GOOD MORNING DOCTOR Prof.JOHN KURAKAR chapter one to Ten

 

GOOD MORNING DOCTOR

Prof.JOHN KURAKAR 

CHAPTER 1 GOOD MORNING DOCTOR

The clock strikes past midnight on March 22, 2022. I wake, cloaked in a fog of numbness, an unsettling void. No familiar faces, no comforting presence. Where am I? "Oh! Amma (Mother), save me," my voice quivers in the silence. "God, save me," the plea escapes my parched lips. "I can't bear the pain," I whisper into the darkness, "Amma, it hurts. Save me from this world of pain..." Around me, the air felt heavy with heartfelt, helpless cries, echoing the torment of souls lost in their own suffering. The only memory that lingers, vivid and unyielding, is the moment I was wheeled into the operation theater at around 7 AM. My wife, Professor Molly Kurakar, along with the Doctor, my daughter Manju and my son Manu, accompanied me, their presence engraved deeply into my mind. Their faces were shrouded in gloom, each bearing the unmistakable marks of grief and depression. The morning sun's rays timidly peeked through the windows, casting a faint light that did little to lift the heavy atmosphere. Even the whispering wind seemed unable to carry away the weight of our collective sorrow. Everywhere I looked, there were only faces burdened with unspoken pain, silently bearing the weight of their sorrows. The Nurses (I call them angels, truly they are) escorted me to a hall just outside the operation theater. In that dimly lit space, I encountered many souls whose lives mirrored my own, each one wrapped in the silent fabric of their own struggle. There might have been rays of hope, but they were faint and brief. Silence

 CHAPTER 1 24 GOOD MORNING DOCTOR reigned supreme, as if words would shatter the fragile peace we clung to. Around twenty cancer patients, clad in identical hospital uniforms, sat with their close relatives beside them. Not a word was spoken; the weight of the moment rendered us mute. One by one, the angels arrived, each taking a patient by the hand and leading them into the theater, where doctors in uniform awaited with calm, practiced hands. The operation theater buzzed with a quiet, focused energy. I remember the sharp prick of IV needles piercing my arms and legs, a sensation that tethered me to the present moment. Lying there, I surrendered my life and my fate to God, feeling utterly helpless. I understood that these are the moments where the doctor became a deity in your eyes. When illness strikes, and we are at the mercy of another's skill and compassion, do we question the form of our saviour? No, for in our vulnerability, the doctor is the divine, a beacon of hope in human form. When the diagnosis of cancer pierced my world, it brought with it an outpouring of prayers and words of comfort from many kind souls. Yet, when I opened my eyes in shock, I found myself utterly alone, enveloped in an icy cold that seeped into my bones. The silence was torn apart by the agonizing cries of patients under going surgery in the ICU, their pain a haunting symphony in the sterile air. My throat was parched, each breath a struggle. After the operation, I found myself in the multi-specialty ICU, surrounded by the critically ill. Time moved with agonizing slowness, each second seeming like hours. My pleas for water went unanswered, my cries for comfort met with silence. No one offered me a single drop to soothe my burning throat. Desperation clawed at my spirit. Unable to cry, I felt as though I was teetering on the brink of death. Gathering every ounce of my 25 Prof.JOHN KURAKAR strength, I shouted, "Is there no one here?" The words echoed in the void, unanswered. How long had I been begging for a mere drop of water? My frustration boiled over, and I threatened to rip down the hospital and the bed in my anguish. My screams finally drew the attention of the nurses. "Isn't there one here with some common sense?" I demanded; my voice raw with desperation. "Don't you know that March 22nd is World Water Day? Did you offer me a drop of water, even on this day dedicated to it?" In that moment, my thirst became a poignant symbol of the cruelty of my condition, and my plea a desperate call for compassion in a world where even a simple need could go unmet. "Acha (Father), please lie down," the nurse implored, her voice laced with helplessness. "We are not permitted to give water. The doctor has said that water should be given only after 9 am." The weight of her words pressed down on me. Is it permissible, I wondered, for a doctor to withhold a drop of water to moisten the throat of a dying person? Lost in my thirst and despair, I began to speak, forgetting my surroundings. I talked to the nurses about World Water Day and its profound significance. The words of the ancient mariner echoed in my mind: "Water, water, everywhere, nor any drop to drink." The irony of my plight struck me deeply, as I lay parched in the best of facilities in the State of Kerala, a land blessed with 44 rivers. My thoughts turned to the maggots polluting our water sources, a stark contrast to the life-giving purity water should represent. My condition mirrored this paradox, a cruel reflection of abundance tainted by neglect. Tears welled up in my eyes, blurring my vision. I remembered the water wasted in my own home, the precious drops carelessly lost. Images of villages, regions, and entire 26 GOOD MORNING DOCTOR countries battling over water flashed through my mind, their struggles resonating with my own desperate need. In that moment, my thirst became more than a physical pain; it was a touching reminder of the universal quest for life's most essential element. The nurse, moved by my plight, dipped a cloth and brought four precious drops of water to my parched throat. It was a small act, yet the relief it brought defied words. Joy surged within me, as if the very essence of life itself had been restored in those fleeting moments. As I drifted into sleep, memories flashed through my mind like a surreal dream—images of the winding roads leading to Amrita Medical College Hospital, scenes from nearly a year ago. In April 2021, plagued by acidity, constipation, and bleeding, I sought solace in the gastroenterology department of a private hospital in Kottarakkara. The days blurred into nights, filled with uncertainty and sleepless vigils. A journey that began with a doctor's visit soon led me to Dr. Deviprasad, renowned for his expertise in gastroenterology in Kottiyam. A colonoscopy altered the course of my life, each moment gravid with anticipation until the biopsy report would reveal the truth: was the lump in my anus cancerous? Fear gripped my nights, casting terrifying shadows upon my dreams. I withdrew into silence, grappling with my fears alone. The stark reality dawned upon me as I lay in the multi-specialty ICU of Amrita Hospital, Ernakulam—my body vulnerable, my spirit adrift in uncertainty. Awakening from haunting scenes, I tried to discern the thin boundary between dream and reality. And then, in a moment of clarity, I saw her: Dr. Manju Kurakar, my daughter, standing by my bedside in her hospital uniform. Her presence affirmed that this was not a dream. Yes. It was Manju. 27 Prof.JOHN KURAKAR The nurses relayed to her how I had called out in the night, a plea for water amidst my lecture on World Water Day. Soon after, my son Manu Kurakar and my wife Molly arrived, their faces etched with hope and resilience. We spoke at length, and in their company, the heft of sadness and adversity gradually lifted. I reclined on the bed, bolstered by their optimism, my spirits buoyed by their stanch support. In the ICU, where days blur into endless cycles of suffering, I witnessed faces worried with the weight of despair. Moans echo through the sterile corridors resembling a haunting soundtrack of agony. Each face bore silent testimony to struggle against pain and the prayer for relief that hanged heavy in the air. Unknowingly my mind started offering prayers—silent pleas to the almighty, asking for solace for those writhing in unrelenting torment. As dawn breaks with its light devoid of warmth, I realize the hour has passed six o'clock. Morning arrives without the gentle caress of a breeze, without the soothing touch of sunlight to alleviate the ache that permeates the room. Then, amidst this bleakness, strides Dr. Sudhindran, a figure revered within and beyond Kerala, the very surgeon who guided me through APR surgery. He doesn't approach me first. Instead, he moves towards those who have languished in the ICU for days, his presence soothing my gloomy heart. With compassion in his voice, he inquires after their well-being, though his words meet only silence. "Good morning, Doctor," I call out boldly, breaking the silence with hope in my voice. To my surprise, he comes to my bedside, his face lighting up with genuine astonishment. "How do you feel now?" he asks, his concern palpable. "I am fine," I reply, lifted by a sudden surge of optimism. "If you feel better, you are fine," he responds, his happiness mirrored in my own heart. His unexpected warmth uplifts me, 28 GOOD MORNING DOCTOR especially given my recent transfer to the ICU after a gruelling surgery. "You'll be moved to the room today," he assures me, to which I gratefully reply, "Okay, Doctor." He shakes my hand warmly, expressing thanks. As night descends, the departing nurses make way for new faces to take over. Mariamma, from Thiruvalla, takes charge of my care that night. With gentle hands, she eases me from the bed to a chair, prompting nearby nurses to discuss the merits of sitting versus lying down. "Would 'Good morning, Doctor,' still echo within the confines of the ICU? Does my voice still carry weight here, I wonder. 29 Prof.JOHN KURAKAR After the APR surgery, I lay in the ICU at Amrita Hospital, jolting awake in shock several times before finally slipping into a half-asleep haze. My mind wandered back through the labyrinth of events that had led me here. The first memory that surfaced was my visit to a private hospital in Kottarakkara.This particular Wednesday in April 2021 stood out vividly in my thoughts. It was a string of sleepless nights, with each day of April spent in restless misery. Alongside insomnia, I battled health issues like constipation and persistent bleeding. Seeking relief, I consulted Dr. Simna, a compassionate gastro surgeon who listened attentively to my concerns and conducted a thorough examination. She reassured me that while my Piles were not severe, the underlying cause of my insomnia warranted further investigation. Dr. Simna prescribed a series of blood tests, an endoscopy, and a colonoscopy. Without medical insurance facilities at the hospital, I considered visiting a private hospital in Kotiyam, renowned for its advanced facilities. I confided in my friend, Shri Paruthiara Kunjachan, who recommended a respected gastro surgeon with a clinic in Kollam. Seeking additional advice, I turned to my brother-in-law, Mr. PC Thomas, who also endorsed the same surgeon at Kottiyam Private Hospital and provided me with his contact number. This collective support brought a sense of relief amidst my health struggles. Upon researching the doctor's profile online, I confirmed that he was indeed recommended by both Shri Paruthiara Kunjachan and Mr. PC Thomas, known for his expertise in Kollam district. Without hesitation, I dialed his number. "Who is this?" he answered. CHAPTER 2 30 GOOD MORNING DOCTOR "Doctor, I am calling from Kottarakkara. I really need to see you. When should I come?" I pleaded. "Tomorrow morning at 7 o'clock," he replied calmly. "Come to the hospital and go straight to the gastro department." Relief washed over me as I prepared for the visit, hopeful that he could finally provide the help I desperately needed. The next day at 7 o'clock, my wife and I traveled to Kotiyam in our regular driver Joy's car. We headed straight to the gastro department and met with the surgeon. I explained that I had visited a private hospital in Kottarakkara, where Dr. Simna, the gastro physician, had examined me. I shared the blood test reports and mentioned that Dr. Simna had prescribed a colonoscopy. The surgeon listened attentively and then said, "There's no need for a colonoscopy. Come ready for an endoscopy tomorrow morning, and remember, no breakfast." "But Dr. Simna prescribed a colonoscopy," I insisted. "An endoscopy is sufficient," he replied with a reassuring smile. Feeling a mix of relief and apprehension, I nodded, trusting his expertise as we prepared for the next day's procedure. An endoscope, a long, thin tube equipped with a camera, is used for endoscopy—a diagnostic procedure that allows for a detailed examination of the throat, oesophagus, stomach, and small intestine. It is known for its painless nature. The next morning at 6 o'clock, Molly and I arrived at Kottiyam Hospital in Joy’s car. By 6:30, we had undergone Corona tests. I was then taken to the doctor for the endoscopy. Shortly after, the doctor conducted a physical examination of my anus and assured me, "There's no problem." He prescribed a few medications. He asked me to return in four days, and I did as instructed. "The constipation and bleeding are still continuing," I told him during the follow-up visit. 