How do you want to die?

I have been thinking about death quite a bit lately. Especially about the 'how' part. Different people have different fantasies about this particular situation. For me I have almost zeroed in on dying in sleep, without lot of pain. The last part is important. I don't want to go through a detailed medical procedure and doctors declaring that nothing could be done now (a la Hindi movie style). I am already super-sensitive about the pain. I want somebody (preferably relatives!) to admit me to the hospital for a minor incident and then I'd sleep and die. As simple as that. Dying in house is not real fun (and lot of inconvenience to the family). Dying within professionals has its own advantage, for example, they know exactly what to do or more specifically know when to stop trying. At home you are at mercy of some half witted idiot thinking you might be just unconscious and urgent action is needed. At hospital one gets to die in company of young, friendly, weirdly dressed women. At home all you have is your old wife (if you are lucky enough!). The post-processing (I developed a software once called post-processor, funny now I think about it!), is rather easy in hospital and a routine procedure (as I recently learnt). On the other hand, death at home is one-off incident and in my religion celebrated as such with mourning and so on. Who wants that funny business? After all there are no feelings when you are dead!
All I want is clean, mid-sleep death. Now I know that I can not really ask for euthanasia in this country, I am sure the appropriate legislation would not come to India for a long time (even though many people want to die voluntarily, not because the disease, but because they can not earn their living in this great country of mine!). But I would want to try some similar techniques so the ultimate moment, whenever it comes, is effortless transition into lump of atoms from a living being. Sigmund Freud once said, "The goal of all life is death". He was describing Death Instinct (referring to Thanatos, the Greek god of death), found in all living things. An urge of returning to state of calm and ultimately non-existence. That is my goal, a quick transition to non-existence. I hope it would be easy.

Returning to (ab)normal life.

Returning to activities construed 'normal' takes lot of doing, especially you have the surgery wound across your abdomen. However this is the most common question you get, 'when are you going back to office?'. Well, I would like to get back to the grind as soon as possible. It would be quite a distraction from the pain and other things (e.g. having cancer).

In medicinal parlance there is a term called, 'quality of life'. Doctors claim that they try to improve patient's 'quality of life'. This generally covers, all the inflicted injections, see-and-don't-touch nurses, surgeries, etc. Of course they mean well. In doctor's opinion a walking and standing patient with little grin on face is an assurance that they treated patient well.. (or earned day's salary). Doctors would always insist that you should resume your regular activities as soon as possible. They want to make sure that you can stand, walk and work after their deeds. What nerve, one would say, but that is their way of ensuring your quality of life. I remember when my brother had angioplasty, the doctor was insistent that he should start working again as quickly as possible. Probably he wanted to make sure that the blood is flowing after he put in the stents (one can never be too sure, you know!). In my case doctor should be happy if I can stand again(!).

All said, there is no normality to resume to. After you have been diagnosed with a major disease, every small symptom is looked in a different light ('you have dandruff? I guess we should better check it out!'). Ordinary people can get away with headache and broken limb with simple treatment, cancer-patients, no way. If they get headache it must be some form of metastases, if they break their leg, it must be because of weakened bones. If cancer patients lack the desire of sex it must be those injections of chemo, ordinary people can simply get away with 'headache'.

Then there are multitudes of suggestions on how to resume normal life. Some people advocate to take it slowly (of course these people never worked in IT services field), others advise to jump into it. I like the later approach. It is more attractive than answering one mail at a time in my inbox of 1733 'unread' mails. It is amazing how quickly a large inbox with multiple 'cappings' can get you back in circulation.

Returning to normal life takes little getting used to. For example, driving the car around the block. I felt that I had almost forgotten how to drive. Fifteen days of compulsory bed-rest and no bath can make a man lethargic. However, the overbearing thought of disease seem to diminish over a period of time. I no longer worry about tumours or their ability to grow or the fact that I have to live 'an-injection-a-month-life'. I am more worried about mundane things such as what is happening to the engagement I was involved in, why the steering wheel of car is making so much noise and why Kareena Kapoor is having affair with Shahid instead of me.

For all good reasons, I like to return to normalacy. It would make me forget all the treatment and blood sucking nurses (you may not believe it but I have distinct marks on my body where nurses used their teeth to suck out the blood from my body... I can prove it). However, I would be a changed person now. I would be more educated about cancer and related treatments. I would also know what an enima means ( ok.. I did not know about this procedure before!) and for sure I would know how painful hospital diet can be. Like I always say, it is a great learning experience. At a cost of course, but there are no free lunches.

I am looking forward to getting back to the normal life. Like an injured warrior returning after a big fight, I would resume my life where I left it, as if nothing happened. People would look at me with an awe and whisper quietly about my courage. Young people would respect me and aspire to be as courageous one of these days. In short it is going to be a grand return. It does not happen every day that people return from celebrity hospital without meeting Bipasha Basu, especially when she was there to meet them. It requires lot of courage!

Pain, Pain, Go Away

After operation the first thing that hits you right in the middle of abdomen is acute pain. There is no escaping it. You try to run, hide, walk slowly, it simply stays with you. It wants entire body for itself. I consider this very selfish nature of pain. Of course you resist, but that is generally very feeble exercise. It gets into your back, it gets into your legs, hands, you name the body part the pain is there. Every activity then becomes a painful activity, like turning on your side. The injections and drugs try to make you sleep so that you forget about the pain, but you wake up and there it is, waiting like your pet cat ready to pounce on you. I have tried ignoring it, I think that has made it more angry and increase its dosage when I am least expecting. My doctor advises that is better way of handling pain rather than paying attention to it. He also advised talking loudly about how the pain does not affect you and perhaps sing about it. The pain listens and eventually disheartened, leaves your body. It seems to be working.

Like most operations they cut open larger part of my abdomen and then subsequently 'stitched' it. This stitching is merely act of stapling together two pieces of skin. So my scars look like second copy of expense report, highly stapled! No wonder it hurts. This confirms my belief that my surgery was closed in hurry. It was late and they thought, 'Ok, what else is remaining? Ah the skin is not together is it? Let us staple it!' Now I am running around finding a right doctor who would remove the staples and put something meaningful there, like good dressing with some anti-septic. I don't think my pain would go away till somebody does that.

