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Prognosis

Ranjit Kulkarni

    “What is the prognosis Sir?” The tense man sitting in front of Dr Winston asked while he looked at the scan reports.
    Unlike other doctors who fiddled around when asked such a question, Dr Winston looked at the man straight in the eye and pronounced his verdict.
    “One year with treatment. Less than six months without treatment,” Dr Winston told the man. His voice had the confidence of a doctor who had made it his speciality to search for death lurking in the background of a terminally ill patient, and to predict its arrival with accuracy.
    The man’s mother had breast cancer for the past two years and it had now spread to the lungs, as per the latest scan report. His face showed the worried anticipation of bad news in the form of a few drops of sweat, despite being in Dr Winston’s airconditioned consultation room.
    The palliation oncologist had developed a reputation for accurate prognosis for terminally ill patients. With years of experience, he had developed the expertise to recognise the signs and symptoms of death, to assess its oncoming speed and, like an air traffic controller, put a number to its expected time of arrival. He had developed quite a reputation for its accuracy.
    The man stared at the ground on hearing the prognosis.
    “We will need to give her another round of chemotherapy next week. She will stop swallowing food in a few weeks. So we will need to start tube feeding. Get ready for a few tough months,” Dr Winston declared with firmness to the man.
    The man tightened his mouth and bit his lip. His cheeks became taut. His eyes moistened.
    Dr Winston turned his attention back to the report. Then he searched for something on the computer. “She will need oxygen in the next sixty days. The tumour is aggressive. I do not expect it to respond to treatment. We have to do what we can. I leave that decision to you.”
    “Hmm,” a tone of reconciliation slipped out of the man’s sober mouth. “Thank you Doctor for your advice. I hope she doesn’t suffer much.”
    “Don’t worry. All we can do at this stage is to reduce the suffering. I guarantee that it won’t last more than six months,” he said. The man stepped out and Dr Winston told his assistant to send the next patient.
    It was almost as if the relatives depended on Dr Winston’s prognosis and planned everything based on it. Many thought of it as some sort of a countdown within which to do whatever that was required to be done. It included whatever they could do medically, financially, or socially. And more often than not, the patient dropped dead at the precise end of the countdown, more or less, give and take a few days.
    In some sense, it was an advantage, both for the patient’s family and the cancer care team. It helped them to decide on many practical things when they got beyond the emotions. And they always thanked Dr Winston for it. Dr Winston himself felt grateful for having that ability.
    After he had finished consulting with all his patients, Dr Winston sat alone. The biopsy report must be ready by now, he thought. He called the pathologist with bated breath.
    “Is.. theÉbiopsy.. report.. err.. ready, Madam?” he asked with trepidation.
    It had been on his mind throughout his consultations today. He had waited for it all day.
    “Yes, Sir. I was going to call you – it’s not looking good. The tumour is quite large. I will email you the report,” she said.
    When he saw the report, his world fell apart. All his experience had suggested that the signs and symptoms were ominous. The report confirmed his worst suspicions. He could hear his heart palpitate faster. His face twitched as he read through the details. He could see that the patient didn’t have much time left. The writing was on the wall.
    His mind was already at work. It had come up with a prognosis number which didn’t look good. The number that popped up in his mind was six months.
    At first, he didn’t believe it. He put his hand on his chin and recalculated. He scampered through the report again. He envisioned the patient and her condition. He scurried through the research journals on the topic. He opened up his past consultations and had a relook at similar cases from the past. There must be something he was missing, he told himself. There must be something unique or different about this case.
    All that background work again added up to a prognosis of six months. He didn’t like it. He clenched his fist and banged it on his table. When his assistant came in to see what happened, he refused to talk and sent her home. He pushed his table away and threw away the reports in a rush of anger. “Why us?” he looked to the ceiling and cried out to God. Tears welled up in his eyes and flowed down his cheeks. He thought of calling his wife but stopped short of it. Because the patient was his seven-year-old daughter.


