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Table of Contents
MUSINGS
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 135-137

The need to know


Department of Medical Oncology, Tata Memorial Hospital; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India

Date of Web Publication20-Dec-2019

Correspondence Address:
Vanita Noronha
Department of Medical Oncology, Tata Memorial Center, Mumbai, Maharashtra; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_94_19

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How to cite this article:
Noronha V. The need to know. Cancer Res Stat Treat 2019;2:135-7

How to cite this URL:
Noronha V. The need to know. Cancer Res Stat Treat [serial online] 2019 [cited 2020 Feb 28];2:135-7. Available from: http://www.crstonline.com/text.asp?2019/2/2/135/273692




  Mumbai, September 4, 2019 Top


6 a.m.

The day began like any other – wake up, prepare and pack the snack boxes and lunches, wake up the kids (to their usual protests) and send them off to school – nothing out of the ordinary to indicate what the rest of the day was going to be like. Gazing out of the window, the green of the garden looked bright and freshly washed by the rain that was coming down. Monsoon-school mom reflexes kicked in: check the school WhatsApp groups and the school website to make sure that it was not a rain holiday. There were many messages from the other mothers wondering the same but no official notice. School was on. We rushed through the morning routine and I dropped my daughter to the bus stop; her brother stayed back as I was taking him to Delhi later that day for a chess tournament.

8.30 a.m.

I headed to hospital, to get some work done before I left for the airport. It was now pouring, with no signs of a let up. My WhatsApp messages are usually on silent, but today's rains with the uncertainty of an early school closing made me unmute all the school-related WhatsApp groups, which unfortunately, were buzzing more than usual … “Will school shut early?”... “Here are some pictures of the road outside our school. Look at all that flooding!”… “Why doesn't school just send the kids home now?”… “Maybe it's better if the kids just stay in school, otherwise they may get stuck in the flooded streets,” and on and on and on. I could feel my anxiety building. If school closed early, I would need to make sure my daughter was picked up from there, or the bus stop.

I saw patients in the clinic, but found it hard to focus – one part of my mind was on the downpour and its ensuing potential problems. I just did not know what was in store, and that unsettled me. By mid-morning, most schools and businesses downed their shutters, but my obsessive checking of messages every few minutes revealed nothing more than parents' doubts and speculations; there was no official news yet from school.

11.21 a.m.

The message from school finally arrived: “School will end at 11.30 a.m. today; children will be sent home on the buses.” For a few minutes, I was flooded with relief – I finally knew what was going to happen, and I could plan accordingly. All I needed to do was arrange for someone to pick up my daughter from the bus stop. I had the information I needed, and I finally felt in control again. All was right with my world, at least for now.

Mumbai's official estimated population in 2019 is 12.8 million. Imagine the chaos that could ensue if even a third of this population were to try to make their way home at the same time on a regular sunny day. Add to this-flooded roads, trains that had all but stopped, and cars and buses that could stall at any moment. To Mumbai's collective credit, although there certainly was chaos, it was managed and civilized chaos. People patiently waited for hours in traffic and helped each other as best as they could. My daughter's school bus left school, but the driver had a hard time navigating the flooded streets. The bus was stuck and just could not pass a flooded stretch. All us parents were very tense: “Will there be an accident on the road?“...”What if the bus enters a pothole that cannot be seen because the road is under water?“...” What if the bus gets stuck indefinitely, leaving the kids without food or water?” The kids had no phones and the parents just did not know what was happening; all we knew was that our kids had not reached.

2 p.m.

After valiantly struggling for about two hours and managing to traverse only a few kilometers, the bus driver turned back and returned to school. A message was sent out to the parents to pick up our kids from school. My husband left to pick her up, but he too could not get past the flooded spots and had to return home. Now, my daughter was stranded in school and I had to leave for the airport. I didn't know what to do. I again felt at a loss. One of the other parents managed to reach school and called me when she saw my daughter there. She offered to take her to her own home, and I gratefully accepted.

4 p.m.