31 Prof.JOHN KURAKAR The doctor performed another physical examination and reassured me, "There is nothing wrong with you. Consume fruits and foods high in fiber." He prescribed some more medications and confirmed, "The piles are not visible." Concerned about my persistent bleeding issue, I mustered the courage to ask the doctor about the possibility of surgery. I showed him the blood test report from Kottarakkara Hospital, and there was a moment of silence before he responded, almost jokingly, "So, shall we schedule the operation then?" His demeanor, however, lacked any hint of joy. His face remained serious, his communication minimal. It felt as though he didn't take my concerns seriously, leaving me with unanswered doubts and a sense that patients were only meant to know so much. After hearing the doctor's answer, I left the room without saying a word, feeling a mixture of resignation and acceptance. I diligently followed the doctor's prescriptions, faithfully taking medications and incorporating plenty of fruits, vegetables, and fiber into my diet. The insomnia and acidity gradually subsided, but the persistent bleeding remained. After a month passed with no significant improvement in my health, I returned to Kottiyam Hospital to consult with the doctor once more. He adjusted my medications accordingly. In the midst of this, I also battled a viral fever and noticed discomfort while urinating, prompting me to seek out a urologist at the hospital. Following the doctor's advice, I underwent an ultrasound scan. It was the 26th of November 2021, a memory that still remains vivid in my mind. Armed with the ultrasound scan report, filled with apprehension and a sense of being engulfed by illness, I returned to Kottiyam. Determined to seek further medical advice, I followed the urologist's recommendation and decided to consult Dr. Devi Prasad. The appointment required me to collect a token by 6 AM the following day. Unsure of the process, I sought advice from 32 GOOD MORNING DOCTOR Mr. Sunil Kumar, Director of the Institute of Fashion Technology, who had recently started working at Kottarakkara Kurakar Education Center, which conveniently housed a branch in Kottiyam. Mr. Sunil Kumar arranged for the token through a colleague, easing my worries significantly. With a sense of relief, I patiently waited for my appointment with Dr. Devi Prasad. At 11 o'clock, I heard my name called from the doctor's room. Molly and I entered to find a calm and compassionate figure in Dr. Devi Prasad. As we spoke, he patiently listened to every detail of my illness. "Don't worry," he reassured me gently. "We will schedule a colonoscopy for tomorrow. If there's an issue, we can address it during the procedure and ensure you leave here feeling relieved." His words brought a sense of comfort and assurance. Returning home that day, I felt a rare calmness settle over me. The following evening, as instructed by the doctor, I returned to the hospital for the colonoscopy. Nurses handed me bottles of cleansing solution to prepare my stomach. I followed their instructions, drinking four liters of medicated water within four hours and taking the prescribed pills. As the nurse predicted, after finishing the pills and the liquid, I ended up with a serious case of what can only be described as marathon bathroom sessions. Let's just say, I got to know my bathroom tiles quite intimately that night! By morning, my stomach was as clean as a whistle. The doctor's orders were crystal clear: no food allowed, just tender coconut water if absolutely necessary. Molly brought 10 tender coconuts, and I sipped on them as instructed. By 8 o'clock in the morning, Dr. Devi Prasad arrived, thorough and attentive, inquiring about every detail. By 3 o'clock, it was time for the colonoscopy—a procedure involving the insertion of a lengthy, slender camera through the colon to 33 Prof.JOHN KURAKAR meticulously examine both the large and small intestines. During the procedure, any small growths can be painlessly removed, and tiny tissue samples can be taken for biopsy, providing further diagnostic insights. The entire process is designed to be minimally invasive and comfortable for the patient. As I watched the monitor in the procedure room, I could see the intricate details from my small intestine to the large intestine, illuminated on the screen. Even before the report arrived, a gnawing sense of foreboding gripped me, and I shared my fears with Molly. An hour later, the report was delivered, and a swarm of doctors gathered around my bedside, their faces marked with shock and concern. A heavy silence hung in the air until the renowned gastro surgeon who had examined me seven months earlier arrived. "What's happening?" I managed to ask, my voice trembling with nervousness. "We conducted a thorough examination just a month ago, and nothing abnormal was detected then. Unfortunately, it appears to be a rapidly growing tumor," he explained somberly. Meanwhile, from Pune, my daughter Dr. Manju Kurakar kept calling Molly persistently. Sensing her distress, Molly asked the doctor beside me, "Could you please speak with my daughter?" The doctor nodded and took the phone, his voice gentle yet weighted with the gravity of the situation. "I examined your father twice seven months ago. There were no signs of any issues back then. It seems to have developed very quickly," he conveyed to my daughter. As night draped its velvety veil over the hospital room, we resolved to stay another day. The weight of the doctor's diagnosis hung heavy on my mind and heart, each starlit hour echoing with whispers of worry and uncertainty.. 34 GOOD MORNING DOCTOR Amrita Hospital isa well-known medical center in India. It is one of the largest medical college in the country, spanning 125 acres with a total area of 3.33 million square feet. The hospital has over 1,400 beds. Every day, more than 4,000 outpatients come seeking treatment. Experienced doctors provide services here. On December 3, 2021, my mother and I arrived at Amrita Hospital. A few days earlier, we had scheduled appointments with Dr. Sudhindra from the Gastrointestinal surgery department, Dr. Pavithran from the Oncology department, and Dr. Haridas M. Nair from the Radiation department. The appointments were arranged based on advice from several friends in Kerala, Pune, and Bombay, including my daughter, Dr. Manju Kurakar, and my son-inlaw, Kuriyan Arimboor. Mr. Kuriyan Arimboor is a Vice President at the highly esteemed Bajaj Company in Pune, and Dr. Manju Kurakkar is a Reader at the Sinhgad Medical and Dental College in Pune. My mother and I met with Dr. Sudhindra and discussed the situation. We reviewed the reports from the colonoscopy and CT scan conducted at Kottiyam. After thoroughly studying the reports and CDs, the doctor showed us the actual condition of the illness. My son, Manu Kurakar, had come from Bombay to see the doctor. Manu is working as a System Manager at SBI in Bombay. Manu’s wife, Moncy’s father, mother Rashmi, and sister-in-law George were also present. I was shocked by the doctor’s detailed explanation about the illness. I hoped that life could have ended already. Although I hadn’t seen the biopsy report, the doctor said it was cancer and that it was at stage 3. Overcome with grief and unable to bear the sorrow, I went out to the veranda, hiding my tears from everyone. My ARRIVED AT AMRITA MEDICAL COLLEGE CHAPTER 3 35 Prof.JOHN KURAKAR mother, son, and others sought the doctor’s advice. Moncy came to the veranda and sat beside me, saying, “Dad, please don’t be upset. Everything will be alright. You will receive the best possible treatment available in the world. There will be some difficulties for a while, but it will get better.” Moncy stayed close to me, offering comforting words. My sorrow did not lessen. It felt like darkness was closing in around me. For a while, I sat with my eyes closed, saying nothing to anyone. I stayed like that for a long time, as if I were in another world. When I opened my eyes, I saw that besides Moncy, there was another person sitting beside me on my right. He appeared to be a destitute man. He was crying and unable to speak. With his heart heavy with accumulated grief, he was trying to steady his heartbeat. I approached the crying man and asked, "What are you crying about?" He replied, "The doctor said that my liver needs to be replaced immediately. It will cost at least 3 million rupees." The man began crying again, breaking down once more. I couldn't comfort the man. I gently asked him, "Have you been taking any regular medications?" He replied that he had never used any medication in his life. I then asked if there was someone available to donate a liver. He pointed to a person sitting on the opposite bench and said, "That’s my son. He has agreed to donate his liver. He works in the army." The man appeared to be around 55 years old. In the face of his grief, my own tears seemed insignificant. I looked around and saw many others in the veranda, sitting in silence, deeply distressed. They had also just seen the gastroenterology doctor. I couldn't bring myself to ask about their reasons for sadness. Meanwhile Surya’s mother, Rashmi, and Sali rushed to me and said they were going to book an MRI scan for me and quickly left. Moncy stayed close to me. No one went to have lunch that day, and not even a drop of water was consumed. There were more than 60 people waiting to get an MRI scan that day. Based on the recommendation of Rashmi's friend who works in the Radiology department, we were allowed to have the MRI 36 GOOD MORNING DOCTOR scan at 7 PM. We arrived at the Radiology Department by 6 PM. By 7 PM, I went to the changing room to put on the uniform. After changing, I waited in the veranda. After some time, we were admitted into the scan room. There were two people already waiting there, and I joined them. They informed us that the scanning would take at least 45 minutes. I was unfamiliar with MRI scans and their sounds, as this was my first experience with one. It was only after undergoing the MRI that I came to understand what the procedure involves. It is a scanning method used to capture the structure and function of internal organs in the body. MRI (Magnetic Resonance Imaging) is a type of scanning that does not pose any health risks, unlike other scanning methods. Imaging technologies like X-rays and CT scans, which use high levels of radiation, can be harmful to the body if used excessively. In contrast, MRI (Magnetic Resonance Imaging) is fundamentally different. It employs a powerful magnetic field to produce detailed images of the body's internal structures, making it a safe alternative as it does not use harmful radiation. MRI scanning provides a higher level of diagnostic accuracy. It works by creating a strong magnetic field to scan the body. MRI is capable of imaging a wide range of body parts, including muscles, joints, bones, nerves, spinal cord, soft tissues, and blood vessels. It is particularly beneficial for examining the brain, neck, abdomen, and pelvic region. However, some individuals may find the sounds produced by MRI machines uncomfortable. Additionally, the procedure requires lying still in a narrow, confined space for an extended period, which can cause anxiety or discomfort for some people. Patients with certain medical devices such as pacemakers that regulate heart function, implants used after bone surgeries, and infusion catheters should not