Matter of Fact

Category: Heritage & History

Documenting the legacy of MGIMS, Sevagram heritage, and medical history.

  • The Silent Surrender

    The Silent Surrender

    In our quiet ward, a son softly asked, “Can I take my mother home?”

    Usually, such requests mean relief. Patients leave with hope, their struggles behind them. Grateful families thank the doctors, smiling. It feels like a victory.

    But this time, there was no joy. No happiness. His question wasn’t about hope—it was about saying goodbye.

    His mother was dying.

    His mother, a 60-year-old woman from a small village three hours away by bus, had endured a life of struggle. She was frail , but her spirit was strong. After losing her husband, she single-handedly raised her son. For decades, her days were filled with labour—planting, weeding, harvesting, and gathering firewood—work that demanded every ounce of her strength.

    Six weeks ago, her strength began to fade. Tasks she once did easily—cooking, cleaning, even dressing—became too hard. A hospital visit revealed a harsh truth: a breast tumor, the size of a small orange, malignant and aggressive. Scans showed the cancer had spread to her liver, lungs, and spine. Surgery wasn’t an option, and neither radiation nor chemotherapy could help.

    “She doesn’t have much time,” the resident told her son hastily, the words cutting like a blade. His medical training had equipped him to diagnose and treat, but not to deliver such crushing news. There was no quiet room, no moment for compassion—just the raw truth, shared in the cold, impersonal space of a hospital corridor.

    The son stood in silence, his heart heavy with those words. His family—his wife and infant son, living in a small, crowded hut—was already trapped in poverty. As a daily-wage laborer with no savings, how could he care for his dying mother? Love clashed with helplessness. He had no money for treatment, no support system, and only the fear that his love alone might not be enough to ease her suffering..

    𝘞𝘩𝘢𝘵 𝘪𝘧 𝘴𝘩𝘦 𝘴𝘵𝘰𝘱𝘴 𝘦𝘢𝘵𝘪𝘯𝘨? 𝘞𝘩𝘢𝘵 𝘪𝘧 𝘴𝘩𝘦 𝘴𝘵𝘢𝘳𝘵𝘴 𝘷𝘰𝘮𝘪𝘵𝘪𝘯𝘨, 𝘣𝘦𝘤𝘰𝘮𝘦𝘴 𝘤𝘰𝘯𝘧𝘶𝘴𝘦𝘥, 𝘰𝘳 𝘩𝘦𝘳 𝘣𝘦𝘭𝘭𝘺 𝘴𝘸𝘦𝘭𝘭𝘴? 𝘞𝘩𝘢𝘵 𝘪𝘧 𝘴𝘩𝘦 𝘴𝘵𝘳𝘶𝘨𝘨𝘭𝘦𝘴 𝘵𝘰 𝘣𝘳𝘦𝘢𝘵𝘩𝘦? His mind raced, overwhelmed by a storm of fears and unanswered questions.

    As he paced the corridor, a hospital attendant noticed his quiet despair. He pointed toward the nearby palliative care ward. “We can move her there,” he suggested. It was a place dedicated to comfort, not cure. The son’s heart sank, yet a small flicker of hope stirred within him.

    He brought her to our palliative ward, clinging to a fragile hope. He had seen others turned away when doctors could do no more. But here, his mother was settled into a bed, and for the first time in days, he lay down in a caregiver bed beside her.

    In this quiet place, he found a bit of peace. It wasn’t a cure, but it gave comfort. The ward was a safe place where love and care could grow, even in life’s toughest times. For now, that had to be enough.

    The familiar sound of guards pushing relatives out of hospital wards echoed in his mind. But this time, no one came to turn him away. No longer forced to sit on hard benches or sleep on cold floors, he finally closed his eyes. Exhausted, he drifted into a deep, peaceful sleep.

    In that moment of rest, he found a bit of relief from the heavy burden he carried. Here, in the palliative ward, with soft whispers and gentle care, he realized he could be there for his mother in a way he hadn’t been able to before.

    We focused on easing her pain, calming her cough, and helping her breathe. Oxygen flowed gently into her nose, while a tube gave her food. For a brief moment, she seemed a little better, and hope flickered—fragile, yet still alive.