Returning home I was worried about the post-operative care. For example, in hospital if it pains they give you injection to make you sleep. You complain more, out come the tablets that go in various parts of your body. At home you do not have this proper care. At home more pain generally causes a long discussion to one's lack of exercise, and how in the first place that started the whole thing. My family is of strong opinion that my cancer is entirely caused by my eating non-vegetarian foods. Consequently they do not see any reason why I should complain. For them it is simple situation of a person who desires cancer. ('You eat cow meat, well you were digging yourself in it!'). It is different kind of pain but you see there it is.

Another painful exercise after operation is working through the beauracracy of insurance companies and hospitals. So I call various people, and they inform me that things are in progress or that they would take some time. Insurance companies and agents however are more humane lately. So everytime I call, they make it a point to tell me that I should pass on their best wishes to the patient and the fact that they strive very hard to make patient comfortable. I assure them that the patient is comfortable and acknowledges their best wishes. It is not considered polite for patients to call hospitals or insurance agents. They generally expect the relatives to do the grunt work. I think it is fair too, they probably expect relatives to carry some pain rather than patient getting lion's share of it and being selfish about it.

I remember the old song about pain (or was it love?); The song goes like this:
'Wherever you go, whatever you do,
I will be only minutes behind you'

I think it must be about pain, there is no other feeling which follows you so closely...

Slaughterhouse and sheep

Once a lamb went to slaughterhouse and asked, "why do you slaughter the sheep?"
Slaughterhouse said,"I don't. The butcher does that".
So the lamb goes to the butcher and asks, "why do yo slaughter the sheep?"
Butcher said,"you see, those sheep make me cut them. I particularly do not like slaughtering."
"how come?" asked the lamb.
"well you see, they come to me with extra weight and sheepish look. They try very hard at being a roast chop or stew. I take pity on them & cut them. It is not easy thing to do, but I guess the sheep like it."
"oh really?" asked the lamb,"can you show me how to cut sheep?".
So the butcher slaughtered the lamb and hung him up to sell. The message of the story is: don’t waste your roast mutton chops. Remember the sheep have worked hard on it... No wait, that is not the message. The real message is 'be careful about what you ask for, most likely you will get it.'
I was thinking about this folk tale on the next day of operation quite a lot..Ok you would argue that you don't have lot of other things to do when you are in ICU, bed-ridden and entirely wired. The story sounds very familiar. I went to the doctor, told him I have cancer. I asked him what would be the treatment & he thought I am interested so he cut me open. As simple as that.

The entire surgery went on for 8 hrs and they charged me for overtime of anasthecist, the RFA guy and even the attendant in operation theatre. No wonder they forgot to cut the larger portion of tumour on the right side (their reasoning: it would have been fatalastic touching right hepatic artery; my reasoning: they were simply tired and overworked and possibly hungry too! It was well past dinner time). After such a long surgery I was anyway tired so I told them let us finish off tomorrow but they wouldn't listen. This is the problem with medical profession, they simply have no commitment to the work (unlike let us say software engineers who always carry working on the problem to next day;never finish a thing in a day,that is our motto). Well being under anasthetic and all I could not really convince them and they sewed it up and put me at the mercy of ICU nurses.
ICU, like other hospital departments is mainly run by nurses who hate their jobs and subsequently their patients. One could argue that they are so dedicated to cure the patients that they do not care for the pains of patients in the process. They do the dressing, they clean you, they give you bucketful of drugs, they inject all sorts of needles in your body, they search body cavities for disease. In short they do everything in their capacity to cure the patients. What if, some patients get wrong dosage in the process or suffer pain while dressing or get reactions of the drugs. I think it is human nature to complain, especially about small things like being unconscious. Just another day a patient next to me became chronic because of wrong dosage, and relatives were all blaming it on the poor nurse. I mean how could they, besides how could a nurse remember sophramycin for a day? For a change you try to spell it after seeing once! See how difficult that is? And doctors are always at hand in hospital, so all the ruckus was really unnecessary. Doctors could always solve such problems, e.g. In this case doctor just put him to sleep. Simple solution to simple problem. Life is much too complicated at the age of 82. He is better off without it.
The nurses being serious people, don’t laugh. You don’t joke with them. I tried once but was punished with a tablet in the lower back (literally, I am not joking). In any case the stay in ICU was more like being tested for astronauts. You have plenty of tubes coming out of your body, including one which allows you to pee and another one which allows to breathe. There are set of tubes to monitor your body performance. Sitting up or sleeping down is very painful process of entangling or dis -entangling various wires, tubes, etc.

In short you learn what an operation and aftermath feels like. The worst part is when they start removing bodily attachments. The first one to go is your anasthetic, and thus goes your painfree life. Why do they have preferenc for this, they cannot explain. My guess is that they wanted to give me special treatment and let me experience the pain first hand, unlike other patients who are kept on extra dose of painkiller out of pity. I earned my firsthand pain, what can I say? It is just my charm!

However, now I can say with atmost authority that I know what an operation is. my expertise lies in long, excruciating liver operations (patients wanting to know about less than 6hr operations or smaller than 6" scar are not entertained) with follow-on chemo or radiotherapy. We can also add ICU experiences as a feature.

I have now officially survived my operation. Agreed it is a small victory against cancer, but how many sheep can know about slaughtering and survive to tell the tale?

Life of pain

I recently saw the ad for movie on Christ by Mel Gibson. The critique was that the movie shows gory details of crucification and pain. I wonder how people had suffered the pain in the days when anasthetics did not exist? Maybe that should explain why witch doctors were burnt so frequently in good old times. The eminent danger for me is the pain of operation and pre-op procedures. They told me about putting a needle in my spinal chord. For some reasons doctors want the bowels to be sparkling clean (well looking at average human insides, I won't blame them) thus meal follows the enima.. It hurts like hell (ok no jokes about backend jobs!). Followed by series of pricks on hand and neck and thighs. The operation is one hell trip you don't want to take, cancer or not. I was getting inclined to chemo, but my brother reminded me of the pains involved. I told him I can take loss of hair (there aren't any!) and vomitting to, 'what is this green thing?... Let us cut it anyway doctor, h
e has paid for it' kind of operation. If I visualize (and my imagination is wild!), I could see bunch of doctors handling my interiors ('hey did you see these? Even Amitabh doesn't has these large kidneys', 'great, what do you say we keep one of these for ourselves? ..would look good in my new office') and cutting at random till they are exhausted. Apparently the pain would be made bearable by anasthetics injected in spinal cord, no less.