undergo MRI scans. This restriction is due to the powerful magnetic field and radio waves used by MRI machines, which can interfere with these devices. MRI scans 37 Prof.JOHN KURAKAR are generally not performed on pregnant women either. Additionally, metal objects like hospital beds, stretchers, and oxygen cylinders should never be brought close to an MRI scanner. Bringing such items near the MRI machine can cause them to move rapidly towards the machine, potentially causing severe injury to individuals caught in the path. To prevent accidents, MRI machines are installed in rooms with high safety standards that prevent magnetic fields from escaping. A list of items that could pose a risk is displayed outside the MRI room. The technician present will thoroughly inform the patient and their relatives about these safety measures. All metal objects, including keys, coins, and mobile phones, must be left outside the room. A metal detector is used to ensure that nothing has been forgotten. If a patient requires medical equipment, alternatives designed for use inside the MRI scanner are recommended. For example, oxygen cylinders made of aluminum and titanium implants are among the types of equipment that are MRI-compatible. By taking the necessary precautions, MRI scanning remains one of the safest imaging methods available. It was my turn for the MRI scan. I was guided towards a large machine and asked to lie down inside it. The scan began, and what started as a small sound quickly turned into a terrifying cacophony of various noises. For the first few minutes, I tried to tolerate the intermittent sounds. As the intensity of the noises increased, they became very disturbing to my ears. I felt as though I was trapped in a large pit. I prayed to God and sought the intercession of Parumala Thirumeni, enduring the relentless noise. I could hear the sound growing louder and lasting longer. I asked out loud, "How much longer will this take?" Someone responded, "About 20 more minutes." Oh God, 20 more minutes in this confinement! I was not allowed to move my arms or legs, and I had no idea how much time had passed. I closed my eyes and lay there, unsure if I had fallen asleep. The noise eventually stopped, and I was surrounded by silence. A technician came and lifted the 38 GOOD MORNING DOCTOR top part of the machine, saying, "Get up, the scan is finished." With his assistance, I got up, feeling a mix of fear and frustration. I spoke to the staff, but they did not respond, likely because they had been working since morning and were exhausted. When I exited from the MRI room, I found Molly, Rashmi and Sali are waiting for me in the veranda. It was already past 11 PM. By around 12:30 AM, Moncy and Rashmi headed back to Thrissur, while Sali went to a nearby lodging close to the hospital. Molly and I returned to Kottarakkara in Joy's car. Throughout the drive, we received continuous phone calls from my son Manu in Bombay and my daughter Manju in Pune. My mother spoke with them, but I was unable to talk to anyone that day. Overwhelmed by the weight of my sorrow, I sat silently in the car with my eyes closed. We reached Kottarakkara around 4 AM, and there was no conversation between us. Once home, I lay down on the bed, my mind troubled by various thoughts. The next evening, Manu Kurakar arrived from Mumbai. We discussed the treatment options extensively, considering recommendations from various hospitals. Ultimately, we decided to proceed with treatment at Amrita Hospital. Within two days, we received the biopsy report. As Dr. Sudhindran at Amrita Medical College had predicted, the report confirmed the presence of cancer. It was identified as Adenocarcinoma, a type of cancer found in the large intestine. Cancer is one of the most distressing and feared conditions in today's world, representing one of the most agonizing diseases known globally. The normal processes of cellular creation, growth, and development maintain order in bodily functions. However, when these processes become dysregulated, they can result in physical illness. Cancer is marked by the excessive and uncontrolled proliferation of cells. Various factors such as chemicals, radiation, pathogens, or lifestyle influences can trigger the transformation of normal cells into cancerous ones. These factors can initiate the disease by causing 39 Prof.JOHN KURAKAR cells to grow uncontrollably. The term "cancer" is derived from the Greek word "karkinos," which means "crab," combined with "- oma," meaning "growth." This terminology was chosen because the appearance of some tumors resembled a crab with its spreading claws. Thus, the term "carcinoma" came to represent cancer, reflecting the disease's invasive and persistent nature. It is well known that every organ in our body is made up of countless cells. The excessive and uncontrolled division of these cells is simply referred to as cancer. The reason for the uncontrolled cell growth is the mutations that occur in the DNA of those cells. Cancer cells multiply and, after a certain period, enter the bloodstream. They then spread to other parts of the body through the blood and lymph, proliferating the disease everywhere. Cancers can be classified based on the location of the affected organ. Cancers that occur in the nose, intestines, reproductive organs, breasts, and bladder fall under the category of carcinoma. About 80% of cancer cases belong to this category. Cancers that occur in muscles, bones, and connective tissues are classified as sarcoma. Cancers found in the blood and blood-producing organs are categorized as leukemia. Leukemia primarily affects white blood cells. Cancer that occurs in the lymphatic system is classified as lymphoma. Cancers in glands such as the thyroid, pituitary, and adrenal glands fall under the category of adenoma. The term "primary site" refers to the organ where cancer begins and spreads to nearby areas, impairing the function of that organ. "Secondary" refers to the spread of cancer to other parts of the body through the blood and lymph, leading to excessive and uncontrolled cell growth in those areas as well. This is why early detection and treatment of cancer are emphasized. If tobacco use is eliminated, it could prevent 50% of cancer cases in men in Kerala. Fruits, vegetables, and leafy greens can help reduce the risk of cancer to some extent. A healthy diet, regular exercise, avoiding substances, and maintaining a positive mental state are all excellent for cancer prevention. Women over 40 should perform self-breast examina- 40 GOOD MORNING DOCTOR tions at least once a month to detect breast cancer in its early stages. Additionally, they should see a doctor at least once a year for a mammogram, which is a special X-ray examination. Mammograms can also be done using ultrasound and MRI. Men over 50 should have regular check-ups at least once a year to ensure they do not have prostate cancer. Colon cancer can also be detected in its early stages. If blood is observed in the stool, this disease can be treated effectively in its early phase. Tests such as colonoscopy are available for this purpose. Kidney cancer is one of the major health issues that causes approximately 180,000 deaths worldwide each year. The kidneys, located on either side of the spine above the waist, help filter waste and excess water from the body. They also play a role in producing red blood cells, maintaining bone health, and regulating blood pressure. Kidney cancer typically starts as a tumor within the kidney. As these tumors grow, they can affect the kidneys' ability to filter blood effectively. The most common symptom of kidney cancer is a change in urine color. Even a slight red tint can indicate a problem in the kidneys. While this could sometimes be due to an infection, it's important to monitor for blood in the urine and consult a doctor for kidney cancer testing if such changes occur. Lung cancer's primary cause is the increasing number of vehicles and the carbon monoxide they emit. The heart is the only organ in the body that is not affected by cancer. Sudden unexplained weight loss or loss of appetite can be warning signs of cancer. Even welleducated individuals sometimes view cancer as a hereditary disease. However, the hereditary component accounts for only about 5 to 10% of cases. Cancer does not develop overnight, and its causes have not been fully established. Factors such as environmental pollution, chemicals, viruses, lifestyle, and genetics can all contribute to its onset. When someone is diagnosed with cancer, it's essential not to hide the information from them. They should be gently informed and helped to understand their condition. It's important to empower them to face the illness. Isolation should be 41 Prof.JOHN KURAKAR avoided; the awareness that they are not alone is something their family and community should provide. It's not about instilling fear or causing distress; rather, it's the responsibility of the family and community to provide support and understanding. If 80% of patients seek treatment in the early stages, they can often overcome the disease. November 7 is observed as National Cancer Awareness Day, while World Cancer Day is celebrated on February 4. When I learned that I had cancer, it brought immense sorrow. I thought my life would be cut short, and the atmosphere at home felt heavy with grief. Before long, we went to Amrita Hospital in Ernakulam with the biopsy report and other scanning documents. We arrived at the Amrita guest house around 8 PM. When faced with cancer or any debilitating disease, it is crucial for all family members to stand together in support of the affected individual. Isolation can exacerbate feelings of fear and despair, making the journey even more challenging. By fostering an environment of love and understanding, family members can provide the emotional strength and encouragement needed during difficult times. Sharing experiences, engaging in open conversations, and participating in treatment decisions can help the person feel valued and connected, alleviating the burden of loneliness. Ultimately, a united family can create a powerful support system, empowering the individual to face their illness with hope and resilience. 42 GOOD MORNING DOCTOR In December 2021,on a Monday, we met with Dr. Sudheendra from the Gastrointestinal surgeryDepartment at Amrita once again. He thoroughly reviewed the biopsy report, CTscan, and CT scan CD. Our daughter, Dr. Manju Kurakkar, had arrived from Punefor the visit. Next, we consulted with the renowned oncologist Dr. Pavithran.He also examined the reports in detail and noted a small lesion in the thyroidgland. He recommended an immediate F.N.A.C. test. Subsequently, we met withRadiation Oncologist Dr. Haridas M. Nair, who spent over an hour explaining theseverity of the condition. He mentioned that surgery could only be considered if the size of the tumor near the throat and rectum was reduced, which wouldrequire both radiation and chemotherapy. He suggested that the course anddosage of radiation and chemotherapy could be discussed and finalized with him.That same day, we returned to see Dr. Sudheendra, who scan. PET scans are a type of imaging test that create three-dimensional of the inside of the body. PET stands for Positron Emission Tomography. A PETscan uses a small amount of radioactive material to highlight areas of the bodywhere cells are more active than normal, which can help in detecting conditionssuch as cancer. This scan is useful for identifying the location of cancer, aswell as determining if and where it has spread. A PET scan typically takesbetween 45 to 60 minutes, and you will need to be in the department for atleast one hour due to the radioactive liquid (radiotracer) injected before thescan. PET scans are often combined with CT scans to provide more detailedimages, resulting in a PET-CT scan. PET-CT scans help in determining whether amass is cancerous, deciding on the best treatment for cancer, and evaluatinghow well the treatment is BEGINNING OF THETREATMENT CHAPTER 4 43 Prof.JOHN KURAKAR working.PET scans aresometimes used to check for cancer in the lymph nodes located in the centralpart of the chest. Most PET scans require patients to refrain from eating forapproximately 4 to 6 hours prior to the procedure. Some individuals mayexperience claustrophobia during