A Friend who couldnt help

Anand was a sprightly young man

Tall well built and handsome he was popular in his class and a bright student too .
He had well laid out plans for a career ,after completing Bsc Physics he would do his post graduation and later his Phd and get into Astronomics .

Space science had alwasy fascinated him and he knew he would be in that field .

His parents both bank employees had only him to look forward to as his twin brother had died in childhood due to leukemia ( Blood cancer ) .
Anandh was the reason for thier existence .

And then it happened

Anandh had been looking pale for the last few weeks ,he had fever and nibbled away unintrestedly at food ,blood tests with the neighbourhood doctor rang alarm bells ,he had a very low hemoglobin and his total counts were pretty high ,he was also developing occasional mild nose bleeds ,hard brushing of his teeth brought gum bleeds too .

For his parents it was all too unnervingly familiar .

The sceptre of the disease that took away thier another child , Anandhs twin when he was six years of age was becoming more real with all these known symptoms .

They always knew the chances of a twin brother getting leukemia was definitely more but over the years they had slowly gotten over that fear .

I met Anandh first when I admitted him in the medical oncology department Lakeshore hospital where I worked

By then his diagnosis was certain having found many blast cells ( immature White blood corpuscles that manifest in acute leukemia ) in his peripheral blood films .

He needed further work up to find out the exact type ,its cytogentics ( chromosomal details ) and start treament .

He also needed supportive treatments which would include transfusions ,high end antibiotics intravenous fluids inserting a central line for his planned chemotherapy ,CT scans , lumbar punctures , bone marrow tests and so on and so forth ,

It was a bewildering list and for a person just diagnosed with a killer disease to go through this torture a painful experience

Even to us physicians who got used to this daily work of ours it was nerve racking.

It was disheartening to see young boys like Anandh in front of us .

Bone marrow punctures are very uncomfortable procedures even though the pain can be minimized using local anaesthetics and anxiolytics the uncanny feeling of something grating into your bone and digging into your marrow was as uncomfortable as it can get

Anandh was brave and lay down quitely even talking to me as I did the procedure .

More painful things followed .

we inserted a hickmans line which is a central line into the subcalvian vein ,we did lumbar punctures and every day bloods were drawn from him .
After this initial tornado of tests we found out that Anandh had a type of leukemia called

Acute Myeloid Leukemia M5 Type

Strangley Anandh was full of confidence and cheer

he was confident he would beat the disease and willing to face anything with a smile .

His cheer and amicable attitude was infectious and during rounds there would be lot of laughter when we reached in his room .

Our chief ,Dr V.P. Gangadharan a well known medical oncologist was known for his timely sense of humour ,he was adept at putting patients at ease while his brain whirred away to do the best for them .

He was higly respected in his field and brilliant in his job with an elephantine memory

he was also a sincere and a deeply humble person

Patients looked forwards to his visits as he made thier pains disappear by his countenance and they would miss him any day he did not come for rounds .

He was particularly fond of Anandh too as we all were .

I still rememebr the day celebrity actor of malayalam filmdom Suresh Gopi happened to visit our ward when he was shooting for a film in the hospital premises ,we took him to Anandhs room and some snaps were taken with a towering Anandh brimming near the superstar a bit taller than the really tall and handsome star .

Anandh loved music and had a good collection of audio CDs ,since it was a common intrest to me I used to borrow some of his CD s .

Days went by as Anandh faced the rigors of chemotherapy ,his body would be ravaged by its ill effects as he fought nausea and vomitting losing his hair and becoming a shell of his old self but his soul would shine through all this and his charming smile would make us feel ashamed for doing this to him .

His parents and his aunt who was a well know personality worried over his prognosis and would heap us with questions .

He completed the intial phase of intensive chemotherapy called induction which lasts for seven days ,this is followed by a period of dangerously low counts when his body is weak and has no immunity he could get all sort of rare infections and the war then was at its peak between the medications and the microroganisms that tried to succumb him , he could have fatal bleeding from anywhere including his brain as his platelets plummeted to near zero his hemoglobin would teether down and he would be dangerously anemic so much so he would be breathless with the most minimum of efforts .

Day in and day out we walked in and and out of his room masked and protected with our hands sanitised to peer into his eyes listen to his rumbling chests and touch his warm fever ridden body ,it all lasted for a month while his bone marrow recovered and brought forth fresh cells which were not malignant

we did another bone marrow on him and found him to be in remission

This would be a brief respite as his cloned cells lurking away deep in his body could rise again if we did not consolidate our victory .

But in between we could afford to give the luxury of a small holiday for the poor boy ,so he went home for a week and them came back for his consolidations .

Each consolidation was a repeat of the induction though slightly different regime they were all followed by similar periods of low counts ,fever and a spate of other complications ,by the end of four consolidations he was like a wet towel squeezed dry

a poor imitation of the Anandh we saw in the beggining but his smile was still there he left us with grateful farewells .

Slowly time would bring back his hair and his muscles and the old Anandh was back to his college ,we crossed our fingers and touched all wood available for it to last .

Generally all remissions if more than three years could be called almost a cure and more than five years the chances are really bright

For AML the percentage was 40 that is out of 100 affected 40 would come out of the fire unscathed ,we hoped fervently that our Anandh would be one amongst that 40 .

But God I feel is reasonably unfair at times ,in fact I would even say most of the times ,Iam sure Iam being juvenile in making such a remark against an unfathomable power whose machinations we know nothing of and can never judge but still

why does he repeatedly do this ?

his vctims are all innocnets ,good people ,while the bad get away continuing thier badness with no such inflictions ,

why doesnt AML affect for example Ajmal Kasab as he gorges on those delcious biriyanis our Government provides him with in his cell after maiming so many

why has it to be Anandh and his like ?

I know I am being immature and foolish to rant like this but working with many like Anandh whom we get attached so much to during thier treament and then losing them after all the hardships makes me angry against the power that is beyond us ( if there is one ) he/she seems to be totally unfair or even a bit crazy .

To make the sad story short Anandh came back with a relapse and quickly detriorated ,,his second line chemotherapy ravaged his body to a great extent and this time he was strangely silent with a lost smile his parents were epitomes of sadness and inevitably it happened one day we lost him to destiny .

to his parents the tragedy they had dreaded had revisited them

I can still figure him in my mind as I can many the other young men ,children, older persons we lost in the deadly battle against Cancer

there have been many sucess stories too for us to carry on our work but frustration and sadness is a part of working in medical oncology .

I went for Anandhs funeral something I rarely do

I felt a kinship with him that of an elder brother or a father or a friend

A friend who could do only so much !

(Have changed the name of the real Anandh in view of patient confidentiality )