People would imagine that I would be ready for pains now that I know I have cancer. I am going to say one word to them, 'marriage'. No matter how many experiences you have seen or been through, one can never accurately predict the pain or suffering their own marriage can cause them. It is same with cancer, no predictions only anxiety.

More you think about pain more scared you get. Especially around future. I guess I should prepare my mind now about frequent pricks on hands, occassional IV fliuds getting in body and chemo cycles. I do not know how long I will live, it is difficult to predict with cancer, but I know certainly that I will die because of cancer (of course if other things such as income tax do not take their chance before!). And for certain it is going to be life of pain. There would be bottles of pain killers that I have to carry around. The travelling life is almost finished (that is probably good part), and occassional wine is ruled out (what me? tee totaller? OMG !!!!!). I wonder how wine sellers are going to make living in Pune area, guess they will have to lump it. Such is life, and I am not saying anything about sex yet(!).

Perhaps it was better life without diagnosis, it would have been easier to face the pain without prior knowledge. Now I know what to expect and that has changed my lifestyle forever ('no more brown sugar just painkillers and absolutely no sex in the morning, it intereferes with my chemo, you know..').

It is going to be painful life, especially when your brothers are drinking the scotch that you bought (which they would, I know) and you can only watch. Such is life, artist and creative people want suffering and pain to get the idea and they don't get any (van Gogh had to cut his ears), whereas me, who likes to keep pain 10 feet away and watch it in glass cabin, get the pain in abundance. I blame this all on capitalist policies of the government, which is going to rule for another 4 years. I do not know how much pain and suffering I can keep up with...

Anxiety Quotient

Is there a thing like anxiety quotient? The doctors informed me yesterday that there is a problem with the machine they use while cutting people open. Apparently the machine being tired of cutting too many people and doctors getting all the credit, decided to call it a day. The engineers are working on it. If they can fix it by the time my surgeon is ready, they might have to cut me open. Otherwise it is another day of anxiety and discussions of pain. The good part is the view from the room and 86 channels of cable TV. Life is never so good. Room service is quick and good. So far I am on fasting(in the anticipation of operation) but they regretted the inconvenience and allowed for late breakfast in case operation does not take place.
I keep pondering over the cancer types and what would have happened if I ignored it long enough. Neuroendocrine cancers do not show the symptoms. In fact I would have never known about it for rest of my life (however short that could have been). The knowledge I have cancer is very...let us say, unsettling. It makes one very anxious. It leads you to the path of writing a will (& spending some money on your lawyer friend so he can take his family out for dinner), false impressions that you might die soon and allows for freak ideas such as brazilian bikini wax. If I live long enough to remember these things, I am sure to have some fun with it. In the process however, my anxiety is going up. I am worried that this anxiety would kill me earlier than cancer. Now I really know what chicken in poultry farm feel like. They never know when they would become chicken biryani, for example. One day happy life of clicking and chucking genetically modified food and another day being served
up with onions and tomatoe gravy. It is very insecure state of affairs. Also when you are in hospital doing particularly nothing and watching seedy movies, the thoughts about when this is going to end are very profound. Every time they tell you about dooms of operation, one gets more anxious about the operation. How it would be painful, what would be after life(i mean after operation.. Not after after) and whether you would be able to get a date with Aishwarya Rai just under the heading of humanitarian cause. My anxiety quotient is going way up. I remember the movie, Holy Grail, where even God wants Sir Lancelot/Zoot to 'get on with it' in castle Anthrax.
Well doctor, don’t wait any longer, can we get on with it?

A room with a view.

Day one at Lilavati. The admission procedure was smooth. Given the fact so many celebrities with ordinary diseases (sprained ankle while killing innocent bystanders after mid-night drinking binge) get admitted here, it is difficult to find place for ordinary people with serious disease. There was some discussion around room availability, but my charm (yeah all with cancer patient look and Arizona cap) won us a good room.

The ho(spital)el is well located. The room has splendid view of Bandra reclaimation and flyover, 24hr hot water, TV, spacious bathroom, full-size mirror, exercise room, personal barber and attendance of pink ladies. In other words an ideal get-away for overworked executive like me. The charges are not very high and generally guests are required to leave behind a body part as tip; prior appointments are recommended.

Hospitals are queer places. Every hour or so a junior doctor walks in and explains you the hazards you are going to face and makes sure that you understand them (make you sign too!).

Doctor1:what’s wrong with you?
Me:well you see there is this tumour...
D1:ok..ok; dr.xxxx would remove that. As part of the procedure, you will have brain damage, liver malfunction, loss of limb, headache and perhaps you will have to leave the country under false identity. Do you agree?
Me: Would I be able change my wife?
D1: No. What do you think this is? We are going to operate on you liver. Wife change requires different procedures..ok enough joking, now sign here and here and put the blood spot here.
Me: What is this one for?
D1: It says that we get to keep your liver and tumour in it if we feel like. Do you want to know anything else?
Me: When is dinner?
D1: No food, liquid diet only (contains no alcohol).

Things happen in repetetive fashion, every doctor explains you the procedures in detail. I joke around but my wife gives me stern looks. An anasthecist walks in,
A: ah, mr. Kulkarni, I will be the anasthecist for you. Do you know what anasthesia is?
Me: no..not really. Is it something that makes you unconcious during surgery?
A: see half knowledge is more dangerous..anasthesia is more of art than science. We make sure you are unconsious and then very cleverly take the bank informtion, ATM pin numbers, password and other personal details so that we can blackmail you once you gain cosiousness.
Me: what about pain?
A: oh you would soon get over it and we never overdraw from our patient's accounts. Besides there would be a catheter in back to continuosly keep you dizzy, so you would never really feel it.
Me: and what if the anasthesia gets over me forever?
A: oh that..don't worry about it, it is called coma and happens to few lucky ones. You see, we are not gods, but we try.
Me: what are those tubes?
A: well.. Let us see, there is nose tube, the neck tube, the lung tube and the catheter and few others that we forgot. But you get used to it. We never keep it more than 6 mths.
Me: would I ever be able to walk again?
A: that depends.. You should drink lot of water, exercise and remember to thank anasthecist instead of the doctor.