the scan. It is important to remove any metal objects such as hair clips, coins, belts, and underwire bras before the scan.While the procedure itself is painless, you will need to remain still, which may cause some discomfort. Additionally, you will hear continuous backgroundnoises during the scan. PET (Positron Emission Tomography) technique that provides unique insights into how an organ or system body is functioning. PET scans are primarily used to evaluate cancers, neurological (brain) disorders, and cardiovascular (heart-related) diseases. The PET scanner consists of a ring of detectors that encircle the patient, resembling a CT scanner in appearance. The scan is conducted by a healthcareprofessional known as a nuclear medicine scientist, in collaboration with anuclear medicine specialist. During a PET scan, a small amount of a‘positron-emitting’ radioactive substance, called a radiopharmaceutical, isinjected into the patient. This substance is painless and helps to highlightpecific areas within the body. The PET radiopharmaceutical, and a computer processes these emissions to createtwo-dimensional and three-dimensional images of the examined In PET scans, areaswhere the injected radiopharmaceutical accumulates—cells—appear 'brighter' on the images compared to normal tissues. Most modernPET scanners are integrated with CT scanners, allowing the PET and CT images tobe combined or fused. This fusion provides a more combining the structural information from the CT scan with the functional information from the PET scan, thus enhancing the accuracy of the diagnostictest. In these combined scanners, the patient passes through both the PET andCT scanners while lying on the same bed and maintaining the same position. PET scans arehighly effective in early detection and monitoring of cancer. They can reveal changesin metabolism and the func- 44 GOOD MORNING DOCTOR tion of organs and tissues. PET scans often detectcancers before they are visible with other imaging techniques and can create awhole-body image to identify if and where cancer has spread. They are usefulfor distinguishing between malignant tumors and scar tissue. PET scans can assess brain function and detect abnormalities associated with neurological conditions. PET scans can evaluate heart function and identify issues related to cardiovascular health.The next morning, Iarrived at the hospital ready for the PET scan. The scan took about an hour and was completed by 9 AM. By around 10 AM, I met Dr. Haridas. He instructed me to return in two days to discuss the radiation plan and other details. By then, the PET scan report had arrived. The report indicated that there were some abnormalities near the lung in the chest area, so Dr. Haridas recommended a bronchoscopy before starting radiation therapy. Dr. Haridas discussed the matter in detail with Dr. Tinku Joseph from the Pulmonology Department. Dr. Tinku Joseph mentioned that he would be on leave for two weeks starting the following day and suggested performing the bronchoscopy after his return. Dr. Haridas emphasized that the patient's condition had progressed to a serious stage and recommended sending the patient to a nearby facility as it was very urgent. Given the urgency, I agreed to be admitted to the hospital immediately so that the bronchoscopy could be performed the following day. Bronchoscopy is a diagnostic procedure used to examine the airways and diagnose lung diseases. It may also be employed during the treatment of certain lung conditions. A bronchoscope is the instrument used for this purpose and can be either flexible or rigid. The flexible bronchoscope, which is most commonly used, is a thin tube about half an inch (1 centimeter) wide and approximately 2 feet (60 centimeters) long. In rare instances, a rigid bronchoscope might be used. The procedure involves inserting the bronchoscope through the nose or mouth, down the throat, into the trachea (windpipe), and then into the airways (bronchi and bronchioles) of the lungs. I was taken to a specialized operating 45 Prof.JOHN KURAKAR theater for the bronchoscopy. I remember being seated in front of a machine, receiving an injection in my arm, and having a liquid poured into my mouth before I lost consciousness. When I regained awareness, it was past 10 PM, and I found myself in a hospital bed. The next day, I was discharged and returned to the guest house. The following morning at 8 AM, I met Dr. Haridas M. Nair. He took me to the radiation room to prepare the radiation plan, marked my body, and completed other necessary tasks. After the examination and marking, I met with Dr. Haridas again. He recommended 25 sessions of radiation and 25 days of chemotherapy. This decision was made collaboratively by Dr. Haridas, Dr. Pavithran, and Dr. Sudhindran. Radiation and chemotherapy were to be administered 5 days a week. Following the sessions, I needed to undergo blood tests and present the results to the doctors. Only if the results were satisfactory would the next cycle commence. Each cycle required mandatory blood tests. I completed the radiation and chemotherapy over five weeks without experiencing hair loss. Radiation therapy,or radiotherapy, is a cancer treatment method that uses high-energy radiationto destroy cancer cells. This therapy involves the use of X-rays and gamma raysto target and eliminate cancer cells.Radiation can be administered in primarilythree ways:Therapy: This method involves directing radiation from a large machine outside the body to a specific area of the body. Since the radiation comes from an external source, it is often referred to as "teletherapy." 2. InternalRadiation Therapy (Brachytherapy): In this approach, a radiation source isplaced inside or very close to the tumor. This allows for high doses of radiation to target the cancerous area directly. 3. SystemicRadiation Therapy**: This involves administering radioactive substances thattravel through the bloodstream to target cancer cells throughout the body.is an essential component of can- 46 GOOD MORNING DOCTOR cer treatment. It works by rapidly destroyingthe DNA (deoxyribonucleic acid) within cancer cells, thereby halting their abilityto reproduce. A combined approach involving surgery, chemotherapy, andradiation therapy is often used for comprehensive cancer treatment. The choice of treatment depends on the stage of the cancer and the overall health of the patient. In many cancers, radiation plays a crucial role in the treatment plan. Radiation therapy, or radiotherapy, is a treatment that uses high-energy radiation to destroy cancerous cells. It employs X-rays and gamma rays to target and eliminate cancer cells. The type and stage of cancer determine the dosage and duration of radiation therapy. Typically, radiation is administered once daily, five days a week. This treatment is generally quick and painless. There's no need to fear cancer or its treatment. The field of oncology has seen significant advances and discoveries, and each doctor will recommend the most suitable and safe treatment for each patient. By following the doctor’s recommendations with confidence and maintaining mental resilience, the treatment can be made comfortable and effective. Chemotherapy is a treatment approach that uses medication to combat cancer. It involves the use of one or more chemical drugs, often classified as cytotoxic, to target cancer cells. Doctors may prescribe chemotherapy before surgery to reduce the size of a large tumor, slow down the growth of cancer cells, treat cancer that has spread to various parts of the body, or eliminate all rapidly growing and mutated cancer cells to prevent recurrence. When the PET scan suggested a potential thyroid cancer, Dr. Haridas recommended the prompt removal of the thyroid gland. Despite multiple FNAC tests showing no signs of cancer, the PET scan's unusual findings led Dr. Haridas to strongly advise the excision of the thyroid gland. In Kerala, thyroid nodules are relatively common. Nodules in the neck are generally categorized as either benign or malignant. While malignant nodules may indicate 47 Prof.JOHN KURAKAR cancer, most thyroid nodules are benign and do not necessarily signify the presence of cancer. The most important test for evaluating such nodules is the FNAC, or Fine Needle Aspiration Cytology. This test is crucial for assessing thyroid nodules, especially when combined with thyroid gland scans and hormone level assessments. FNAC helps determine whether a nodule is cancerous and identifies the type of nodule present. Removal of such nodules, followed by a biopsy, can confirm whether cancer is present. However, there is a rare possibility that some nodules may still be cancerous despite these tests. Following Dr. Haridas's recommendation, we consulted with Dr. Subramanyan Iyer from the Head and Neck Department.Dr. Subramania Iyeris currently the Professor and Chairman of Plastic and Reconstructive Surgery,Head and Neck Surgery/Oncology, and Craniomaxillofacial Surgery at the Amrita Institute of Medical Sciences. He completed his undergraduate medical education at Medical College Kottayam, followed by an MS from the All India Institute of Medical Sciences, New Delhi. He then pursued an MCh in Plastic Surgery from the University of Calicut. Dr. Iyer has extensive experience in the UK, having worked in various centers including Chepstow, Hull, and Liverpool, specializing in Plastic Surgery and Head and Neck Surgery for five years. Prior to joining Amrita in November 2003, he served as the head of the Division of Head and Neck Surgery and Reconstructive Surgery at Amala Cancer Hospital, Trichur. In addition to hisclinical work, Dr. Iyer is a dedicated educator and researcher. He teaches and trains postgraduate students pursuing MCh in Plastic Surgery, MCh in Head and Neck Surgery and Oncology, and MS in Otorhinolaryngology at Amrita School of Medicine, Amrita Vishwa Vidyapeetham University. He is also an approved research guide at the Amrita Center for Nanosciences and Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram. 48 GOOD MORNING DOCTOR Dr. SubramaniaIyer, who has received numerous national and international awards, thoroughlyexamined me. He recommended that a tracheoscopy be performed on the same day. Tracheoscopy is a procedure that allows a provider to look inside the windpipe (trachea) and into the lower airways using a thin, flexible tube called an endoscope, which has a tiny camera and light at the end. This procedure is useful for evaluating conditions such as tracheal collapse, tracheal tumors, extramural compression, or tracheal foreign bodies. Following Dr. Subramania Iyer’s recommendation, junior doctors promptly took me to the scoping room. I was seated in a special chair and instructed to open my mouth and say "Ah." While doing this, a liquid was poured into my mouth. I was then asked to say "E," during which a very thin, flexible tube equipped with a small camera was inserted into my throat. After a brief period, the camera was withdrawn from my throat. Subsequently, several medical tests were conducted, and the date for the thyroid gland removal surgery was scheduled. On the same day, I visited the anesthesia department for a detailed examination and received clearance from there. General Anesthesia is the technique used to induce loss of consciousness or sensation to enable surgical procedures. Various types of anesthesia are employed based on the nature of the surgery. These range from general anesthesia, which renders the entire body unconscious, to regional or local anesthesia, which numbs only the specific area where the surgery is performed. General anesthesia involves rendering the patient completely unconscious and is used for procedures requiring full-body sedation. Prior to administration, the patient undergoes a thorough assessment, including laboratory tests and a review of medical history, to determine the most appropriate anesthetic approach. In contrast, regional anesthesia includes techniques such as spinal anesthesia and epidural anesthesia, which numb only specific regions of the body. These methods are used to avoid the need for full-body sedation while ensuring the area of surgery remains insensate. 