For a cancer surgeon seeing patients battling various stages of the disease, some days may be dark and depressing, others a whirl of surgeries and follow-ups, and many filled with the warm glow of hope. And the courage of patients and caregivers may help doctors see the light, even in the bleakest of times.
When Dr MS Ganesh, chief surgical oncologist and head of the department of surgical oncology at Vydehi Institute of Medical Sciences, Bengaluru, was contacted by a patient with oesophageal cancer about a year ago, little did he imagine that he would have to make one of his most difficult decisions regarding the treatment. But the doctor is glad he took that call because it helped the 55-year-old cancer patient come back from the brink.
“When you step back and look at the patient’s situation with empathy and reorient your thinking, the outcomes are usually good,” says the senior surgeon.
Oesophageal cancer is cancer of the food pipe. Worldwide cure rates are around 25-30 per cent. The procedure used for treatment of the cancer is called oesophagectomy, where the surgeon removes all or part of the oesophagus and reconstructs it using tissue from another part of the body.
“It is a challenging condition to treat mostly because of the advanced nature of the disease and the nutritional deficiency that it causes,” Dr Ganesh says. “This patient is from Santiniketan in West Bengal and his son contacted us through our website and sent us scanned reports of his father’s diagnosis through WhatsApp. After examining the reports, it was decided that the patient needed one round of chemotherapy and radiation, and after two months he would have to undergo oesophagectomy.”
Since the family said it would be difficult for them to stay in Bengaluru for an extended time, Dr Ganesh suggested that the therapy be started in a cancer centre closer to their hometown. Meanwhile, the doctor and his team remained in constant touch with the patient and his son to allay any doubts.
After treatment, there was a slight improvement in the man’s condition. Scans and endoscopy results showed he had responded well. The doctor encouraged the family to go ahead with surgery near their hometown, but the patient’s son was not comfortable with the idea since he had built a good rapport with the Vydehi team by then. He wanted to bring his father to the Vydehi Cancer Centre in Bengaluru for the surgery.
“We performed the oesophagectomy, and it went well,” says Dr Ganesh. “He was out of the ICU in a few days. But being a known patient of coronary artery disease, he suffered a heart attack on the tenth day after surgery and was shifted back. His condition deteriorated and this delayed his recovery from the cancer surgery. At this time, the son started having doubts and feeling guilty about allowing his father to undergo surgery. I was spending a lot of time counselling him and told him these things were beyond anyone’s control. And the patient was not improving.”
Dr Ganesh could understand the family’s dilemma. “But I told the son not to lose hope,” he says. “As a team, we persevered and decided to take it one day at a time. It was a difficult call to take, but I decided to continue treatment [critical care treatment (in the ICU) for the cardiac episode and post-surgery care for the cancer] for a few more days. It paid off because he was stable after 10 days and was shifted to the ward. Once pathology reports showed he was doing well, the patient’s family decided to take him back home.”
The senior surgical oncologist says his biggest learning from this experience was realizing the importance of “situational awareness”. “Surgeons often get caught up in the medical jargon and technical details, and fail to see the larger picture,” he says. “Having perseverance and empathy was important, and situational awareness led me to the right decision.”
Dr Ganesh kept in touch with the family, checking on the patient’s progress through video calls. He has also examined their living conditions and found out more about Santiniketan to get an idea of the medical support available.
Two months after surgery, the patient was deemed a cancer survivor. It is now over a year after the surgery and the father continues to do well.