I was so scared by this time that it was impossible for me to keep straight face. I signed on all forms and told them that being a poor man I can not really sign on the one which required me to fund fully paid trip to Las Vegas for the ward-boy and his girlfriend. Ward-boy took more humanitarian view and agreed to go to Singapore instead. The doctor was, however pretty crass about compromises, but things being as they are he lumped it.

The nurses apparently are very forgetful, for example, each nurse takes my blood pressure at different times. One of them is called Florine. She made me eat same colored tablet three times in the day. I made a point to repoprt her like flowers or not.

The best part of admission process was the body shaving. I would never have got such a nice brazilian bickini wax so cheap in India ( and barber who explains liver operation to you ).

Barring few gliches the hotel is pretty good. Once the payment of organ parts procedure is finished tomorrow I would have more time to test various facilities (breathing exercises, heard of them?)

Now I must return to my porridge, they tell me that is the star attraction of liquid diet, and helps you forget the suffering of operation. Looks interesting..

How scared are you?

The first thing that strikes you when somebody says you have cancer is, how many days I have got to live. It is natural for humans (who, by the way, are accidents on earth) to be worried about the life span. Every doctor I met was impressed with my +ve attitude, and told me that I would survive this cancer.
I go fooling around, I tell them examples from physics. Explain difference between practical reality and visible reality. The tumour well concealed in my liver is harmless as little puppy. Once cut open I would have series of problems with it. First two third of my liver would be gone, then I have to get chemo cycles to remove whatever is left of it. Then I will have cancer officially (Generally you don't have a cancer till you have chemo. It is important step in social standing of cancer patients), and I will have to go through series of test periodically. In short what is theory now would become reality once operated. This scares shit out of me. Now we are happy people, me and my tumor. The liver is also used to large non-functional encroachment. My liver functions are normal. Everything is hunky dory. We occassionally plan for picnics and outings. But things are going to change now...(see this fooling is going to cost me).

Doctors keep wondering about my jokes. One guy told me candidly that I would recover since I am taking this very lightly. Part of the light-heartedness comes from my inexperience about the cancer and the fact that I have no symptoms at all. I joke about the operation, the procedures, nurses and doctors. I am literally enjoying all the attention. My wife's relative was asking whether I am scared. I told her, 'yes a bit' which is true. Mostly I am worried about the pain of operation. I have already passed the phase of being scared of my life because of cancer. Here today gone tomorrow...what? Inexperienced in pain and suffering (barring few meetings and trans-continental flights, or listening to wife..ok let us just stop here), I have no idea what having cancer feels like. Only people who seem to be scared are the doctors. Ignorance is real bliss here. No fancy blood vomiting or pains in abdomen, just plain cancer (only visible thru ct scan).

It turns out that doctors are generally disappointed if the patients are not scared. They want to play the role of saviours. Not a happy situation when the patient jokes about surgical procedure. For them it is complex procedure involving life and death (and day's pay which could be substantial). No wonder they are scared when they get a patient with cancer. I mean really scared. The treatment and councelling time depends on the scare quotient of the patient. High sq qualifies for long sessions and assurances. Sarcastic remarks get nothing!

Am I scared? Not really. It is my firm belief that the people who are going to operate should be scared, my loan officer should be scared, my insurance company should be scared, not me. I am the guy who is getting operated under anasthesia and painkillers, assisted by young nurses for everything (yes including baths and what not..in case you are wondering). Nowadays even chemo does not hurt. And in case of death, having no prior experience I could not say, but definately not scared at the moment.

My mother is upset that I am not scared enough. How much scared I should be, she could not say. Lacking prior experience and guidance, my scare quotient is dwindling in -ve. Is that a good thing? I do not know..

Unusual Vs Impossible

How many times in our lives we really distinguish between unusual and impossible? We assume in good faith that life threatening diseases happen to others ('liver problems? The guy must be living in the swamp of alcohol 24x7!'); AIDS happens to the people who do weird stuff in their bedroom(s), so on and so forth. Middle class upbringing encourages the impression that it is almost impossible to have these diseases. What we tend to forget that it is not unusual to have these diseases for an average young person (even tall, dark, handsome, intelligent, not so average, such as myself.... OK I exaggerate, maybe not that tall).

The theory of life, as such, is built on 'impossibility' premise and not on 'unusual' phenomenon. My wife alludes my liver tumor to Kolkata water. I forgot the name of the philosopher now, he proposed that human minds always like to think 'rationally'. i.e. we always try to fit everything in cause-and-effect box. Thus it is easier to convince people to buy more lottery tickets(?)...er sorry, got in the moment there. Actually this is a popular proposition in Artificial Intelligence systems where computers try to be as rational as possible to pass the Turing Test.

It took me long time to convince her (and internet medical sites helped too) about the time it takes to get a tumor of this size. Kolkata water or not, this was going to happen (to be fair, the Salt Lake water *is* bad, and people do die because of that, but I think that happens instantaneously rather than delayed). In all chaos of asymptomatic diseases, she was trying to find a reason that explains the cancer. Well... on the second thoughts it is just as good that I did not tell her about my drinking binge and cigar smoking or brown sugar addiction, that would have given her some reasons. On the serious note, I was practically in denial at first when I heard I had a cancer. I felt like Peanuts cartoon, 'why me?' (and then the voice from sky said, 'why not you?').