49 Prof.JOHN KURAKAR Additionally, regional blocks can be applied to specific limbs or areas for localized numbness. After examining the patient's condition, a tube is inserted into the airway through the mouth/nose. Once the tube is properly positioned, it is connected to an external machine. Through this tube, oxygen, nitrous oxide, and various gases for anesthesia are administered. Special medications are also given to prolong the anesthesia. Throughout the operation,the patient's respiration and the oxygen levels reaching the lungs are monitored using monitoring systems. After the operation, medications are given to help the patient wake up from the anesthesia. Once the patient is awake, the tube is removed. As the date of the operation approaches, there is considerable anxiety. Will there be loss of voice or breathing difficulties after the thyroid surgery? Manju Kurakar asked the doctor about these concerns. The doctor assured her that there is no likelihood of any complications. The thyroid glands are located at the front of the neck. The thyroid gland is situated just below the larynx (voice box). It consists of two lobes located on either side of the trachea, which are connected by a narrow band of tissue called the isthmus. In adults, the thyroid typically weighs between 20 and 40 grams. On the upper part of the thyroid gland, there are four parathyroid glands located on either side. These parathyroid glands produce a hormone called parathyroid hormone (PTH). The primary function of the parathyroid glands is to regulate the levels of calcium ions in the body. The hormone produced by the thyroid gland is thyroxine. The thyroid gland plays a significant role in regulating metabolic processes in the body. Both the thyroid gland and the thyroxine hormone are crucial for the functioning of body cells. If the body produces excess thyroid hormone, the condition is known as hyperthyroidism. Conversely, insufficient thyroid hormone production is termed hypothyroidism. Both conditions are serious and require medical treatment. The thyroid gland is 50 GOOD MORNING DOCTOR crucial for regulating and maintaining various bodily functions, including heart rate, muscle function, bone health, digestion, and brain development. A tumor that originates in the thyroid gland is referred to as thyroid cancer. My thyroid surgery took place on February 10, 2022. I was admitted to Amrita Hospital on February 9 and discharged on February 12. On the morning of February 10, I was taken to the operating theater at 7 AM for the surgery, which was my first operation. After the procedure, I was transferred to the general ICU and monitored for four hours. Once I regained consciousness, I was given water and food, and shortly after, I was moved to a regular hospital room where I spent two days under observation. Dr. Subramanyam Ayyar led the surgery. I was discharged on February 12. Ten days later, during a follow-up visit, the biopsy report was reviewed. Dr. Ayyar recommended radioactive iodine therapy. Since an A.P.R surgery was scheduled for March 22, two injections were required to elevate my T.S.H. hormone levels, which was noted to be somewhat costly. For more detailed information and to proceed with the iodine therapy, I was referred to the Nuclear Medicine Department. God is the ultimate source of all power and healing, often working through the hands of doctors and medical professionals to bring about restoration and recovery. While human skill and knowledge are crucial, it is divine intervention that ultimately guides and strengthens the healing process. Patience is key in this journey, as we trust in the timing and wisdom of a higher power. By maintaining faith and allowing the process to unfold, we open ourselves to witness the profound and miraculous ways in which God acts through the dedicated efforts of those who are committed to healing and care. 51 Prof.JOHN KURAKAR Following Dr.Subramanyam Ayyar’s recommendation, we went to the nuclear medicine department. Nuclear medicine is a cutting-edge branch of science. Here, radioactive substances are introduced into the body, which emit invisible rays during chemical reactions. Using these emitted invisible rays (gamma rays) and modern technological advancements, hidden cancers and other conditions can be detected and treated. Many conditions that cannot be identified through other diagnostic methods (such as CT scans and MRI) can be detected through nuclear medicine. It is a medical specialty that involves the use of radioactive materials in both diagnosis and treatment.Nuclear medicine involves imaging techniques that capture radiation emitted from within the body, as opposed to the external radiation sources used in X-rays. This is why it's described as "radiology happening inside." Unlike traditional radiology, which focuses on anatomical imaging, nuclear medicine emphasizes functional imaging, making it a physiological imaging modality. The most widely used techniques in nuclear medicine are Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) scans. For evaluating thyroid cancer, an Iodine-123 whole-body scan is performed. This study is conducted after withdrawing thyroid hormone medications, along with total thyroidectomy and TSH stimulation. The scan reveals small residual thyroid tissue in the neck and metastatic thyroid cancer lesions in the mediastinum. Observed increases in the stomach and bladder are considered normal physiological findings. The capability of nuclear medicine to visualize disease processes arises from its ability to detect variations in metabolism.Nuclear medicine is a medical specialty that utilizes NUCLEAR MEDICINE & THYROID TREATMENT CHAPTER 5 52 GOOD MORNING DOCTOR radioactive substances for diagnosing and treating diseases. Unlike traditional radiology, which relies on external radiation sources like X-rays, nuclear imaging records radiation emitted from within the body, effectively making it "radiology done inside out." Furthermore, while traditional radiology focuses on anatomical imaging, nuclear medicine emphasizes functional imaging, which is why it is referred to as a physiological imaging modality. The two most common imaging techniques in nuclear medicine are Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) scans. This diagnostic method helps in detecting malignant diseases, such as cancer, that may be hidden anywhere in the body, even in the very early stages. Nuclear medicine is also used to treat conditions like thyroid cancer, lymphoma, and blood cancers. The head of the nuclear medicine department is Dr.Shanmugham. Prior to our arrival at the department, Dr. Subramanyam Ayyar had already informed Dr.Shanmugham in detail about the matters concerning our case.We had an extended discussion with Dr.Shanmugham. He informed us that, since the A.P.R. surgery was scheduled by the Gastroenterology Department for March 22, 2022, it was crucial to quickly elevate the T.S.H. hormone levels. Therefore, he advised administering two injections promptly, emphasizing their significant importance. He mentioned that each injection would cost approximately fifty thousand rupees. Dr.Shanmugham recommended coming back for the injections after four days. With this in mind, we returned to our home in Kottarakara for the four-day interval. On the evening of March 6, we arrived again at the guest house of Amrita Medical College. On March 7, we underwent an RTPCR test, and on March 8 and 9, we received the TSH injections. Thyrotropin alfa injection is a form of human thyroid-stimulating hormone (TSH) used to test for the presence of thyroglobulin (Tg) in patients with thyroid cancer. Thyrogen (thyrotropin alfa) helps identify thyroid disease by measuring thyroglobulin levels in the 53 Prof.JOHN KURAKAR blood, particularly during the follow-up of patients with well-differentiated thyroid cancer. This injection may be used with or without a radioactive iodine imaging test.Following the thyrotropin alfa injection, a radioactive iodine scan is performed for therapy. Radioactive iodine (RAI) is a treatment for hyperthyroidism and certain types of thyroid cancer. Despite the term "radioactive," RAI is a safe, well-tolerated, and effective treatment that specifically targets thyroid cells, minimizing exposure to other body cells.Radioiodine therapy employs radioactive iodine to shrink or destroy thyroid cells and is used to treat various thyroid conditions. The thyroid gland, located in the front of the lower neck, produces hormones that regulate metabolism. Iodine, essential for thyroid function, is obtained from food, and excess iodine is excreted in the urine.Radioiodine therapy is administered by specialists in nuclear medicine. Depending on the dosage, you may be able to go home the same day, but higher doses may require a hospital stay in a specialized room, where your urine will be monitored for radioactive iodine excretion. Radioactive elements are substances that emit intense, invisible radiation as a result of their inherent chemical properties. These elements are utilized in the treatment of various diseases, including malignant conditions like cancer. This method of treatment falls under the field of nuclear medicine. A key radioactive element used in the treatment of thyroid cancer is Iodine-131. It is a very effective and safe treatment method for thyroid cancer, as it is both painless and non-invasive. When radioactive iodine is ingested, it is absorbed by the thyroid gland, where it targets and destroys thyroid cancer cells. The radioactive particles emitted from the iodine destroy the cancerous cells within the thyroid gland, thereby providing a highly effective treatment option.A person who has received radioactive iodine treatment will emit high levels of radiation from their body. This radiation can be harmful to the general public, especially to children and pregnant women. Therefore, it is essential for the patient to undergo isolation in a hospital 54 GOOD MORNING DOCTOR for 2 days immediately after the treatment. Following this, the patient should continue self-isolation at home for an additional 7 days to minimize exposure and ensure safety for those around them. On March 9, I was admitted to Amrita Hospital for iodine therapy. That same night, I received a high dose of radioactive iodine and was moved to a complete isolation room for two days. This room was designed for total isolation, with no contact with anyone, ensuring a complete separation from other people. The room had a small hatch through which food was passed to me. For two days, I remained alone in this isolated environment, akin to being locked in a cage or cut off from the world.There were four patients, including myself, in separate isolation rooms. Three of the other patients were women. On the second evening, we were all taken for a scan, dressed in yellow uniforms. The elevator used for our transport was restricted to ensure no contact with other patients or visitors due to radiation concerns. The scanning took about 30 minutes, after which we were returned to our respective cells. By night, we were discharged, and our family members came to pick us up.No hospital staff or assistants came close to our isolation rooms or the adjacent hall, further emphasizing our complete isolation. The experience felt like a significant turning point in my life, marked by intense solitude and separation. It reminded me of the severe isolation experienced by Malayalees in the Gulf during the early days of the coronavirus pandemic.By 7 PM, my wife Molly arrived at the nursing room to take me home. The sense of relief after such prolonged isolation was palpable. Upon arriving at the Amrita guest house, I spent another week in a different isolation room, continuing my period of separation. Mental isolation can significantly diminish a patient’s willpower and overall resilience. When individuals are isolated not only physically but also emotionally, they may experience heightened feelings of loneliness and despair, which can undermine their motiva- 55 Prof.JOHN KURAKAR tion and ability to cope with their illness. Emotional support is crucial for patients, as it fosters a sense of connection and belonging that can bolster their psychological strength. Without such support, patients may struggle more with their treatment and recovery processes. Therefore, it is essential to ensure that patients remain emotionally connected, receiving encouragement and companionship from loved ones and healthcare providers, to help maintain their morale and improve their chances of recovery. 