By Moni Abraham Kuriakose, MD, FRCS
February 12 is a special day in the Orthodox Church calendar—Remembrance Day of all who departed from this world. (It almost coincided with Maha Sivaratri on February 18, when Vavu Bali, a Hindu ritual, is carried out for the departed souls. Was it a coincidence?!)
During the sermon, the priest metaphorically mentioned that he could see many more people than those who are physically present. He could see the spirits of ancestors departed from the earth. I couldn’t resist looking around with the hope of “seeing” some of these souls. Suddenly my eyes caught on Joseph*. While the entire congregation was sitting on the floor, he positioned himself on a chair by the wall. I rubbed my eyes—was I seeing the real Joseph or his spirit?
My mind flashed back to events that occurred over 30 years ago, in my village in India. I had returned for a summer holiday while I was undergoing my surgical training in the UK. Hearing that there was a foreign-trained cancer doctor in the village, a senior family member of Joseph’s household came to find out whether anything could be done for Joseph, who was dying of kidney cancer. I profusely apologized, stating that I had only started my surgery training in head and neck surgery, and was not qualified to make any recommendations on the kidney cancer that Joseph was suffering. My mother, who was listening to the conversation, wouldn’t accept no for an answer. I didn’t have any option but to follow the orders. We walked about five kilometers to his house, located two hills away from ours; I carried my stethoscope to look professional.
On the way, I found out more about Joseph. His family recently moved to our village to work in a new electronics factory. Perhaps to establish his loyalty to the village, he was involved in several village social activities. Church became his second home. Every day at the crack of the dawn he would be there to light the candles; he cleaned the premises on Saturdays to get the church ready for service the next day. His faith in St. Behanan, the patron saint of the church, was unshakable.
More than a year ago, Mr. Joseph walked into a city hospital with the complaint of blood in his urine. He came out in a wheelchair after undergoing nephrectomy for renal cell cancer.
I was taken to Joseph’s dimly lit room. I could see the frail curled-up body of a middle-aged person. I looked through his neatly filed medical records and noted that he had stage I renal cell cancer. I made a few inquiries about his well-being and any symptoms associated with the disease recurrence. Clinical examination that followed revealed no untoward findings.
The operating surgeon had informed the family that he had done everything possible, and the disease being cancer, was unable to predict Joseph’s fate. Joseph, although he had not been directly informed of the prognosis, assumed that he belonged to the departed souls, and had spent most of his time since the surgery lying in bed, awaiting his imminent death. His family accepted this fate, and Joseph became a passive recipient of care. The villagers extended their support in caring for the dying patient with cancer. Joseph claimed every new day as a bonus, given by the blessings of St. Behanan, who is regarded as a healer of incurable diseases.
As I heard Joseph’s story, I remembered my general surgery posting in the urology ward. This certainly did not make any sense—the cure rate of stage I renal cell cancer is over 90%.
I explained my dilemma to Joseph’s household. With their permission, I called the surgeon who operated to understand whether there was some error in the documentation. His memory was vivid, as this was the first renal cell cancer surgery he had ever performed. The surgeon appeared to be rather perplexed to learn that Joseph was still alive. Since he couldn’t find any reasonable explanation for Joseph’s good fortune, he took solace in the supernatural—“It must be my beginner’s luck,” he said. On his guidance we obtained scans, chest x-rays, and a few blood tests, which all came back normal.
Armed with the normal scan reports and other investigations, and my own recently acquired knowledge by reviewing my surgery textbook, I was excited to inform Joseph and his family that he didn’t have any evidence of cancer. This happy news was met with blank, melancholic faces. Their thoughts had been entrenched in the belief that cancer is always fatal.
So, there I was, facing Joseph, alive “against all odds,” and against the belief of everyone, from the doctor who treated him, his family, the community, and above all Joseph himself. How, I wondered, could I reverse this deep-seated delusion?
I remembered attending cognitive behavioral psychotherapy lessons in medical school. The key is earning trust and anchoring the faith on immutable facts. During my month-long summer holidays, I decided to test these principles. After all, I thought, nothing worse can happen. I started by explaining the medical fact that stage I renal cell cancer is curable. I connected Joseph with others in the village who had been cured of cancer. I demonstrated his physical ability to walk and to do day-to-day chores. I also explained that even if death is imminent, by worrying it will neither be hastened nor delayed.
None of this worked.
But finally, something did: the advice for him to serve his patron, St. Behanan, during the rest of his life. On the last Sunday of my holiday, the frail Joseph made an appearance in the church, to the surprise of the parish. Perhaps because of the special attention that he received, the old habit of regular church attendance came back.
At the end of the Remembrance Day service, I asked Joseph of his well-being. The deep entrenched fear of cancer was still there. “Against all odds,” Joseph is still alive. The irony is that it is easier to cure cancer than the fear of cancer.
Dr. Kuriakose is the medical director, cofounder, and CEO of Kerala Operations at Karkinos Healthcare, Mumbai, India. He is professor and vice chair of the Department of Head and Neck, Plastic and Reconstructive Surgery at Roswell Park Cancer Institute. Follow him on Twitter @makuriakose. Disclosure.