My life was based on 'impossible' premise, thus I never thought about the cancer. The best guess was heart disease (now this one happens to even the best of us). The first oncologist I met kept telling me unusual presentation of my tumor and related cancer. Like my wife, all doctors were also trying to find the cause-and-effect. They needed something to go by. None of them wanted to concede that it is not unusual for young people with no background (and no sufficient social standing) to have cancer. Thanks to the medical education system and what have you, they always thought it is impossible to study non-alcoholic young patients with liver cancer in India. Well, my case should teach them to be prepared at all times. Next time they wouldn't be making second guesses at casual breathlessness. The world of medical diagnosis as we know it, would be fundamentally changed; people with breathlessness and left shoulder pain would be checked for cancer first and cardiac problems later. There would be package advertisements about cancer checks and cardiac diagnosis would be part of routine physical. Hospitals would compete with each other to diagnose liver cancer first. In short, Cancer would no longer be an impossible disease, it would be categorized to mere unusual. I look forward to that day.

Latest biopsy revealed that I have neuroendocrine carcinoma and not HCC so I might live after all. It is unusual but not impossible!

Beauty is only skin deep

Then the wise guy argued, 'who the hell wants to see the inside?'. I agree. For past several weeks I have been going through one CT (computed tomography for you medically unsound people) scan a week treatment. The mechanism is fairly simple. They give you a colorful drug to drink and then scan the flow of that drug throughout the body using spiral X-rays. End result: a nice set of pictures printed on black(!) film showing your interiors. This is the time for men and women to blush. Every other doctor I visit, starts looking at these interiors of mine. It is embarassing, makes you feel like in slave market and the buyer is checking out your interiors. Maybe dancing girls, more appropriate. Another oncologist, I was talking to, said that these are the most beautiful pictures. Well, the beauty is in the eye of beholder. For me, I am happy with my bald head and little bit of pot belly, I do not want to see what is inside. Liver tumors or not.

Today's CT scan was to find out if I had a cardiac problem too. I was just afraid that I might be promoted from a rank brigadier to general (one star to two stars - cancer and heart disease both). It turned out my promotion is long way off, all my arteries in and around heart are performing fine (even though that was the youngest and shapely doctor around!). These images are way too detailed, some times more uncomfortably so. For example, one of the reports said, my bowels were covered due to gas. This is absolute invasion of privacy. You literally die many deaths (was is Keats?) when some doctor in broad light is looking at those films and discussing in front of all of your family members how your kidneys are in nice shape. Thankfully we do not go beyond liver most of the times, where I have star attraction (for now). I wouldn't want another pretty young doctor making guesses about life on planets beyond liver ('do you see the small thing there?'.. 'oookay doctor, I did not come here for checking that..'). The eMedicine site describes that CT scan is just like slicing the bread and looking inside it (it helps doctors to look inside your body, soft tissue and all!). Go figure what your upper body slice is going to look like. I tell you from experience, it is not a pretty picture. Then there are, of course, bone scans with radioactive isotopes. Besides the contrasts that they use, wow amazing! These drugs really give you out of body experience in 2 minutes or less (LSD anybody?).

The doctor was very detailed in explaining the pains and after effects, e.g. I might vomit or die of suffocation. Your photographer in studio does not warn you, these guys do (very professional!). Talk of advancement in clinical procedures. To be fair, Angiography was done quickly and the drug was injected through IV so no pain. I recall the days when my brother went through these procedures, he invariably had to cut his thigh every single time doctor felt like looking at his heart.

So one more digital image in collection and lot of money less we progress on our path of medical diagnosis. My wife was complaining that doctors these days depend more on circumstantial evidence than actual physical checking. I tried to convince her that these are complimentary techniques (and that we already landed a man on moon, however far it may appear to a naked eye), but no avail. These wanna-be doctors are more dangerous than the original one's.

For the moment at least, I am happy that I do not have blocked arteries like many others on this planet do (and imagine all the fuss they make about heart attacks!). In pure competetion, we cancer patients can take on these heart disease guys (sissies) any day. We have bigger terms like 'metastases', 'carcinoma' and what not, the heart patients have to live with cardiac arrest (heart attack) and 'blocked arteries'. Poor chaps. Even the treatment is a wash-out ('change in life style'). C'mon what is treatment in that? I would like to change my life style every other day. Cancer treatment, on the other hand, requires chemotherapy or operation. It changes your face (literally!) and life changes automatically. You 'survive' the cancer, you can write a book and participate in celebrating marathon. Who would buy a book by heart disease survivor (there are just too many of them out there)? And seriously how many heart patients can plan to run marathon? In my opinion the medical fraternity should wake up to the reality and start treating cancer patients with more respect they deserve. (Cardiac department, bah! why would you need that?). There are just too many inequalities in this world.

On the other hand, I was going to ask about few more things that did not seem right in my body in the CT scan. However, I was afraid it might lead to another discovery (in style my liver tumor) and would put me on bed for rest of the year. For example, I am almost certain that I am missing one of the ribs on left side, but telling this to the doctor had its own risk... and what if insurance company rejected the claim under 'pre-existing' condition (a.k.a. manufacturing defect)? I learnt my lesson and kept quiet.

Thinking it over, I am planning to spend little more time on looking at the cover and not inwards ('Do not look inwards', would be my message to the young generation, 'the picture is not pretty and you probably have a tumor in stomach!'). Hence I plan to spend more time on my tan, pay more attention to my facial, hair-cut and ever glowing skin , after all that is where beauty is.

Biopsy, A liverly experience.

Day 2 of anxiety. Now the surgeon is thoroughly pissed of with me (I ask too many questions) and thinks that my operation would be more of a liability than success that he can show around. Compounded with multiple queries from various other doctors, he thinks that a biopsy would be more fruitful. So here we are, at Raheja romancing with another doctor with attitude willing to insert needles in my liver. I must say that having serious illness does has its advantage. For example I have visited all major hospitals in Mumbai by now, Jaslok, Lilavati, Raheja, you name it.