    During our morning rounds, we found him by her bedside. Three days had passed since she was admitted. Her breathing was shallow, the oxygen mask fogging with each strained exhale. He sat close, hunched over, his hands gently on her blanket. His wrinkled and stained shirt hung loosely on his tired frame.

    Unshaven and dishevelled, his torn shirt and worn slippers showed the strain of his empty pockets. Exhaustion weighed on him, and fear filled his eyes.

    “I want to take my mother home. Please let her go,” he said. His voice was thick with tiredness and shook a bit. His lips were cracked and dry, and his words were slow, showing he hadn’t slept. This wasn’t just a request; it was a desperate plea. He knew the dangers, but he wanted her to be with familiar faces and elders—searching for any bit of control in a situation he couldn’t control.

    We waited. She wasn’t stable. The trip could make her worse or even end her life.

    “My family wants to see her one last time,” he said. “They’re too old to come here. I know she might not live long, but I have to take her back.”

    His hands shook, but his voice was steady. He wasn’t being reckless. He had no choice: no money, no help, and no room for her at home.

    We let her go.

    Her story stays with me. Why did he want to take her back? Was it love, family duty, or something practical? When he said, “I want to do what the elders think is right,” I wondered what “right” meant to him, in a life full of sacrifices and tough choices.

    In her family, the elders made all the choices. Throughout her life, she obeyed them, and so did her son. Even now, at life’s edge, their choices still guided him, leaving little room for his own.

    Her illness wasn’t just cancer. It was poverty, fear, helplessness, and exhaustion. Medicine could ease her pain, but it couldn’t lift the heavy burden of his circumstances

    Palliative care often feels an imperfect science. How do we comfort the dying when their lives are full of hard struggles, leaving little room for dignity?

    Maybe all we can give is a fragile, flawed space where families can say goodbye—in their own way. Imperfect, yet deeply human.

  • A Hole in Her Heart

    It was a typical Thursday, my OPD day. After completing rounds, I settled into the clinic, surrounded by my medical residents. The waiting hall buzzed with life, crowded with patients, many standing near the door, each waiting their turn. Mornings like these felt routine, but they never lacked purpose. Our hospital, a beacon of hope for rural patients, is where many find care they can’t afford elsewhere. Here, we don’t just treat; we teach.

    The OPD is where residents learn that Medicine isn’t just a science; it’s also an art.

    I had just finished explaining how to approach patients with acute unexplained fevers when she entered—a 24-year-old mother of two, her eyes full of life yet clouded with fear. “I have a hole in my heart,” she said, her voice trembling. “Can you fix it, sir?”

    She clutched a battered file, the edges warped from the rains—smudged ink, crumpled papers, the faint musty scent of dampness. Inside, there were two crumpled, handwritten discharge summaries with fading ink, a nearly illegible ECG strip, a creased chest X-ray sealed in a yellowing envelope, and a damp, stained echo report.

    Her husband stood beside her, holding the file with trembling hands. “Doctor, please look at this first,” he said, urgency in his voice.

    I gently set the file aside. “We’ll come to that,” I reassured him, meeting her anxious gaze. Sometimes, the story a patient tells is more revealing than the one written in their file.

    I listened as she shared her story. Diagnosed with an atrial septal defect after her first childbirth, she reported no breathlessness, chest pain, palpitations, or swelling—just the lingering worry over what the diagnosis meant.

    Despite the defect, she appeared remarkably well. Her pulse was steady, blood pressure normal, feet un-swollen, breathing effortless, lungs clear. Her neck veins lay flat, showing no signs of pressure. Her body seemed at ease, hiding the condition within, as though shielding her from fear.

    But as I leaned closer, her heart revealed its secret: a soft murmur, faint yet distinct. The second heart sound split widely, its two components perpetually apart, like doors left ajar in quiet defiance, hinting at the unseen defect.

    “Are you sure her heart condition was only discovered after marriage and pregnancy?” I asked gently.

    Her husband, standing beside her, his hand on her shoulder, replied, “Her parents were poor and uneducated. They didn’t know. We found out only when she was pregnant.”

