Abstract

You place your life in their hands, trust implicitly, and diligently follow their instructions. Still, there’s a lot of slip between the cup and the lip. Is that inevitable? Can’t at least a small percent of lives be saved if doctors stop playing God, asks V S Gopalakrishnan.

That Revathy Gopal, Bombay-based poet, writer and columnist, passed away on 7 March 2007, after a brave battle with cancer, has already been covered in tribute-rendering reports and articles in print and elsewhere. She was my wife and life partner for 38 years, and died untimely at 59 years of age. The story of her illness has lessons for everybody who values his or her own life and others' lives, by spreading awareness in the matter.

She was imbued with very good health at all times that lent strength to her beautiful and attractive appearance. Like any widely read person, she was attentive about health and nutrition and was familiar with modern-day diseases and afflictions and preventive practices.

In April 2006, during a self-examination, she suspected a lump on her left breast, and quickly underwent a mammography which confirmed her suspicions. A top breast surgeon from a prominent Mumbai hospital came on the scene, and within a week the small cancerous lump, less than a centimetre in dimension, was removed. An adjoining lymph node in the armpit was also removed as a precaution. The breast-surgeon assured us all was well and there was nothing more to worry. Some radiation was prescribed. A tablet was to be taken daily to prevent oestrogen formation in the body. So far so good.

Later in May 2006, Revathy underwent an ultrasound procedure for abdomen and pelvis as she was 'spotting'. This was at another hospital and the report showed unusual endometrial thickness of the uterus. Armed with this report, we met the breast-surgeon who did the lumpectomy, as a first step. The mortal mistake was he did not refer the matter to a gynaec-surgeon in the next cabin. On the other hand, he assured Revathy that the thickness must be due to oestrogen deposit and could vanish soon due to the non-oestrogen forming pill she was taking already. That was a welcome assurance. For Revathy had planned a three-week trip to England in July to see her son. Could she go, she asked the doctor, in keen anticipation. “Yes, indeed!” was the response. This pleased Revathy immensely. He suggested for another look at her uterus after her return, and assured the problem wouldn’t be life-threatening.

Imagine a breast-surgeon of great eminence assuming the mantle of a gynaec-surgeon! Sure enough, Revathy went to England, had a great time, and returned by mid-August by which time the spotting had turned into bleeding. A fresh ultra-sound report showed the condition of the uterus was much worse. The original thickness had doubled in thickness by mid-August. So again, as a first step, we rushed to our doctor. Seeing this report he got a real shock. He led Revathy at once to a gynaec-surgeon in the next cabin for the first time for further procedures. We had lost two precious months in this process!

After a Dilatation and Curettage procedure, the biopsy revealed carcinoma of the uterus. Post-procedure, Revathy was prescribed antibiotics and painkiller for five days. The painkiller cum anti-inflammatory was Combiflam, taken three times a day. After the fourth day, Revathy developed severe drug-induced gastritis, thanks to Combiflam, that lasted a month during which time she could hardly eat. So, my wife lost one more month before she could undergo a CT scan of the abdomen and pelvis.

The CT scan (in the latter part of September) revealed extensive ‘metastasis’ (secondary disease of cancer) in the abdomen, pelvis and thorax areas. There was now no point in removing the uterus. The whole system had to be treated. Hence chemotherapy, to be done intravenously in six cycles, was immediately commenced by a very competent oncologist. The sixth cycle ended in mid-January 2007. Revathy had hardly any side-effects barring loss of hair and some loss of weight. We thought she had survived and the worst was over.

That was not to be. She developed some pain on the back. An MRI of the spine found that four vertebrae showed lesions. Then followed radiation of the vertebrae. A little later, Revathy suddenly found her left leg going limp. This led to an MRI scan of the brain. That showed two secondaries in the right section of the brain.(When the world-famous cycling champion Lance Armstrong was detected with testicular cancer in the USA, every part of his body was scanned at once including the brain which showed two secondaries that were surgically removed right away and as luck would have it, they were found to be necrotic, meaning already dead!). Revathy's MRI scan showed two secondaries in the right lobe. Further complications followed and she passed away peacefully and painlessly in that famous hospital on 7 March 2007.

Another note-worthy part of this tragedy is that the oncologist at no time suggested the use of monoclonal antibodies (MAB) which are part of the recent medical developments and which attack the cancerous cells only and do not harm the normal cells. MAB is very expensive with one injection priced at Rs one lakh. Due to my extensive readings, it was I who suggested to him sometime in January 2007 or so about the administration of MAB to Revathy. It was ultimately done on March 3, just four days before she passed away!

I don’t intend to point fingers now at any of these eminent doctors. I’m just raising some issues so that the readers are enlightened and could save their own or a loved one’s lives.

• Can a breast specialist, however eminent, take over the role of a gynaec? Revathy may not have had the secondaries if those two months had not been lost. I would now recommend to the readers the importance of a second opinion.
• Are drugs like combiflam, which many people don’t tolerate, require to be prescribed for our patients? Revathy lost a month for a CT scan due to drug-induced severe gastritis.
• Why do our doctors go for scanning piece-meal? In the US, they scan head to foot at one go, right at the beginning.
• Why didn’t the oncologist suggest treatment with MAB (possibly together with chemos) at the beginning of the treatment? This could have been a surer way of saving a life.

Finally I have taken consolation in the theory of karma. The only thing is that the erring doctors' karma apparently sealed Revathy's fate.

(The author, an ex-IAS officer, retired as Additional Chief Secretary, Govt. of Maharashtra, and was also Director General, World Trade Centre, Mumbai.)