Getting on with biopsy the doctor is trying to humour me.
"what do you do for living Srinivas?"
"umm.. it is difficult to explain, you sure you want the answer?"
"sure, I have time"
"I am IT architect"
"oh there is such a thing?"
"see I told you.."
Doctor by this time looses the interest and takes out real long needle and stabs in my abdomen. It hurts like hell, even with local anaesthetic. I was going to ask him what he did for living, I think he guessed it and wanted me to shut-up. These livewire procedures are not for the people with weak heart, l mean if you look at the size of needle there are good chances that you'd faint.
I endure it, old military training comes handy. After the needle is in the liver, doctor has free hand to take out as much tissue he likes. There is this chuga-chug sound when he is taking out the stuff. Once the sound stops you are ready to kiss your wife good-bye, they declare, its over. He asked me to sleep on my stomach and after half hour there's a small blood spot on the cover. Now I know why they call biopsy as 'traumatic' procedure. One more scan to confirm that my liver is functioning (or not..) and we are out. Coming out I warned everyone about cracking jokes on my posture (I was sleeping on my stomach in hunched position). Outside an old man told me that I should not worry, he had his biopsy done just now & it didn't hurt. I was going to tell him that this was my first baby so I am little inexperienced. Good sense prevailed. I said nothing.
The doctor walks in, "is the pain better ?" I told him it was a trick question, he did not get the joke. One particular thing I noticed is that medical professionals do not have much sense of humour as we would like. Or maybe they see life in bare form everyday, so find nothing funny in sarcastic jokes of a cancer patient. The nurse called me, 'madam' by mistake and I told her that I am still a man, they are yet to perform the surgery. She, of course, didn't get it. My wife did, so it was very difficult for her to conceal the laughter. They ask you to drink something and attendant is watching to see if something oozes out of the body puncture. I almost felt like the cat in cartoons. Well nothing interesting happened, the water & tea went straight in stomach. I even had lunch after that.
On journey back home, we were discussing next action plan and my eldest brother told me that I have a long life barring few inconveniences later this year, which may include some surgeries. I told him, that meant two things, I need a long term pension plan and 'inconvenience' is good choice of word for an operation which involves removal of two thirds of the liver and subsequent chemotherapy.

Journey of No Return

Today I start my personal journey of no return. A day in my life when I can make grand statements like this. I was talking to my son today, and I realized that my outlook of the world might be changing soon. Today the doctor would decide to operate upon me, on the other hand he might open up and declare that cancer is spread so much that it is impossible to operate and chemotherapy is the only option. watching lot of strangers decide whether you should leave or not is wierdest experience of all. I also realized that I may not survive this ordeal as much I would like to. I had, what is known as, deathbed experience. There are high chances that I may have malfunctioning liver and go in coma and die naturally. Once the death is accepted as inevitable rest of decision making is rather easy. As I think about it, I am kind of short circuiting the pains part. I am told that surgical procedures of any kind are extremely dangerous and could be fatal. On the other hand chemotherapy is
seen as equally dangerous, e.g. Loss of desire for sex.. I mean what is the point in living life after that? Death might be easier option in that case. Don't think I am sex maniac but let us be serious, I will not be drinking for rest of my life, no smoking and now you take out sex what remains behind? So what is life?
That is a good question to ponder over at such an artificial Sunset of my life. I would have still liked to run that marathon with my Nike shoes you know! But all my material aspirations seem very distant now. Now the only aspiration i have is to live my life. Fight for my life, be a cancer survivor. I want my son to remember me as person who fought hard.(And of course write a book about it,with photographs of before and after, no less! :-))
With all these grand thoghts i start my journey of survival today, with abundant hope and a gratitude towards life lived. 'Right ho!' as bertie wooster might have said...

I have cancer!

Well finally my day in glory. As noted before I do not have great achievements and I used to brood over that. The fate however was in my favour. It decided to give me a glamorous disease instead. Finally I have my golden oppty to write the book, whether I survive or not!
I passed the first stages of yes/no dilemma fairly quickly and now am choosing between surgery or chemotherapy. Life is just another Starbucks.
Every doctor I meet is at first surprised, then resigned, and finally consultative. I have been dignosed to have HCC (hepato cellular carcinoma). This was based on FNAC of the large tumor in my liver, accidentally discovered during CT scan of my abdomen. However I have no other commonly observed symptoms of hcc, such as AFP markers, hepatitis (b or C). I do not have alcohol abuse history and I do not stay in sub-saharan africa to eat something carcinogenic. In short I have rather unusual case of HCC. This puzzled many doctors as the signs do not follow textbooks. Funniest part is almost all doctors agree that I would be treated well, if I go to US. Doctors are also divided on the treatment. One school proposes that first the size of the tumor should be reduced and then operated, while other school of thought is more aggressive in cutting first and treating later. However both schools are certain that if I do not treat it I will die. No brainer there... I mean, who needs highly trained doctors to tell you, you are going to die, once you have cancer? One certain Einsteine predicted long time back that life is accident!
Well it gets better, couple of doctors I met today almost wrote me off. They said the 'd' word too frequently while looking at my reports.
Now I am waiting for my chemotherapy, first ever! I read on internet that chemotherapy affects the desire to have sex, I wonder whether that is true (this will be quite a disappointment with my all new georgous look, 'see no hair', another side effect of chemo!)
Well I will find out soon enough...

