necessity. It is just that we are unwilling to accept that they are transactional. Such non-transactional relationships are based on intangibles and don’t end easily when their need diminishes or ends. They linger longer, causing angst, misery. They end bitterly, or when they can’t be ended, they continue to fester. Maturity dictates that all relationships should be started with a conscious thought to their end-by date. But sentimentality forces us to continue with relationships that may have ended a long time ago.

When we begin working, some of our colleagues become our friends. Over the years, I have developed deep friendships with some of my colleagues. But often, I feel that there is more to my relationship with a colleague, and I invest a lot more into it. This inevitably leads to disappointment when a former colleague moves on as times and circumstances change.

That brings me to the phenomenon of forgetting. Human life is in the present. For most of us, past is an encumbrance; and future is a plan when we are young, and remorse as we age. In our lifetime, we forget more than we remember, this is especially true of people. It would be impossible for any of us to recall all the people we have known in our life – both dead and alive. Forgetting the dead – even those who were close to us when they were alive, such as members of our family – is natural and inevitable. We also forget those who are alive.

As we age, the past begins to weigh on us more and the only way we deal with it is by turning it into nostalgia. Nostalgia enforces selective amnesia. But forgetting is not easy because some memories are a wound that drip blood forever. This is especially true of failed relationships. We spend a lifetime thinking about what we could have done to right a wrong.

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Could He not have arranged the food chain in such a way that one species would not have to kill the other so as to survive? Could He not have planted a gene for vegetarianism in humans, for instance? In the alternative could He not have created food directly from molecules – as is going to be done using nanotechnology tomorrow? Or did He stay His hand from doing so, so that man may discover nanotechnology on his own?
Does He Know a Mother’s Heart, Arun Shourie

I have never felt alone or lonely because of a lack of good friends. My childhood friends in Teli Gali, and school friends were from a lower-middle-class background. My college friends were not too different, either, and so were friends and acquaintances at different workplaces during what has been a long and tedious working life.

I have preferred to do things on my own – going to movies that nobody wanted to see, getting introduced to global cinema through a film society, enrolling in many libraries, reading authors not many had heard of, finding myself excited every time I discovered a new author who changed the way I looked at the world; they have been my friends ever since I read their books, although I haven’t known any one of them personally.

Reading ensured never being lonely, but it didn’t lead to academic brilliance. I barely managed to graduate. Reading led to journalism, which brought me closer to writing, but paradoxically, I have never been comfortable writing, and yet, inexplicably, I have not been able to stop writing, even after I quit journalism, more than 25 years ago.

I think in our world today, which is the age of social media, writing is increasingly becoming irrelevant. In the age of social media, where everyone is a writer, we are facing the true horrors of the irrelevance of language. Words have lost meaning. Politics of demagoguery and the social media have the same effect on language and its enormous richness. We may soon end up using just acronyms and emojis.

I am reminded of a quote from Milan Kundera’s (1929 – ) The Book of Laughter and Forgetting, “Once the writer in every individual comes to life (and that time is not far off), we are in for an age of universal deafness and lack of understanding.” The English translation of the book was published in 1980, a long time before the age of social media transformed us comprehensively and forever.

While being alone or keeping my own company has always been my preference, in the past year-and-a-half, since I was diagnosed with cancer, I have been offered help in various forms by the many people I know. Friends from Bombay, friends, and acquaintances in Toronto, all have come forward to help.

One recommended an ayurvedic practitioner, another a naturopath, yet another a guru in alternative healing. A friend emailed detailed instructions to my wife on intermittent fasting. Another recommended a TV series, and a book. Since July 2020, I have been to a hakim, a vaid, have visited a temple, taken prasad. These are not things that I would normally do. But I have done them willingly. Everyone who offers help is doing so because of her / his concern for my health and wellbeing.

I don’t let my eternal skepticism come in the way of these manifestations of love and affection. I have come to appreciate these gestures of concern. Yes, there may be some, who mouth such platitudes as a matter of routine, but most of those who have offered to help or have suggested a new remedy, are genuine.

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No cosmic purpose is served by our suffering or that of those dear to us—just as no cosmic purpose is served by our being born or by our dying; and that for the simple reason that there is no ‘cosmic purpose’
Does He Know a Mother’s Heart, Arun Shourie

These days, dates have acquired a deep meaning for me. The expiry dates on my credit card, the validity of my Ontario identity card, and the health card. Will I be alive six years from today, when my Ontario identity card will expire? Will I be able to travel out of Canada before my passport expires in 2024? When mortality is so palpable, so tangible, the exploration about divinity – which has been a major preoccupation over the last year-and-a-half – acquires both urgency and nuance.