***

    With a heavy heart that evening, Dr Winston gathered himself and went home. On his way home, he told himself that he is going to fake it. All his knowledge and experience can go to hell, he told himself. He stopped staring at the reports and hid them away in his bag. He gathered all his inner strength while he drove back. He took a deep breath in his car. He wiped his face.
    “All the history of past cases doesn’t matter,” he rationalised. “Let the calculation point to a prognosis of six months. But my daughter is going to be an exception. She is going to make it. I am not going to talk about this prognosis,” he resolved. “I am not going to let it show on my face or in my body language. I am going to pretend,” he made up his mind.
    With those thoughts, he rang the doorbell of his house.
    His daughter ran towards him and hugged him straight away. He picked her up in his arms. With the prognosis at the back of his head, he swayed her in the air with a big grin.
    After dinner, his wife asked, “Did you get the report?”
    He gulped and remembered what he had promised himself. Overcoming the lump in his throat, he forced a smile and said, “Oh yes. I got it. It’s a small lesion. She needs some medicines. We have lots of treatment options. She should be alright.”
    Then while pulling over the blanket, he added, “I forgot to tell you because there’s nothing much to worry.”
    “So when do we start the medicines?” his wife asked.
    “Right away,” he said at first, but bit his tongue. He curtailed the sense of urgency in his voice, lest it trigger panic and suspicion.
    “I mean, whenever we want. There’s no hurry. How about we start next week? After her dance program. It is on this weekend, right?” he added. “What do you think?”
    “Yes. Whenever you want,” his wife replied. “You are the doctor and the father. You know best,” she added.
    Dr Winston wished that were true. He pretended to go to bed. He didn’t sleep much that night. He shifted from one side to the other. Should I tell her about my prognosis? He wondered first. No way, he told himself the next moment. He took a few deep breaths. But his mind did not become steady.
    He finally decided that this is the only right way to deal with this situation. “This is the right way. I am not going to come to the prognosis again,” he resolved.
    “I am going to go ahead with the treatment. There is no need to discuss anything about how serious the disease was. It doesn’t help anyone,” he concluded. “She will get to know anyway after a few months once the condition worsens, so why pre-empt her grief so early?” he determined.
    In the darkness of the night, unable to contain his grief, he woke up. He went to the kitchen and had a glass of water. While sipping it, he cried alone, in secret. He opened his bag and looked at the reports again. He came to the same conclusion.
    Not more than six months was his firm prognosis. If it were any other patient, he would have pronounced it with confidence. But for his daughter? At seven years old? Only six months? He sobbed uncontrollably again in silence.
    At her dance programme on the weekend, Dr Winston was the loudest clapper. He applauded her every step. He got up and did a few steps himself. His wife exchanged a few weird glances. She had never seen her husband dance. At one time, he stood on his chair and whistled. Others gave him stony looks for creating a ruckus. Everyone wondered why the father of this child was going overboard. He looked around and realised what he was doing. He controlled himself. But that was just on the surface.
    On his way back from the dance program, he told his daughter, “From tomorrow, you have to come to my clinic every day.”
    “Yay,” she cried in delight. “No school.. holiday,” she broke into an impromptu dance. Dr Winston turned to the skies.
    “But you have to come home and do your homework,” his wife said. “And after that, you will get ice cream,” she promised.
    Dr Winston pushed back a desperate tear. He took the driver’s seat in his car. But his attention was not on the road.


***

    On Monday, he told his staff at the clinic to prepare for his daughter’s treatment. “I want all arrangements to be perfect. No one talks about the disease to her or my wife,” he warned them.
    His daughter’s treatment started in full earnest. She went through it as if it was some sort of school excursion.
    “I want that bed,” she demanded whenever she entered the clinic. “Hello, nurse aunty. What have you got for lunch today?” she asked the nurses every day.
    She picked and chose whatever she liked from their lunchboxes. She played with the nurses and chatted with the ward boys.
    Dr Winston went through it as if it was her last journey.
    “Make sure the IV doesn’t hurt her,” he told them. “Don’t prick her too hard,” he instructed the nurses. “Who is sitting with her at her bed?” he checked obsessively with nurses. “Who is measuring her doses?” he asked the ward boys. “Give her some sweets, some soft drinks, some snacks when you administer the dose, so that she is distracted,” he told the ward boys. “Cancel all my appointments of the day,” he often told his assistant, when his daughter was in the clinic.
    He maintained a wide grin all through it on his otherwise grim face. Doctors are trained for that. But fathers aren’t trained to smile through such ordeals. He reminded himself to forget the prognosis. He kept pushing his mind to neglect the reality that his daughter, like his other patients, was terminally ill.
    She went through all the chemotherapy sessions and the radiation sittings with a smile. She cried when she lost her hair, but quickly had a grin again when she saw a bald patient in the clinic. She lost her strength, but not her joy of life. She got some side effects, some infections, some complications but no negativity infected her.
    Ignorance is bliss. Knowledge can be lethal.
    Dr Winston stepped up the treatment further. At the end of the treatment over four gruelling months, Dr Winston wasn’t sure what was worse, the disease or the treatment.
    His wife asked him when she will get better. He kept telling her that all the loss of strength was due to the treatment, not the disease. She will recover her strength back, once the side effects wear off, he told her. But in his rational mind, he knew that the clock was ticking. Four out of the six months were over already. Two months were all that were left for his daughter, his mind reminded him. But he told his daughter and wife that now that the medicines are over, she is going to get better.