Prisoner of Hospitals

It is now a week that I have been out of my prison (Hospital !). I had little breathlessness on couple of weeks ago and that started a string of tests and subsequent hospitalization. I was diagnosed to have a cardiac problem, a cancer and pulmonary complications (at the same time!). The hospitalization itself was not that bad.. well there were lot of young nurses to begin with, but the being-instructed-where-to-pee is not a state one would want to be. Especially if you are used to sufficiently democratic house (now don't get me wrong, we do have bathrooms, but we also have balconeys with potted-plants). The worse part is most of the young nurses did not know their trade, thus they would insert the needles everywhere in my body without lot of professional skill and cause all kinds of IV fluids to get in my body, where least expected. I consider this to be very dirty game on the part of nurses. After all one is expected to be warned about the punishment before treating to full effect of it. The good part is I learnt how to manage the IVs and a great deal about 'Hepatoma' (hepato-cellular carcinoma or HCC. We, in medical trade, like to use the shortforms you see..), but none about what caused the 'breathlessness'. My doctor has a hypothesis that tumour in liver causes pressure on diaphragm and causes breathlessness. I think if proven true, he would probably publish a paper on it. In other words we have a rare condition. I wonder how useful this case would be for generations of medical students. There would be discussions about whether alpha-phetoprotein level should have indicated it or it was just another form of FLC (Fibrolamellar Carcinoma). Professors would have pop-quizzes on symptoms and the right answer would be 'breathlessness'.. :-). I am looking for quite a bit of photographs taken of my tumour in liver and become famous posthumously.
My wife (who wanted to be doctor but became engineer and assumes that she has the knowledge of medicine), on the other hand, thinks that I have a problem of overgrown nose bone which is causing all this 'breathlessness'. According to her I have sinuses problem compounded with pollution. My mother thinks I do not have problem and I need lot of rest.
However all of them agree on putting me through the experiences of hospital. I do not hate hospitals in general, but what gets you, is sleeping on rexine beds and staring at the white ceilings (well.. er and also the fact that you can not really flirt with the nurses, however young - it is like being in strip clubs, you can watch but can't touch!). Hospitals are almost like a prison, you have to drink tea at time they give it to you, lunch on time, dinner on time, even sleep on time (if you decline they force a pill down your throat to make you sleep) and absolutely no sex..not even thoughts (in case it increases your blood pressure). I am sure in even in real prison they treat prisoners better and nobody is drawing their blood 2 times a day. I have got so many pricks on my hands that it is difficult to find the contiguous part of the skin. I have radioactive isotopes in my body, lungs, liver. I have been treated through multiple magnetic scans. The tests ensured that if I do not have cancer, I would have one eventually.
I have few more tests planned this week, I am assured that the new prison is in different place and has better nurses, however punishment would be little severe... this time they plan to cut me open. It is true that prisoners don't have choice, only change of wardens...

Being Rude Indian

I recently came across Talk to the Hand (Lynne Truss) and it put me on the thought of rudeness in Indian society. I think we do not have any decency left in Indian society. People push each other around, everybody speaks English but has rarely used words like 'Thank You' or 'Sorry' or 'Excuse Me'. The part that drives me nuts is that nobody holds the door, for women, old people, children, handicapped. The worst part is that the people in this category don't expect the courtesies either. For example, another day at the Airport I let an old women go ahead she didn't even thank me! Women rarely expect door to be held open for them in India. Now it is a different story that Indian hypocrites argue that women are more respected in India (!).

I have my own theory for this utter rudeness in Indian society. I think that years of foreign rule have made people very protective and focussed on self-preservation. In the process people have simply forgotten to pay attention to others. The society became so self centered that people simply forgot that there are other people. The endemic queues for getting daily things and overall poverty for generations made even rich people to be greedy. This reflected in the behavior of the larger society. Indians have tough time in standing in queues, it is another thing that the famous for queueing British ruled India for more than 200yrs. Indians don't really excuse themselves before interrupting others. Indians don't say sorry for cutting the lanes and traffic rage is notorious (sometimes you might get stabbed simply because you were not giving the side for faster vehicle!). John Moulton argued that nation resided not in obedience to laws but abiding by conventions that were not obligatory. Indians at least presently have tough time in obeying the laws, we have long way to go to 'obedience of nonenforceables'.

Orphan Generation

Finally I landed up in India for Diwali (Festival of lights). Story has it that people started celebrating it when the great Ram (of Ramayana fame, assisted in parts by monkeys, monkey gods, brother and wife who preferred to die than continue marriage), returned to Ayodhya after killing Ravana. I do not know if this is true or not, for me, gourmet ever, Diwali is lots of fun and time to eat variety of sweetmeats. I also had my vacation on the sea (Dapoli, west coast Maharashtra) and had lot of quality time with family.
Returning to India is always mixed feeling for me. I like to see the western finess in India and Indian culture in US. Sometimes I think we are really an orphan generation. Due to economical situation and other factors we definately have much better life in India or US, but we do not belong to either countries. In India my parents can not simply accept the ways of modern world. In US I can not relate to the individualism. I belong to that community which has no identity and no context in either society. I have seen many of my colleagues in US trying to find their sense of belonging in NRI communities and hindi movies. On the other hand colleagues in India find significance in buying an imported car. Where do we belong? To Diwali or X'mas that browns can not relate?

Parking Attendant in US

Ok..so I had my first well profiled remark in US of A. Time was Friday evening, when most of the world is enjoying themselves about the fact that they don't have to work for next two days. I went to this hip Japanese place for Sushi (big picture with naked girl and remark, "She Sue" and then a picture of a Fish with remark, "Sue Shi"; I thought it was fun). By and large I am not much in favor of Sashimi (fresh sliced raw fish), but the art and style of making Sushi always gets me.
Since we were in hurry I chose Valet Parking. In Phoenix AZ most of the city is always in short pants. Either the heat gets them or it is a fashion statement in this part of the world. Following do as Romans, I had my work shirt (white) and short pant for an evening outing. Little did I realize it was the dressing disaster (as style connoisseur would have it). The restaurant did allow us to get in and finish our dinner. We came out exchanging good tip and thanks with our Sushi-chef and waited for Valet to get my car. At this time two 'Friday evening' attired girls came out of the restaurant and almost handed over their parking ticket to me and asked me to get their car.
I did not get it first time, I asked, "Do I look like Parking attendant?", one of the girl said, "yeah sure, you are wearing this white shirt and dark pants and standing by the parking booth". I laughed it off, my friend consoled me that we could have really taken her card and probably drove in her car, which could have been better... Eventually I got it, she was not referring to my dress at all, she thought, genuinely, that I was the parking Valet. I was overwhelmed by the acute feeling of racial profiling. It was funny and at the same time very real. I told the 'real' parking attendant about it, we all had a good laugh about it and he was worried whether I pocketed the tip from her.
Driving home I realized what racial discrimination meant. In workplaces and people I meet are too influenced by world economy, it is only outside the ordinary people can give you the real feeling of social undercurrents.
I always get this question, "if you travel to US so much, why don't you stay here forever?", now I think maybe I should, afterall parking attendants make way more money in US than imported software engineers with bad dress code.