Many atheists are conversant with Albert Einstein’s quote, when he was asked by a New York rabbi in 1929, whether he believed in God. Einstein said, “I believe in Spinoza’s God, who reveals himself in the orderly harmony of what exists, not in a God who concerns himself with the fates and actions of human beings.”

Baruch Spinoza’s (1632 – 1677) metaphysics of God is summed up in a phrase that occurs in the Latin (but not the original Dutch) edition of the Ethics: “God, or Nature”, Deus, sive Natura: “That eternal and infinite being we call God, or Nature, acts from the same necessity from which he exists.” It is an ambiguous phrase, since Spinoza could be read as trying either to divinize nature or to naturalize God. But for the careful reader there is no mistaking Spinoza’s intention (Stanford Encyclopedia of Philosophy).

I borrowed Arun Shourie’s Does He Know a Mother’s Heart – How Suffering Refutes Religions (Harper Collins India 2012) because of its theme – exploration of divinity and its linkage to suffering. Shourie, a World Bank economist, became an iconic editor of the Indian Express in the late 1970s, when Indian journalism experienced a post-Emergency renaissance. He earned a well-deserved reputation for introducing investigative journalism in India, and exposed innumerable politicians for what they really were – frauds and cheats, milking the system.

After his glorious stint as an editor, Shourie devoted his time to enhance the soft power of Hindutva, the political ideology of India’s Hindu nationalist Bharatiya Janata Party (BJP). He channelized his considerable erudition to produce meticulously researched books debunking everything that he seemed personally opposed to – communism, Babasaheb Ambedkar, Christian missionaries, and their role in India, the politics of fatwa, affirmative action, reservations for the Dalits, and many more contentious issues that continue to divide contemporary India.

Shourie was (is?) very much a right-wing ideologue, the only saving grace has been his scholarship. A cursory review of the books he has authored reveals his beliefs and biases. His fall from grace within the Hindutva hierarchy, under the new dispensation that took charge in 2014, seems to have given him both time to reflect upon larger issues, and to write about matters that touch people’s hearts.

Does He Know a Mother’s Heart is an exploration of divinity across three major religions – Hinduism, Islam, and Christianity, and why these, and in general most organized religions, are silent to extreme suffering by human beings. Written in response to his son Aditya’s heroic battle with cerebral palsy, the book examines the scriptures and how they fail to explain human suffering. It is an enlightening book that is also intensely disturbing. Shourie finds solace in Buddhist philosophy, which doesn’t require belief in God.

One of the highlights of the book is Shourie’s analysis of Mahatma Gandhi’s religiosity. He dissects Gandhi’s position on the Bihar earthquake of 1934 (when Gandhi said, “I want you to be superstitious enough to believe with me that the earthquake is a divine chastisement for the great sin we have committed against those whom we describe as Harijans.”), and the genocide of Jews by Hitler. Shourie says, “Gandhiji’s observations – on the reason for the Bihar earthquake, on why non-violence is bound to melt even a Hitler’s heart – also show where a line of reasoning based on faith in God leads. For one thing, it pins the blame on the victim. As God is just, the victim must have done something to deserve the chastisement.”

As with the previous two essays, where I began each section with a quote from a book, I have begun each section of this essay with a quote from Shourie’s book. And I will end with one that seems to be apt with which to conclude this essay. He ends by quoting the concluding part of Faiz Ahmed Faiz’s (1911 -1984) poem Bahaar Aai to Jaisay

 

…Ubal pade hain azaab saare

malāl-e-ahvāl-e-dostāñ bhī

ḳhumār-e-āġhosh-e-mah-vashāñ bhī

ġhubār-e-ḳhātir ke baab saare

tire hamāre

Sawaal saare, javaab saare

Bahaar aayi to khul gayen hain

Naye sirey se hisaab saare…

(Click here to enjoy the entire poem, with English translation by Agha Shahid Ali, sung by Tina Sani)

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Notes
Cover image of painting ‘Fighting for Hope’ Chariklia Kariniotaki, Medical School – University of Crete, Greece  Courtesy: https://esthinktank.com/paintings-for-world-cancer-day/

Mayank Bhatt is a Toronto-based author. His debut novel, Belief was published in 2016. He is also on the panel of Editors with The Beacon

Mayank Bhatt in The Beacon