56 GOOD MORNING DOCTOR I arrived at Amrita Hospital in Idappally after a CT scan at Kottiyam Hospital revealed a tumor in my colon, which was diagnosed as colorectal cancer. Colorectal cancer is one of the most prevalent cancers today. Its development is influenced by changes in lifestyle and dietary habits. Key factors contributing to colorectal cancer include a high-fat diet, consumption of processed meats, a sedentary lifestyle, obesity, smoking, and alcohol use.Colorectal cancer is more common in men than in women and typically occurs in individuals over middle age. The primary symptom is usually changes in bowel habits, such as blood in the stool, along with other signs like loss of appetite, weight loss, fatigue, nausea, and vomiting. This cancer is most commonly found in people over the age of 50. As the cancer progresses, it can cause the colon to become completely obstructed, leading to severe abdominal pain and persistent constipation, along with vomiting.During a colonoscopy, the colon can be examined in detail, and if any obstructions or tumors are detected, a biopsy can be taken for further analysis. This test is crucial for diagnosing colorectal cancer accurately. Once cancer is confirmed, staging is the next step, which determines how extensively the cancer has spread in the body. An MRI scan helps assess the extent of the cancer's invasion into nearby tissues. Additionally, advanced technology such as PET scans can provide a comprehensive view of how far the cancer has spread throughout the body with a single scan. The symptoms of colorectal cancer often resemble those of benign conditions, leading many patients to choose various treatments before accurate tests are conducted. As a result, colorectal cancer is frequently diagnosed at stages three or four. The primary UNDERGOING A MAJOR SURGERY CHAPTER 6 57 Prof.JOHN KURAKAR treatments for colorectal cancer are surgery, chemotherapy, and radiation therapy. In the early stage, surgery alone can often completely cure the disease. Effective surgical intervention plays a crucial role in removing the cancer entirely. A modern surgical technique called Total Mesorectal Excision (TME) is used, which involves removing not only the rectum but also the surrounding mesorectum to address potential spread. The decision for postsurgery treatment is based on pathology results, which help determine the risk of recurrence. Factors in the pathology report influence whether additional treatments like chemotherapy, radiation, or immunotherapy are necessary. If the cancer is in a condition where surgery is not feasible, radiation therapy and chemotherapy can help shrink the tumor, allowing for a more effective surgical intervention later on, ultimately leading to successful treatment. Even if colorectal cancer has reached stage four, it is still possible to manage and treat the disease effectively with the combination of surgery, chemotherapy, and radiation therapy. Colorectal cancer, which is also known as colon cancer, rectal cancer, or bowel cancer, can be diagnosed at various stages. Tumors that occur in the anal area are referred to as anal cancer. In India, approximately 150,000 new cases of anal cancer are reported each year.Surgical procedures involving the anal area are complex and require a high level of expertise. Laparoscopic surgical techniques are employed in the treatment of colorectal cancer, enabling minimally invasive surgery. Tumors often start as polyps on the wall of the rectum, which can appear in a grape-like shape. Early detection of the disease is crucial. Regular cancer screening for those over middle age can significantly improve the chances of early diagnosis and successful treatment.When performing surgery for colorectal cancer, the affected portion of the colon or rectum is typically removed. After removal, the remaining part of the colon is usually reattached to the rectum. However, due to the anatomical constraints of the pelvis, which is a narrow and complex area, open surgery can present significant challenges. The difficulty 58 GOOD MORNING DOCTOR arises from the need to maneuver within the restricted space of the pelvis to perform precise surgical tasks. In cases where reattachment is not feasible, a new external opening, known as a stoma, is often created. This procedure involves pulling a portion of the colon through an opening in the abdominal wall to create an artificial exit for waste. This new opening is called a colostomy. Instead of the natural rectal passage, the waste is collected in a plastic bag attached to the stoma. This bag must be worn continuously to collect and manage waste.The limitations of traditional surgery for colorectal cancer are overcome by the laparoscopic surgical technique. This minimally invasive method allows for surgery in confined areas by using a TV screen to view the site in detail, ensuring precision and accuracy. With laparoscopic surgery, the "purse-string" technique can be employed, which maintains continuity from the large intestine to the new external opening, enabling the patient to have normal bowel movements. This approach requires a high level of skill and experience from the surgeon to ensure successful outcomes. Upon arriving at Amrita Hospital, the first specialist I encountered was Dr. S. Sudhindran from the Gastrosurgery department. Dr.Sudhindran is a renowned Gastrosurgeon both within Kerala and beyond.Dr. S. Sudhindran serves as the Clinical Professor and Chief Transplant Surgeon in the Department of Gastrointestinal Surgery and Solid Organ Transplantation at Amrita Institute of Medical Sciences, Kochi. He is recognized as the first liver transplant surgeon in Kerala and is highly regarded for his expertise in liver transplants, having performed over 820 liver transplants, predominantly live donor procedures. His skills also extend to pancreas and small bowel transplants.Dr.Sudhindran completed his MBBS and MS degrees from Trivandrum Medical College and further trained in vascular surgery and solid organ transplantation in the UK. He worked as a Clinical Fellow in Transplantation at Addenbrooke's Hospital, Cambridge. With over a hundred publications, he has made significant contributions to his field. On Feb- 59 Prof.JOHN KURAKAR ruary 15, 2020, he was honored with the "Distinguished Alumnus Award" by Trivandrum Medical College for his leadership, exceptional service to his alma mater, and his broader contributions to society. After reviewing the CT scan and biopsy reports, Dr.Sudhindran confirmed that I had colorectal cancer. He indicated that a major surgery would be required and mentioned that prior to the surgery, a combination of radiation and chemotherapy would be necessary. He emphasized that these treatments were the only viable options for saving my life. The type of surgery recommended is known as APR (Abdominoperineal Resection), which involves the creation of a colostomy. The radiation and chemotherapy treatments are managed by Dr. Haridas M. Nair and Dr. Pavithran. Dr. Haridas M. Nair is the Clinical Assistant Professor in the Department of Radiation Oncology. Hearing this was both distressing and disheartening, but I understood the gravity of the situation and the necessity of these treatments as explained by the doctors.Your summary of the surgical procedure and the role of intensive care units (ICUs) is clear and well articulated. Dr.Sudhindran was supported during the surgery by Dr. Vijay Ganeshan, Dr. Binoy, Dr. Rahul, and Dr. Dinesh Balakrishnan. The operation commenced at 8 AM on March 22 and was completed around 10 PM. While the surgery was ongoing, my wife Molly, daughter Dr. Manju Kurakkar, and son Manu Kurakkar anxiously waited outside the operating theater. At 10:30 PM, as I was being moved to the ICU under anesthesia, my family watched with tearful eyes.Major hospitals are equipped with sophisticated intensive care systems, including the Intensive Care Unit (ICU), the Intensive Treatment Unit (ITU), and the Critical Care Unit (CCU). Patients who lose the ability to breathe on their own often require mechanical ventilation in the ICU. These units provide crucial care for patients with severe or life-threatening conditions, ensuring continuous monitoring and the use of life-support equipment and medications to maintain essential bodily functions. 60 GOOD MORNING DOCTOR Intensive Care Units (ICUs) are managed by highly trained physicians, nurses, and respiratory therapists who specialize in treating critically ill patients. The ICU is distinct from general hospital wards due to its high staff-to-patient ratio and access to advanced medical resources and equipment not typically available elsewhere. Common conditions treated in the ICU include Acute Respiratory Distress Syndrome (ARDS) and septic shock.Typical ICU equipment includes mechanical ventilators for breathing support, which can be delivered via endotracheal or tracheostomy tubes; cardiac monitors for tracking heart conditions; and various devices for continuous monitoring of bodily functions. The ICU is also equipped with a range of tools such as intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains, catheters, and syringe pumps. Pain management and induced sedation are essential components, and various analgesics and sedatives are utilized to alleviate discomfort. The recommended nurse-to-patient ratio in an ICU is typically 1 nurse for every 2 patients.While I was in the ICU, I woke up at 4 AM feeling completely numb and heavy. My body felt like it was paralyzed, with a sensation as though both legs were encased in plaster. I could barely move and experienced an overwhelming sense of heaviness. The ICU was filled with distressing sounds; I could hear faint, agonized cries such as "Mommy, mommy" and "Oh, oh" piercing through the environment.I felt as though my throat was parched and cried out for a drink of water, but no one seemed to hear me. I noticed nurses attending to other patients in pain, moving from one bed to another. When I called out again for a bit of water, several nurses hurried to my side. They gently offered me a sip of water, which provided some relief. I then lay back, eyes closed, amidst the mournful sounds of the ICU and the constant beeping of life support equipment. Each patient had a screen mounted above their head, and various life support devices were connected to their arms, legs, and body to monitor and sustain vital functions. 