National Doctor’s Day: When a patient gave us a life lesson

His oxygen saturation was just 35 per cent but he approached his diagnosis with a remarkable sense of optimism and a determination to beat the odds. Knowing that he would be put on a ventilator and that clinically, chances of survival were grim, he never allowed himself to succumb to self-pity or despair. Instead, he took interest in and followed the treatment plan with his will power, cherishing every moment, finding joy in the simplest things and spreading happiness to those around him. And he made sure to call his mother daily, despite being too breathless to talk. He had to live.

Dr Imran Nisar Shaikh, Consultant Medical Oncologist and Hemato-oncologist, Kokilaben Dhirubhai Ambani Hospital, Mumbai

I recall an extraordinary case that was a milestone in my practice as an oncologist, a case that demonstrates the power of precision oncology in providing hope in even the most advanced complex cancers. In 2016, a 28-year-old woman from Kenya walked into my clinic. She was a shadow of her former self, having been diagnosed over a year ago with Stage IV rectal cancer. Despite undergoing aggressive chemotherapy and radiation at the renowned MD Anderson Cancer Center in Houston, Texas, her condition had only worsened. The cancer had spread to her liver, and she was given a mere four to six months to live. Still she had come with hope and belief that she could beat her disease with precision oncology and gave this new therapy a chance.

I vividly remember her first visit. She had a gaunt frame and was slumped in despair. Her father, who had accompanied her, had to gently coax her into my consulting room. She was in tremendous pain. As I meticulously reviewed her medical records, a glimmer of hope appeared. Amongst the stack of documents, I saw that her genetic profile had been done at MD Anderson which showed a genetic mutation. My mind raced back to a paper that had been presented at the American Society of Clinical Oncology (ASCO) conference a year prior. The paper discussed a clinical trial involving a ground-breaking class of drugs called immune checkpoint inhibitors, with nivolumab being one of them effective in colorectal cancers. We counselled the patient and started her on nivolumab. The results were nothing short of miraculous. After just one dose, she experienced significant relief from pain. Over the next three months, she underwent therapy every two weeks. Her weight, which had plummeted to 42 kg, went up to 60 kg. Her scans showed an astounding 90 per cent resolution of the cancer. Another scan six months down the line showed no evidence of a tumour in the body. She required some surgery to correct a narrowing in the rectum but there was no other problem. In July 2017, the USFDA granted accelerated approval to nivolumab for MSI-H metastatic colorectal cancer, reaffirming our decision. We had successfully turned the tide in what seemed like an unwinnable battle.

This case made me realise the power that knowledge gives doctors to help patients triumph in their battle against even seemingly invincible enemies. Precision oncology and genetic profiling give us the tools to personalize treatment for every patient.

Dr Aashish Chaudhry, Senior Consultant & Head, Department of Orthopaedics & Joint Replacement, Aakash Healthcare

“Being positive is the only option I have. So, I want to fight and I have complete trust in you.” I still remember these words of 39-year-old Dinesh Kumar, who could not even sit up to speak as he had been suffering a debilitating joint disease for 15 years. He had Psoriatic Arthritis Mutilans that causes severe joint deformity.

As a doctor, I have seen advanced medical technology and knowledge triumph over disease and pain. But when you see human attributes such as pure grit, hope and refusal to give in shown by a patient, you just have to go the extra bit. Dinesh had bravely gone through a series of painful operations (six in all, including one on his jaw to assist normal eating), the testimony of which were the several metal implants placed in several joints in his body. For a few years, despite doctors telling him not to try it, he trained himself to walk using a ‘platform walker’ and did manage to walk a bit. But over time, he gave up as his hips were completely damaged and his knees could not support his frail body frame. The doctors he had consulted till then had refused surgeries, saying they would be life-threatening.

As an experienced surgeon, I knew it was a daunting task. But when I spoke to Dinesh, he said he could take it if both of us could work to his body capacity. We devised a graded treatment plan spanning over two years that involved multiple joint replacement surgeries, specifically bilateral hip and knee replacements. Post every operation, even though it must have been very painful for him, Dinesh never once missed his physiotherapy and rehabilitation, pushing us to stay invested in his goals as he did more than what we expected him to. For years Dinesh needed an ambulance to move out of his home. Today he can travel by an auto-rickshaw or a cab. He now wants to learn computers and revive his passion for painting.

Dr Varun Bansal, Senior Consultant, Cardiology and Cardio Thoracic surgery, Indraprastha Apollo Hospitals, New Delhi

Surgeons are not heroes. Real heroes are patients who lie there unconscious and let us perform surgeries on them. But among these many heroes, I remember an 88-year-old woman, who had come to us in a very sick condition. We were all worried if she would survive a heart surgery that was required but we knew it could go either way. But she told us that we were specialists in our job and that she knew we could do no wrong to her body. So we should go ahead without doubt. She had eliminated any negativity we might have harboured. Her smile and encouragement steeled the team’s resolve to give her a good life. Now she lives a symptom-free life. She still comes to us for a follow-up once a year, with a brighter smile and many blessings for us.

Dr Murarji Tanaji Ghadge, Consultant ENT Surgeon and Sleep Medicine specialist, Ruby Hall Clinic, Pune.

Each patient encounter offers unique insights that can shape your perspective and enhance your understanding of the human experience. So I do not want to name any particular patient but can recount life lessons that I have learnt from them. Foremost is resilience. Witnessing their strength and determination despite adversity can inspire you to persevere in your own challenges and remind you of the power of the human spirit.

I have learnt empathy. Understanding the emotions, fears and concerns of patients strengthens your ability to connect with others at a deeper level. Each patient interaction provides us an opportunity to listen and improve our communication skills. Since each patient is unique, we tend not to stereotype and are reminded of flexibility and open-mindedness in providing optimal care.