    Two pregnancies later, she had sailed through both without complication. Her heart remained steady despite unnoticed strain. She had required no medications, and her daughters—four and two—were her world. Now, with a glimmer of hope from a cardiac surgeon, they saw a chance to fix what had been broken for so long.

    The surgeon arrived—confident, calm, kind. Reviewing the results, he said, “It’s a simple hole in the heart. The surgery is straightforward. She’ll likely wake up right after, and be home by the weekend.”

    His reassurance filled the room with hope. The procedure seemed routine—another day’s work for a seasoned surgeon.

    On surgery day, the operating room was focused and quiet. Her husband waited outside, holding his phone, pacing but remaining still. Inside, the team worked swiftly and carefully.

    The surgeon made the incision, and the heart-lung bypass machine seamlessly took over. With steady hands, he carefully sutured the hole—about the size of a small coin—sealing the defect with precision.

    “I’ll be done in less than three hours,” he had reassured us. Three hours passed. Then four. Four stretched into five. Something was wrong.

    Anxiety crept in. Each passing minute grew heavier, time itself seeming to stretch.

    Finally, the surgeon emerged. His face said it all—pale, exhausted. His voice trembled. “I’m so sorry. We did everything we could, but… air got into her brain during the surgery.”

    He paused, explaining. “The oxygenator—the machine that keeps blood flowing—ran low on blood. The level dropped too much, and under pressure, the perfusionist missed it. Air got into her arteries and went to her brain. We tried, but there was nothing we could do.”

    He took a deep breath and spoke softly, “Her heart’s still beating, but… her brain is gone.”

    The room fell silent, heavy with sadness. How could this happen? A simple surgery. A young mother. Two daughters waiting at home.

    Her husband collapsed into a chair, crying. The nurses cried too. Even the perfusionist, who had made the mistake, cried. I stood frozen, unable to speak or cry.

    Doctors are trained to act, to search for answers, not to feel. But in moments like this, all that training feels empty. How do you measure the loss of a life full of hope?

    The surgeon visited the family, preparing them for the worst. He admitted his error, and to his relief, the husband placed the blame on destiny rather than on his hands.

    The next day, she passed away. We waived the hospital charges and arranged transport, but those gestures felt hollow. What could possibly console a man who had lost his wife? How do you comfort children too young to understand why their mother wasn’t coming home?

    I stood frozen, speechless, unable to shed a tear. We had tried, but it wasn’t enough. Despite the hope we had clung to, we had failed.

    Weeks passed, but her memory lingered. It surfaced quietly, catching me off guard. I thought I had moved on. Then one evening, while sitting with my sister—ten years older—and my wife, the grief came crashing back.

    The tears came suddenly, as if they had been waiting. I cried like I hadn’t in years. Just an hour earlier, I was laughing with them. The house felt warm, full of life. Now, the room was still, the lightness gone, replaced by an unbearable silence.

    They watched, stunned. My sister’s eyes widened. Her hand hovered near my shoulder, unsure. My wife sat motionless, mouth slightly open, struggling for words. Neither had seen me like this before. After what felt like forever, my sister placed a hand on my shoulder. “What’s wrong?” she asked gently.

    Through my sobs, I managed, “I lost a young mother a few weeks ago.” My voice cracked. “She came in with so much hope, and I couldn’t save her. Now her daughters are without her.”

    The words cut deep. “Those little girls… they’ll never know their mother because of us.”

    It wasn’t just guilt—it was helplessness, regret, and the crushing weight of knowing that sometimes, despite everything we do, we still fail.

    Doctors aren’t supposed to cry—or so we’re told. We’re seen as strong, the last hope. We project confidence—not just for our patients, but for ourselves.

    But behind closed doors, we do cry. We’re trained not to, yet we do. We cry for the lives we couldn’t save, for the families left behind, for the mistakes that linger.

    In the days following her death, I replayed every detail. I consulted heart surgeons, studied cases of air bubbles during surgery. Could we have done something differently? Was there a sign we missed? These questions lingered, casting shadows in quiet moments.

    Textbooks, case studies, experienced surgeons all agree: ‘Even with the best care, things like this can—and do—happen. But they are rare.’

    How do you cope with the weight of a life lost? That day, I cried because I thought of her daughters—two little girls waiting for a mother who would never come back. I cried because I couldn’t escape the feeling that I had failed her. I cried because I cared, and sometimes, caring is what breaks us.