Life is short, buy the Shoes

Labor day (Labour for us General Indian English folks) is a long awaited holiday in US. It is official start of Autumn. Compared to India, in US the official holidays are very few and insecure Americans keep working through these holidays anyway!
The last holiday was the independence day on 4th July. Of course in capitalist world holidays translate in more retail sales and high turnover. Even the mall barber shops are open during holidays. Both holidays, 4th July and 4th September translate in more sales as these are immediately after the payday for most of the average Americans (yes in contrast to what many people in the world believe, average Americans make approx. $45K per annum and have limited disposable income). So I joined the bandwagon of many million Americans in holiday spending spree. It is important for my business that American economy is stable and growing, so I contribute wherever and whenever I can. I buy the stuff, I may not need, would never use, but hey, this is business not personal (The Godfather - it is a bible of life and has answer for everything, "What to pack for travel?", "..leave the gun take the cannoli.").

Well anyway, I had to do my bit so I tried multiple things. It is very difficult for me to go buy something at a whim (called incidental shopping in US). Especially with all that middle class background in Indian family. This is true for the things I need, now imagine trying to do incidental shopping for the things that I don't need!

At first I tried with some gift articles I wanted to buy for my relatives back home, this proved to be quite time-consuming exercise and I was not convinced that the salesperson knew any better. I decided to do some internet research before buying. Then I tried something for my own use (or not)... I could never submit myself to buying clothes in US, since majority of them are made in India, Srilanka, Malaysia or Pakistan and I could buy them much cheaper back home. To my mind this is last step before Americanization, so never do it.
Finally I zeroed on shoes. The story goes like this, in past few months, my weight went up exponentially, so I had to do lot of exercise, one of the things I do is a long run in the morning on Green belt behind my apartment. As it turns out, I have never done the hard court running in the past. This resulted in shin splints (very painful at that!). The 'wise' people advised me to buy better shoes than my $15 Walmart all purpose athletic shoes. As if I needed another reason to spend money. I went through internet running sites, branded goods sites and Men's Health magazine (yes the same one!). Nike had new 'human engineering' shoes, which were supposed to be much better cushioned for runners. Well, that was enough convincing for me to buy the $85 shoes. Sports Authority was very close and the commitment to run 2-3 times a week seemed very much achievable. So after 5 mins long research and a resolve to run everyday, I was ready to spend the $85 plus tax (gotta pay Uncle Sam!). Now the most needed thing was bought, I was thirsty for more.
Typically when I travel I carry one formal shoes pair and one casual. But now I realize how uncivilized I was. What I really needed was one casual, one athletic, one for running and one formal. Ignorance is never bliss. Now I know why I was feeling so out of place in United States. I just did not had enough shoes! I wanted to fix the problem so I went to another shoes shop in the mall, now the kindly people at the store were offering me half price on second pair. It would have been very rude of me to just reject their offer. We checked various shoes and finally managed to leave with only one red cordovan shoe pair. It took me long time to select the red shoes, but you know, there is never such a thing called perfect shoe. So you have to buy more than one imperfect pairs, at least you would get closer! Thus, after $200 on shoes and a Joni Mitchell CD (Both Sides now - Love is life's illusion - I heard it first time in Love Actually, nice songs), I was out of the mall. Happy that I contributed something to the $9 trillion economy of US. 25% of that comes from Retail. If I am ever to be known to the posterity, I would be known as one good shopper in US who spent lots of money on shoes. After all life is short, everybody needs to buy more shoes, whether in US or otherwise.

Staying in America

Every time I visit, United States of America it is always a new experience. At immigration counter, I get questions like, how many times you visited US? I am usually tempted to answer, this is my first time..
Every time I visit, there is a new crisis the country is going through, last year it was war, year before that there was homeland security, this year it is gas prices... The list goes on. I do not watch the news closely enough but I think US probably has crisis every day. One day it was missing girl in Aruba, another day it was Drunken Driver going bersek, few days ago it was a dead news reporter. I love the media in US. They cover each and every thing as if it is first time it is happening. The US media is so powerful that it can help an average (and not so average) American Joe/Jane to become a president.
US is also considered as "melting pot" of various cultures and ethnicities. I love this part, anywhere in US you would get a Chinese eating place, Mexican restaurant, Outback (Australian), Indian eatery, Jewish food... the list can go on. Seriously one can get all kind of food in America. Another thing I like about US is, despite such large land mass, one can get seafood
practically anywhere. For a gourmet like me it is indeed a party.

There are three most important things in US a person should have... Credit Card, Car and a Cellphone (also known as 3C's). Practically every bank would open an account for you (if you have sufficient money), with or without a SSN. A Car can be rented and pre-paid Cellphones are available (now!). Most of the companies now issue international credit cards so no worries about frauds or authorizations.

Filet Mignon

Filet Mignon - French Derivative, it means small or dainty fillet (filet = boneless meat - mignon=small dainty).
So we were at Monty's steakhouse. This is American thing. If you are in America you have to eat the steak. Americans from early days of settling were infatuated by the beef and have carried that tradition very well. I was convincing my friend to eat a steak, he naturally was afraid, being an Indian Hindu Brahmin, perhaps it was more of my fault than his. One of the things I do not like about American steaks is its flatness. Even the best steakhouses do not serve the spicy richness that is required to go with the red meat. So I always go for Filet Mignon, thanks to the French, it is gurranteed of being same taste world over. Also thanks to the food fashion statement of calling everything French, Filet Mignon is known as Filet Mignon in most parts of the world. Some places in US they sell it as Tenderloin Steak but it means pretty much the same thing.

I can say that I do have some authority on the steak in particular (10 yrs of eating as opposed to getting used to it as a lifelong staple food!). It has to be medium rare for best taste and the meat has to be tender, not the heavy duty fat content stuff... Not because I am health concious (at 170 pounds you generally become one!), but mostly due to the chewi-ness that comes with the fat.
Thankfully I have sharp teeth, so not much worries about choking hazards.

Filet Mignon goes very well with Cabarnet. In Matrix (first part) Cypher says, "You know, I know this steak doesn't exist. I know that when I put it in my mouth, the Matrix is telling my brain that it is juicy and delicious. After nine years, you know what I realize? [Takes a bite of steak] Ignorance is bliss". Except in my case it did exist and was juicy and delicious...well and I missed Cabarnet as well. Being the designated driver in the group I had to sip on Iced Tea.

Sometimes I wonder, what would world have been, had it not been for French to invent how to cook beef?