61 Prof.JOHN KURAKAR In the ICU, my blood pressure was recorded on the screen every five minutes. Some patients had ventilators with oxygen support, while others had oxygen masks. The atmosphere in the ICU was tense, filled with the sounds of distress and alarm signals.I pondered my way out of the ICU, feeling completely immobilized as life support devices were attached to my arms, legs, and neck. Despite my inability to move even a little, my mind wandered aimlessly. I drifted in and out of consciousness, with countless images and memories flashing through my mind. Doctors and the operating theater appeared intermittently in my thoughts, like fleeting glimpses of a vivid, disjointed dream.I dreamt that Molly, Manju, and Manu were all by my side. When I woke from the anesthesia, I was unsure whether it was a dream or reality, but to my surprise, my daughter, Dr. Manju Kurakkar, was indeed standing beside me. I was astonished that my dream had become reality. Manju stayed with me for a while, talking and offering comfort. Shortly after, my son Manu Kurakkar arrived at the ICU and shared details from the previous day. Later, Molly joined us and recounted the difficulties of the operation day. Hearing about the distress my family had experienced added to my own sorrow. After Molly left the ICU, I lay there for a while, deeply affected. Before 7 AM, Dr.Sudhindran came to see me. He informed me that the surgery had been very successful, lasting over ten hours. Due to the colon cancer, the rectum had to be removed. He explained that the surgery was laparoscopic, involving the use of a camera inserted through small incisions in the lower abdomen for observation. After one day of ICU monitoring, I was moved to a hospital room. I received antibiotics and pain management injections three times a day. The pain persisted for several days, but the doctors reassured me that after about 20 days, the outer wound would begin to heal. The next day, they informed me that I could be discharged. The following day, complications arose as an infection developed in my abdomen. It was suspected that the infection might have been a result of the 25 rounds of radiation therapy I had under- 62 GOOD MORNING DOCTOR gone prior to the surgery. Despite efforts to manage the infection and promote healing, the gastroenterology department was unable to address the issue effectively and referred me to the plastic surgery department for further treatment.April 9, 2022, marked my 70th birthday. Given the pain and distress I was experiencing, the idea of celebrating seemed almost impossible. The day passed in anguish, and I had little inclination to acknowledge the occasion. However, at around 9 PM that evening, Dr. Vijay Ganeshan, along with his team and the hospital staff, unexpectedly arrived in my room with a grand birthday cake. The sight of them and the cake was surreal, leaving me in a state of disbelief. Dr. Vijay explained that the celebration was a gesture of his deep affection and concern for me. He had brought the cake during a break in the operating theater, turning what seemed like a grim situation into a heartwarming celebration. This unexpected gesture was one of the happiest moments of my 70 years. Throughout my hospital stay, Dr. Vijay and I developed a relationship akin to that of a father and son. Additionally, Sister Merlin from the gastroenterology department, who treated me with the utmost kindness and care, became like a beloved daughter to me. 63 Prof.JOHN KURAKAR 64 GOOD MORNING DOCTOR Plastic surgery is a surgical specialty that involves restoration, reconstruction, or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofacial surgery, hand surgery, microsurgery, and treatment for burns. While many people associate plastic surgery primarily with aesthetic enhancement, it is actually a broad field. Cosmetic surgery is only a small part of this extensive field. Beyond cosmetic enhancements, plastic surgery effectively addresses severe conditions that can impair life, including congenital deformities, injuries from accidents or surgeries, and damage from burns, by providing effective surgical solutions.Even cosmetic surgeries can greatly boost the self-confidence of individuals undergoing them. For those experiencing conditions such as facial deformities, scars, or burn injuries, plastic surgery can effectively help them overcome these challenges and lead a life with restored confidence. Those who have suffered accidents, severe injuries, or limb deformities can also benefit from plastic and reconstructive surgery to overcome their conditions. In addition to surgeries, this field offers a range of procedures for weight loss, eliminating signs of aging, and enhancing beauty. The term "plastic surgery" is derived from the Greek word "plastikos," which means "to mold" or "to shape." On April 8, 2022, doctors from the Plastic Surgery Department at Amrita visited my room for a detailed examination. Dr. Sandeep Vijayraghavan is the chief doctor in this department.Dr. Sandeep Vijayaraghavan is a specialist in Cosmetic, Plastic, and Reconstructive Surgery, Hair Transplant, and Composite Tissue Allotransplantation. He holds an MS PLASTIC SURGERY DEPARTMENT TOOK OVER THE TREATMENT CHAPTER 7 65 Prof.JOHN KURAKAR in General Surgery, an MCh in Plastic and Reconstructive Surgery, and a DNB in Plastic and Reconstructive Surgery. His special skills also include obesity surgery. On the morning of April 8, the Plastic Surgery Department took me to the operating theater. After the operation performed by the Gastroenterology team, the stitched area developed an infection, necessitating a reopening and the installation of a VAC (VacuumAssisted Closure) device.Vacuum-assisted closure (VAC) therapy is a method used to promote wound healing. Also known as wound VAC, this treatment involves a device that reduces air pressure on the wound to facilitate faster healing. In everyday life, the atmospheric pressure exerts force on our bodies, but a wound vacuum device alleviates this pressure from the area of the wound.The VAC system works in several beneficial ways: it gently extracts fluid from the wound, which can reduce swelling, help clean the wound, and remove bacteria. Additionally, it helps to pull the edges of the wound together and may stimulate the growth of new tissue, aiding in wound closure.The wound vacuum system consists of several components: - A foam or gauze dressing is placed directly on the wound. - An adhesive film is used to cover and seal the dressing and wound. - A drainage tube extends from beneath the adhesive film and connects to a portable vacuum pump.The vacuum pump then removes air pressure from the wound area, either continuously or in cycles, depending on the specific treatment plan.On April 8 and again on April 13, the surgical site was reopened, and a VAC device was installed to remove contaminated blood and fluid, which promoted the growth of healing cells. On April 18, I was taken to the operating theater for the third time, where the site was examined and found to be healing well. The wound was then permanently sutured, and I was moved back to my room. Over the following days, the wound was dressed regularly. Once the wound 66 GOOD MORNING DOCTOR was fully dry, I was discharged from the hospital on April 26, 2022. Believing in God provides a profound source of strength and comfort, especially when faced with recurring hardships. Faith can offer a sense of purpose and reassurance during times of adversity, reminding us that even when challenges seem relentless, there is a greater plan at work. Holding onto hope, despite repeated setbacks, is crucial for resilience. It encourages us to view difficulties as opportunities for growth and transformation rather than insurmountable obstacles. This unwavering hope, fueled by faith, can inspire perseverance and optimism, helping us to navigate through life's trials with a renewed sense of courage and determination. By trusting in a higher power and maintaining hope, we can find solace and strength to continue moving forward, even in the face of persistent challenges. 67 Prof.JOHN KURAKAR Although I was discharged from Amritha Hospital on April 26, 2022, my health issues continued to be severe. My left leg persisted with swelling and began experiencing electric shock-like sensations. This was followed by several sleepless nights. Rather than returning to Kottarakkara, we remained in the guest room at Amrutha for an extended period. After a month and a half in the hospital following the APR surgery, living in the guest room proved to be quite difficult. Along with the stoma bag, a urine bag was also in use. I had to visit various hospital departments daily, and the Gastrosurgery department performed several Doppler tests to investigate the cause of the leg pain. A Doppler ultrasound is a noninvasive diagnostic tool used to evaluate blood flow through blood vessels by emitting high-frequency sound waves (ultrasound) that bounce off circulating red blood cells. Unlike a standard ultrasound, which produces images of internal structures, a Doppler ultrasound specifically measures blood flow and velocity. It is particularly useful for assessing various conditions such as:Venous insufficiency, Poorly functioning valves in the leg veins that can lead to blood or fluid pooling in the legs, Heart valve defects and congenital heart disease, Issues with heart valves that affect blood flow, Arterial occlusion: Blocked arteries that impede blood flow, Peripheral artery disease, Reduced blood circulation to the legs, Aneurysm: Bulging arteries due to weakened vessel walls, Carotid artery stenosis: Narrowing of the carotid artery in the neck, which can increase stroke risk. During the procedure, a trained technician (sonographer) uses a hand-held device called a transducer, which is about the size of a bar of soap, to send and receive I HAVE BEEN DISCHARGED, STILL UNABLE TO GO HOME CHAPTER 8 68 GOOD MORNING DOCTOR sound waves from the area being examined. The test measures how fast blood flows by detecting changes in the pitch of the sound waves. Doppler ultrasound can be an alternative to more invasive procedures like angiography, which involves dye injection for clearer X-ray imaging. It can also help doctors monitor treatments and assess injuries to arteries or veins. Despite undergoing several Doppler tests over multiple days, no issues were found in my leg. However, the pain and sensations persisted without relief. Consequently, I consulted orthopedic doctors, who specialize in diagnosing and treating conditions related to bones, muscles, nerves, and joints, all of which are crucial for movement. Even after a thorough examination by the orthopedic specialist, the cause of the leg pain remained undetermined. I tried various medications without significant improvement. Following this, I sought help from the neurology department, where the doctors assessed my condition further. They performed not only blood tests but also a nerve conduction test (NCT) to investigate the issue. A nerve conduction study (NCS) is a diagnostic test used to assess the function of the motor and sensory nerves in the body. It evaluates how well electrical impulses travel through the nerves, helping to identify potential nerve damage. This test can be performed by specialists such as clinical neurophysiologists, physical therapists, chiropractors, or physiatrists (physical medicine and rehabilitation physicians). The nerve conduction velocity (NCV) test, a key component of NCS, measures the speed at which electrical impulses move through the nerves. During the procedure, electrodes are placed on the skin to stimulate the nerve and record the electrical activity. By analyzing the speed and strength of the nerve signals, the test can determine if there is any damage to the nerves or if there are disorders affecting the muscles or nerves. NCS is valuable for diagnosing various conditions related to nerve function and for guiding appropriate treatment. Despite extensive consultations, neither the neurology department nor any other specialists were able to identify the cause of my leg 69 Prof.JOHN KURAKAR pain, muscle spasms, and insomnia. With the urinary tube and bag left unchanged for two months, it was impossible to return home. We consulted urologists who tried replacing the tube multiple times, but due to improper urine flow, they were unable to resolve the issue. The doctors advised that I would need to continue using the urine bag for an extended period. Feeling completely overwhelmed by the combination of the stoma bag, urine bag, persistent insomnia, and the inability to return home, I felt that life had become unbearably difficult. My daughter, Dr. Manju, replaced the large urine tube with a leg bag, which provided some relief. The next day, we visited the psychology department, where the doctors recommended three to four days of counseling to help manage the psychological stress and emotional strain.Counseling is a process designed to mentally prepare individuals to address their own issues with equanimity. It involves a trained counselor and the individual experiencing conflicts working together to find solutions through mutual sharing. In counseling, the individual analyzes painful experiences and strives to find independent solutions to their problems. The goals of counseling include enhancing personal integrity, achieving good mental health, and acquiring life skills that contribute to life success. However, when counseling did not yield significant benefits, we followed their recommendation and consulted psychiatrists. Despite receiving various medications, I did not experience any improvement. Eventually, we turned to the podiatric department, where we consulted doctors specializing in podiatry. Podiatry, or podiatric medicine, is a branch of medical science focused on the study, diagnosis, and surgical treatment of disorders related to the foot, ankle, and lower extremities.Here's a refined version of the translation. To relieve the leg pain, we purchased a pair of orthopedic shoes from the podiatry department and then returned to the guest room. After staying there for a few more days, we traveled to Kottarakara with a stoma bag and a urine bag, despite the unbearable leg pain. After coming back home and still suffering from 70 GOOD MORNING DOCTOR insomnia and severe leg pain for several days, our son Manu Kurakkartraveled to Navi Mumbai, and we went to Mumbai with him. It was also a relief that our daughter, Dr. Manju Kurakar, is a Reader in the Maxillofacial Department at a medical college, which is about an hour and a half away from Navi Mumbai via the express highway. Mental strength plays a pivotal role in overcoming disease, serving as a cornerstone of resilience and recovery. When faced with a health challenge, maintaining a positive mindset and emotional fortitude can significantly influence one's ability to cope with the physical and psychological stresses of illness. Mental strength helps individuals navigate the uncertainties and setbacks of treatment, fostering a proactive approach to managing symptoms and adhering to medical advice. It empowers patients to remain hopeful, which can enhance their overall well-being and potentially improve outcomes. By cultivating mental strength, individuals not only bolster their ability to endure but also create an environment that supports healing and recovery, demonstrating that the mind's power is integral to conquering physical adversity. 