    But we carry on. We return to the hospital, to the operating rooms, to the clinics. We smile, comfort, and reassure. Because we must. If we let the tears take over, they might never stop.

    Medicine is full of contradictions. It empowers us, yet makes us vulnerable. We save lives, but we also lose them. We perform miracles, but we’re not immune to tragedy.

    In the end, we’re not just doctors—we’re human beings. And sometimes, the weight of that care becomes unbearable, like a heart strained by a hidden defect.

  • Delay. Delay. Delay.

    This Diwali, Ravi (name changed) turned 19. He lived in a small town, 100 km southeast of Sevagram. Fresh out of his teens, he had completed his tenth grade at a local school and enrolled in a technical college. A promising future awaited him—steady income, a stable life. His parents, both laborers in the fields, dared to dream of a brighter future for him.

    But two months ago, those dreams began to crumble.

    It started with low-grade fevers. His face swelled. His skin turned pale. His appetite vanished. The neighbors whispered, “It’s jaundice.” A village healer offered herbs and oil. For a brief moment, Ravi seemed to improve—but only for a week.

    Then came the lumps. Tiny swellings under his arms. A hard lump above his collarbone.

    “Why does my neck feel tight, Aai?” Ravi asked, his voice trembling.

    Aai’s face tightened as she examined the swelling. Fear flickered in her eyes, but she tried to reassure him. “Don’t worry, beta. Let’s go see the doctor in the next town tomorrow.”

    She took him to a private doctor 45 kilometers away, a man with an MD degree. The doctor’s face grew serious as he examined Ravi.

    “This is not simple,” he said. “I’ll need to do blood tests, X-rays, and a biopsy.”

    For two weeks, the doctor treated Ravi. IV fluids, antibiotics, and painkillers. He checked on him daily. The tests indicated a serious illness, but the results left more questions than answers.

    “I’m afraid I can’t offer the care he needs here,” the doctor said, his voice full of compassion. “You must take him to Nagpur. It’s your best chance.” He waived part of the bill.

    Nagpur—a city Ravi’s parents had never seen. With their sick child, they braved the journey, their hope battling their fear. They arrived at the massive teaching hospital, known for its affordable care. The OPD was packed. Lines stretched endlessly. The air was thick with exhaustion. Ravi’s parents joined the queue, their fatigue evident, both physically and emotionally.

    But what lay ahead felt even harder.

    By the time they entered, it was mid-afternoon. The doctor glanced up from the chart. His expression turned grave when his eyes met theirs.

    “I’m sorry, but we don’t have any beds. It could take at least two weeks before one becomes available,” the doctor said softly. “He needs urgent tests. I suggest you come back after having them done as an outpatient.”

    The doctor’s voice was gentle but helpless. His empathy was clear. But can empathy alone change the harsh reality?

    Exhausted and hungry, Ravi’s parents made their way back home. The city felt overwhelming.

    “Nagpur is not for us,” they decided.

    Aai, fighting tears, nodded. “We’ll go back to the local doctor. Maybe he’ll have an answer.”

    Back at the local hospital, the doctor continued his treatment. More antibiotics. More vitamins. More saline. This time, he added steroids.

    Slowly, Ravi began to improve. The family breathed a sigh of relief. They praised the doctor and cursed the big city hospital.

    Weeks passed. Then, Ravi’s back began to ache—sharp, relentless pain. He couldn’t sleep. He couldn’t eat. His legs swelled. His face puffed up.

    “We can’t just sit here and wait,” Aai said one evening, desperation in her voice. “Let’s try another doctor.”

    Another town. Another doctor. More tests. More medicines. More expenses. Nothing worked.

    The doctor suggested an MRI. Back to Nagpur they went. The report said tuberculosis. Finally, a diagnosis. Ravi was started on TB medications, but his condition worsened. He vomited everything. His urine turned red. They stopped the treatment.

    The fear in Aai’s eyes was now replaced by anger. “What is happening to my son?” she cried.

    A relative from a nearby town intervened. He arranged transport to Sevagram Hospital.