***

    What surprised Dr Winston was that she actually started getting better. The side effects wore off and she started getting back her strength. She got her smile back. His wife got the spring in her step back. The reports seemed to get better.
    But Dr Winston had an awkward grin. He told himself that these things happen. He knew what was going to happen. The disease is shrewd and cruel. It plays with the mind. It is a temporary phase of wellness when the disease lurks in the background before its final strike.
    But in the case of his daughter, the disease never made any final strike. It never struck back. The two months got over. Dr Winston checked the calendar. He started seeing more of other patients, but his mind was still stuck on his daughter.
    “Has she eaten well today?” he called his wife after lunch daily. “Yes, she has gone out to play,” his wife told him often. Dr Winston wondered how that was possible. “Did she sleep well overnight?” he asked her in the morning before leaving. “Yeah she is still in her bed. We should start her school now, else we will find it tough later,” his wife reported.
    “No, not for a couple more months, she needs rest,” he revolted. In his mind, he knew it was a matter of a few more weeks before the disease gets her. He had never gone wrong in his prognosis, he told himself.
    Six months passed by. Dr Winston’s daughter kept getting better.
    Six months slowly became nine. Nine became twelve.
    Dr Winston got impatient. He should have been happy, but he turned restless. He got all her medical checks redone. Everything seemed to have gotten better. The prognosis date was well passed. The prognosis turned out to be wrong. The patient was better off without it. She had recovered.
    For many days after that, Dr Winston wondered. How did this happen? What about my prognosis when I saw her report? How did she recover? How did my prognosis go wrong?
    Did I go wrong because she was my daughter? Why did my prognosis go wrong? Was it because I didn’t talk about it? Was it because she didn’t know?
    And then another thought struck him. What about my other patients?
    How was I always right about them?
    He dug out records of all his past patients. Patients who were all long dead. Patients who had been terminally ill like his daughter had been, at one stage.
    Patients whose death he had predicted with accuracy with his prognosis.
    And one fine day, a serious doubt cropped up in his mind.
    Did the disease kill them? Or was it the prognosis that killed them?
    The thought didn’t escape his mind. It crossed his mind every time he met his new patients. It didn’t let Dr Winston escape from his guilt.
    Every time a patient’s relative asked him the dreaded question about the prognosis, now he fumbled. He started fiddling. He started looking for excuses to avoid answering. He gave the patients and their relatives a blank look. He didn’t speak up.
    He felt maybe, just maybe if he doesn’t talk about it, some patient may survive longer.
    Dr Winston was caught in a bottomless pit of worry. His reputation as the accurate provider of prognosis dipped.
    He started questioning if the prognosis was more dangerous than the disease.
    Around a year after the failed prognosis of his, by then fit and fine, daughter, Dr Winston started hallucinating. He started seeing his dead patients. He saw them curse him in broad daylight in his clinic. He saw them turn up in the middle of the night in his bedroom. He saw them sitting next to him when he consulted with other patients.
    “I killed all my patients with my prognosis,” he declared to his staff one day. He ran around helter-skelter in panic. He said his dead patients were chasing him.
    He was admitted to the mental health ward of his colleague’s hospital soon after all antipsychotic medications failed.
    It was seventeen years today since then. His daughter had come to take his blessings on her wedding day. “This is my father. The man who saved my life,” she told her husband.
    “I saved my daughter. But I killed all my patients,” he shrieked from his cell, “with my prognosis.”

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