My flight was scheduled for 9 p.m. On a regular day, the 15 km journey to the airport would take between 45 minutes and an hour. Accounting for the weather and traffic and the fact that it was exceedingly important for my son to get to the tournament on time, we left home at 4 p.m. by car. The trip was a nightmare. In two hours, we had traveled barely two kilometers. We would reach a particular spot, and the police or other drivers would tell us not to go farther on that road, since there was massive flooding or storm damage, and to loop back and take an alternative route. This happened several times, and by 7 p.m., we had almost given up hope of making it to the airport on time. My son constantly asked me, “Mum, will I make it? I really want to play tomorrow.” My husband called and asked me whether to cancel the flight and book us on a later flight – we were still within the cancellation period. To all of these questions, I had only one answer, “I really don't know!” How could I know for sure? Even though everyone was looking to me for answers, I had none, and that made me angry and frustrated.

7.30 p.m.

We made it to the Western Express Highway, which although partially submerged, had a relatively clear path on one side of the road. We made slow, but steady progress and got to the airport by 8.20 p.m. – in the nick of time. The agent at the check-in counter told us that our flight was on time and would fly out from Gate 25. We checked in and rushed through the security checkpoint.

8.40 p.m.

We reached our gate and heaved a sigh of relief. But our happiness soon turned to confusion. The display at the counter showed that the next flight out from Gate 25 was for Chennai at 9 p.m.! Clearly, today was not a day for peace of mind. There was an angry mob in front of the gate counter – these were passengers who were headed to Visakhapatnam – their flight had been canceled because of the weather, and they were demanding an alternative flight out. There was no sign of our Delhi flight, even though it was just 20 minutes to the scheduled time of departure. It was impossible to get to the airline officials at the gate – they were surrounded by the mob, and their hands were full answering those passengers.

How then were we to find out what was happening? It would be unthinkable to actually reach the airport on time and yet miss the flight because we were at the wrong gate. My son and I rushed to one of the large display boards in the airport to see if there had been a change of gate – it showed that our 9 p.m. flight was on time and at Gate 25 – this was at 9.15 p.m.! I called the airline helpline hoping to get some information and was informed that the flight was indeed scheduled to fly out of Gate 25. By now, our nerves were totally frayed. Nobody was giving us accurate answers. We would have been ok with a delay, as long as we knew where and when the flight was departing. By 9.25 p.m., the flight to Chennai boarded from Gate 25, and some arrangement was made for the Visakhapatnam passengers. The crowd calmed down a little and dispersed. I managed to make my way to the counter and speak to the airline official, who told me that we would be boarding shortly, but from a different gate. Eventually we did, and got to Delhi late at night, but in time for the tournament.

Reflections

As I allowed myself to gradually relax on the flight, I reflected on the awful day we had had. Most of my tension stemmed from uncertainty – if I knew what was going to happen, bad or good, I could accept it and prepare for it. It struck me that this is precisely what we face every single day, both as oncologists and as patients. We just don't know. What exactly is our patient's prognosis? Which regimen will give him/her the best chance? What side effects will occur? What will the patient's quality of life be?.. and so on. So many questions, and really no accurate answers. I think that's a large part of the stress of oncology – the not knowing. Although we know with a fair amount of certainty what will happen to a group of patients, i.e., we know the expected median survival, we know what percentage of a group of patients will have severe toxicities, etc., yet when it comes to a specific patient, we have no clear idea. If we could somehow predict accurately for our patients what will happen and when – both disease-related and therapy-related, perhaps a lot of the stress would go out of the experience. If only we knew! How do I know for sure what the right treatment advice is to give to my 82-year-old fit patient with early-stage prostate cancer? I know the risk stratification tools and life expectancy tables; I know the pros and cons of radiation versus surgery versus watchful waiting. But, how do I know with certainty whether the prostate cancer will progress in this patient or whether there will be competing risks for death? How do I know whether he will develop terrible side effects from treatment or whether left untreated, the tumor will progress and cause more trouble? There is no way to know for sure in each individual patient – we have to use our best judgement. I doubt that we will ever come close to full knowledge about each patient's path. The alternative is learning to accept that we will never know for sure and making our peace with it. That kind of wisdom seems a distant dream, but it is certainly something I will constantly aspire to.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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