    Here, the doctors listened. They examined Ravi carefully—eyes, neck, armpits, chest, abdomen—every inch of him. Scans were ordered. A surgeon biopsied the lymph node. Pathologists pored over the microscope.

    The report arrived: lymphoma. The diagnosis was daunting, but the doctors knew it was treatable. If they acted quickly and aggressively, they could offer Ravi hope—hope for a full and lasting recovery.

    Months of fever, night sweats, weight loss, and swollen nodes—a textbook case. Yet, it took four long months, countless visits, and a small fortune to reach this point. Four months of anguish. Four months of mounting debt. Four months of sleepless nights for a family already stretched to their limits.

    Ravi’s story is far from unique. It mirrors a grim reality. Just days before, a Lancet study highlighted the delays in cancer care across India—delays in diagnosing and treating cancer patients. Ravi’s case could have been pulled straight from that very study.

    Delays that steal lives. That crush dreams. That rob families of their dignity.

  • How much time do I have?

    “How much time do I have now?”

    His voice on the phone was calm, almost casual. We had discussed the sudden cold wave, his family, his niece’s recent grand wedding, Jasprit Bumrah’s lethal bowling—everything except his illness. Then, out of the blue, he asked that question.

    It’s a question I hear often. Families ask it when hope starts to fade. Patients ask it when they’re gathering the courage to face reality. Sometimes, they don’t ask at all—fear keeps the words trapped. They want to seem strong, to keep fighting. Or maybe they notice the doctor’s haste and hold back.

    Doctors avoid the question too. We circle around it, pretending optimism. We dismiss their anxiety. We brush off their worries and offer promises that may never be fulfilled.

    Predicting the future is never easy. As Lauren Rissman, a palliative care physician, once described it, prognostication is “an imperfect art of foreseeing what lies ahead—like piecing together a puzzle while knowing that some pieces will always be missing.

    It’s true—predictions fail more often than we’d like to admit.

    Not long ago, my residents treated a young man who had ingested a lethal pesticide. His brain was swelling, his heart barely pumping, his lungs rigid and infected, his liver failing, and his kidneys completely shut down. Twice, he went into cardiac arrest—just a straight line on the monitor—and each time, the residents managed to revive him.

    I was convinced he wouldn’t make it. Almost certain.

    Two months later, he walked out of the hospital.

    And then there was the man with pneumonia. His recovery seemed swift. We removed the ventilator, and soon he no longer needed oxygen. The tubes came out, and he began talking about going home. We believed we had triumphed.

    But we were wrong. He died suddenly—likely from a clot in his lungs.

    Once again, I had misjudged.

    During our MBBS and MD training, we were never taught how to talk about death. In my early years, we avoided these conversations altogether. Breaking bad news was often left to the junior doctor—without guidance or preparation.

    Now, back to him.

    He was in his late seventies. Years ago, surgeons had discovered cancer in his abdomen. They removed as much as they could, followed by three rounds of chemotherapy. The treatment took his hair but not his resolve.

    His hair grew back, as did his determination to fight. Blood tests, chemo sessions—nothing fazed him anymore. He studied his reports with quiet acceptance. Though he ate less than he should and felt increasingly tired, he never voiced a word of complaint.

    He was the picture of resilience

    “So, how much time do I have?” he asked again, his tone steady.

    I hesitated. Did he truly want an honest answer, or was he looking for comfort?

    “Maybe a year or two,” I said softly.

    He laughed.

    “One year?” he said, still laughing.

    His reaction caught me off guard. I expected sadness or frustration, but instead, he seemed… relieved.

    “You know,” he said, “there was a time when every extra month felt like a victory. I truly believed I could beat this. I thought I’d win.”

    He paused, his voice gentler now.

    “Not anymore. I’m tired. I don’t want to keep fighting. I just want peace. Don’t try to prolong my life—just help me go peacefully.”

    He probably wasn’t familiar with living wills or advance care directives, but his experience had taught him something invaluable—how to recognize when to keep fighting and when to let go with dignity

    After decades of practicing medicine and teaching residents, I’m still learning how to navigate these conversations. In the palliative care ward, I spend a lot of time with families. I’ve learned to sit with their tears and silences, to feel their anger, and to bear their grief.

    Doctors are expected to provide hope. Patients look to us to fight for them. No one wants to be the one to sever that thread of hope.

    But moments like this remind me that truth, though hard, can bring a different kind of comfort.

    “Honestly, I don’t really know. It could be a few months, or maybe a few years,” I said. “These biopsies, scans, and labs—they don’t always give us the answers we expect.”

    He laughed again. “So, you were lying earlier. Now you’re being honest.”

    He was right.

  • The Middle Path

    For decades after completing my MD residency and becoming a physician, I held firm to a belief: diagnose accurately, treat effectively, monitor diligently, and ensure that patients followed my advice. This was the creed I practiced in OPDs, wards, ICUs, and even during cross-department consultations in the hospital.

    And it worked. Most of the time.

    There is no greater reward for a physician than seeing their patients recover, adhere to treatment, and return for follow-ups with gratitude in their eyes. It’s a validation of our efforts, a source of quiet pride, and a moment of shared joy with patients and their families.

    But not always.

    This young man was an exception. At twenty-three, he ran a teashop in the city, full of energy and brimming with ideas—new flavours, clever promotions, and plans to grow his business. He was a man with dreams. Until one morning, a headache—unlike any he’d ever experienced—changed everything.

    A visit to the doctor. A scan. And then, the bombshell.

    The MRI showed a massive brain tumour, occupying almost half his brain. The swelling was severe, the pressure life threatening. It bore down on the vital centers controlling his heart and breathing. The tumour was inoperable. Three neurosurgeons—each a veteran—reviewed the case and unanimously declined to operate. Neither surgery, radiation, nor chemotherapy offered any hope. Nothing could stop the tumour’s growth, or so said all the doctors.

    And so, he came to us—to the palliative care center. A shadow of the vibrant young man he once was. He struggled to speak, his words broken and unclear. He couldn’t swallow, couldn’t move his left arm or leg. He depended entirely on his family for every basic need—feeding, bathing, turning in bed. A tube nourished him; a catheter managed his bladder.

    Days blurred into weeks. The family cycled through the stages of grief—denial, anger, depression, and finally, acceptance. He, too, began to grasp the reality from whispered conversations and tearful silences. We could offer little beyond attentive ears, kind words, and measures to ease his suffering. We focused on sparing him unnecessary interventions and futile medications.

    Eventually, he went home.

    Yesterday, he returned. Propped in a wheelchair, flanked by his parents and a devoted sister, he greeted me with a faint smile. We exchanged pleasantries. I lightened the mood with a few jokes, asked about his teashop, and teased him about Pushpa 2—the latest movie he might have watched. Our resident held his hand, and that simple human touch lifted his spirits visibly. Minor tweaks to his medication followed, and then came the question.

    “Doctor,” his father hesitated, “can I take him to a baba in a remote Rajasthan village? He’s known to cure cancer with miraculous powers. People say he’s healed so many. But there’s one condition: we must stop all modern medicines. The baba insists on sacred rituals—a thread on the wrist, ash mixed with honey. That’s all.”

    The room fell silent.

    Years ago, my younger self would have scoffed. Dismissed the idea. Maybe even chastised him for suggesting it. But years of practice have taught me otherwise. Desperate times drive people to desperate measures. It’s not just about faith in the extraordinary; it’s love, guilt, peer pressure—all tangled together.

    And it isn’t just “babas.” They go by many names: gurus, mystics, healers. Each weaving with their own mix of rituals and promises. Some offer sacred threads and ash. Others recommend exotic herbs or chants to align the cosmos. To the modern mind, it can seem bizarre, even absurd. Yet, to families grasping at straws, these remedies become beacons of hope.

    I chose a different response.

     “You may go,” I said, carefully measuring my words. “But try not to stop his seizure medications or supportive drugs. You can follow the baba’s advice alongside.”

    The father’s eyes welled with relief. Gratitude poured out in his words. This was what he needed—validation of his decision, assurance that he was doing everything for his son.

    Sometimes, nobody is entirely right or wrong. What remains is the middle path.

    As they left, I watched the family disappear down the corridor, the father wheeling his son out with cautious hope. And I wondered: perhaps the greatest medicine isn’t one we prescribe but the understanding we extend. A touch. A word. A bridge between worlds.