71 Prof.JOHN KURAKAR In May 2022, I arrived at Swan Harmony Apartments in Navi Mumbai. After two days, I saw Dr. Rajesh, a Gastro surgeon at Apollo Hospital. Apollo is one of the best hospitals in Navi Mumbai.Apollo Hospitals Navi Mumbai prides itself on being able to offer cutting-edge advanced treatments in almost all aspects of healthcare and surgery. This Apollo hospital Belapur branch has an extensive team of experienced and talented doctors, further supported by a pool of highly qualified, dedicated, and experienced support staff and sophisticated medical technologies. Apollo Hospital Navi Mumbai is a 500-bedded facility with world-class infrastructure and facilities. It also has 13 ultra-modern operation theatres, state-of-the-art laboratories, and 120 ICU beds. Dr. Rajesh reviewed all the treatment records from Amrutha and issued a satisfaction certificate for the care received there. He conducted a comprehensive examination and demonstrated both kindness and compassion. He explained that the leg pain was likely a side effect of the chemotherapy and radiation administered before the APR surgery. He recommended consulting a general physician, as well as specialists in oncology and urology.Dr. Rajesh S. Shinde, MS, M.Ch., is a Consultant Surgical Oncologist specializing in Gastro-intestinal Oncology, HPB Cancer, and Robotic Surgery at Apollo Cancer Centres. He has extensive experience in performing complex surgeries for colorectal, stomach, liver, pancreas, gall bladder, bile duct, and retroperitoneal cancers. Dr. Shinde completed his Surgical Oncology training at Tata Memorial Hospital in Mumbai. He further honed his skills in Robotic Surgery at Severance Hospital, Yonsei University, Seoul—an esteemed instiFURTHER TREATMENT IN MUMBAI CHAPTER 9 72 GOOD MORNING DOCTOR tute renowned for its advanced robotic systems. Additionally, he trained in advanced Pancreatic and HPB Surgery at the University of Verona, Italy, a leading center for pancreatic surgeries. The next day, Dr. Rajesh advised that the urine tube and bag could be replaced. Although they were changed the following morning, urinary issues continued, necessitating another visit to Apollo that night for a replacement. Following Dr. Rajesh's recommendation, I consulted Dr.Amool, a urologist at Apollo. Based on his guidance, a uro-dynamic test was conducted under the supervision of Dr. Mrs. B.K. Daster.Most urodynamic tests evaluate how well the bladder can store and release urine. These tests can also detect if the bladder contracts involuntarily, which can lead to urine leakage. The urodynamics test typically lasts about 60 minutes and is generally painless, so sedation is not required. To begin the test, a nurse will ask you to empty your bladder in a specialized chair. The tests assess the efficiency of the bladder and urethra in storing and expelling urine, providing insight into their overall function.The uro-dynamic test was reviewed by the urologist. Due to the bladder's decreased functionality, he recommended continuing with the tube and bag. Managing and emptying the urine bag daily was very challenging.After arriving in Mumbai from Kottarakkara and staying with my son Manu, my physical and mental condition remained quite poor. Insomnia was my biggest problem, along with unnecessary fear, feelings of isolation, claustrophobia, and anxiety about confined spaces, closed rooms, and elevators. I found no joy in anything. At Apollo Hospital, Prof. Dr. Rajesh S. Shinde, noticing my condition, tried to uplift my spirits with his words. He reassured me, saying, 'Don't be afraid of anything; everything is fine. The elephant is gone; only the tail remains.' His demeanor, dedication, and kindness are something I will never forget. "As the pain in my leg worsened, we visited Dr.Bhaimangesh Naik, a well-known general physician near Swan Harmony in Belapur, where we were staying. Dr.Bhaimangesh Naik is a Consultant 73 Prof.JOHN KURAKAR Physician and Diabetologist with 18 years of experience. He practices at M.G.M. Hospital and Research Centre in Belapur, Navi Mumbai. Dr. Naik completed his MBBS from MIMSR Medical College, Latur in 2002 and his MD in Medicine from Government Medical College, Nanded in 2008. He is a member of the Association of Physicians of India (API) and the Association of Medical Consultants. His services include Electrocardiography (ECG), treatment for Chronic Obstructive Pulmonary Disease (COPD), fever treatment, insulin treatment, and infectious disease treatment.Dr.Bhaimangesh Naik adjusted my blood pressure medications and recommended a thyroid test. He also prescribed several medications to alleviate the leg pain. I visited him again on May 24, July 14, and July 19, 2022. Although Dr. Naik’s medications provided some relief from the leg pain, the insomnia and mental stress persisted.My daughter and son frequently discussed my issues with their colleagues and sought solutions. My son, Manu Kurakar, works as a Systems Manager at the SBI Global Office. Following the recommendation of a colleague from his bank, we consulted Dr.Seementini, a well-known psychiatrist in Navi Mumbai. Dr.Seementini is a compassionate individual.Dr. Seemantini Unawane is a renowned psychiatrist with 14 years of experience. She completed her MBBS from the Maharashtra Institute of Medical Education & Research (MIMER) in 2005 and then pursued her DPM (Psychiatry) at the same institution, finishing in 2008. Dr. Seemantini currently practices at Dr. Sangani Diagnostic Centre & Multi-Specialty Clinic in Nerul East, Navi Mumbai, and also at Chaudhary Clinic in Nerul West, Navi Mumbai.Dr. Seemantini is approachable and friendly. I discussed all my issues with her, and she provided effective strategies for managing my problems. Her advice has helped me control my obsessions, and I am now more relaxed and cheerful compared to my previous depressed state. She provided clarity to my thoughts and understood exactly what I was feeling and trying to convey, which made me feel at ease. Dr. Seemantini is sensitive, a good listener, and treats patients with empathy. She has handled numerous complex 74 GOOD MORNING DOCTOR medical cases with attention to detail, accurate diagnosis, and compassionate care. My sleep patterns have improved, and my anxiety has significantly reduced since beginning treatment with her. Dr. Seemantini Unawane asked about all my issues and understood my situation. She explained that experiencing mental disturbances after undergoing such extensive surgeries is quite common. Over a short period, Dr. Seemantini became one of our closest friends. Thanks to her care, I was able to regain my mental well-being. Dr. Seemantini has become a highly cherished doctor for us.She also mentioned that it might be possible to reduce the frequency of changing the urine tube and bag. Following Dr. Rajesh's advice from Apollo Hospital, we consulted with Dr. Salil V. Patkar, a medical oncologist.Dr. Salil Patkar is a distinguished oncologist in Navi Mumbai, currently practicing at Apollo Hospital for the past 10 years. He has extensive experience as a Medical Oncologist and has developed expertise in various oncology fields. Dr. Patkar earned his MBBS degree from Pravara Institute of Medical Science, Maharashtra, in 2004, followed by a DNB in General Medicine from KLES University JNMC and Dr. Prabhakar Kore Hospital, Karnataka, in 2014. He completed his DM in Oncology from B.J. Medical College and Civil Hospital, Gujarat, in 2018.Dr. Patkar offers treatments for a range of cancers, including cervical, blood, liver, throat, breast, lung, and oral cancers. His services also include chemotherapy and immunotherapy. Known for his attention to detail, accurate diagnosis, and compassionate care, he has managed numerous complex medical cases.Dr. Patkar thoroughly reviewed the treatments provided at Amrutha Hospital and other relevant details. Dr. Salil Patkar reviewed the details of the surgeries and subsequent treatments for rectal carcinoma and thyroid adenoma. Following the recommendation of Dr. Pavithran, the medical oncologist at Amrutha Hospital, Dr. Patkar advised completing a regimen of six cycles of chemotherapy tablets, with each cycle lasting 14 days. I began the chemotherapy in June 2022, taking five tab- 75 Prof.JOHN KURAKAR lets daily. The six cycles of chemotherapy were completed by the end of December 2022.I consulted Dr. Patkar approximately ten times throughout the treatment, on dates including June 15, July 28, August 13, September 2, September 10, September 16, October 10, and November 18. During these visits, I discussed my issues, reviewed medical test results, and assessed the progress. Dr. Patkar confirmed that the treatment was satisfactory.Following Dr. Salil V. Patkar’s guidance, I also consulted Dr. Amit Lengote, a nephrologist.Dr. Amit Langote is a distinguished nephrologist at Seawoods Clinic, Navi Mumbai, and a full-time Consultant Nephrologist at Apollo Hospital, with over 23 years of experience in his field.Under Dr. Langote’s care, I underwent regular blood and thyroid tests every two weeks to keep track of my health. He also provided guidance on my chemotherapy regimen. His compassionate approach was reassuring, and he was pleased to see positive changes in my condition.After removal the urine tube and bag, I had several remaining unused leg bags and tubes that were no longer needed. I donated these items to Dr. Langote for use by underprivileged patients in need. Willpower plays a crucial role in overcoming deadly diseases, serving as a driving force behind a patient's ability to endure and persevere through rigorous treatment regimens and emotional challenges. It empowers individuals to maintain a positive attitude, adhere to complex medical protocols, and make difficult lifestyle changes that are essential for recovery. The strength of will can significantly influence a patient’s resilience in facing side effects, managing pain, and remaining hopeful despite grim prognoses. By harnessing their willpower, patients can actively engage in their healing process, collaborate effectively with healthcare providers, and foster a mindset that contributes to their overall well-being. In essence, willpower not only supports the physical aspects of battling a disease but also fortifies the psychological resolve needed to confront and overcome the adversity of serious health conditions. 76 GOOD MORNING DOCTOR Even after three or four months following the APR surgery, urinary problems continued. It was not possible to get rid of the urine tube and bag. If the tube was removed, urine would not flow. Every day was a struggle. Dr. Manju Kurakar brought a leg bag that could be fitted to the leg instead of the large urine bag. Dr. Manju Kurakar is working as a Reader at Sinhgad Medical and Dental College and Hospital in Pune. Sinhgad Dental College and Hospital, commonly known as SDCH Pune, is one of the premier private dental colleges in Maharashtra. Established in the academic year 2006-07, the college was founded with the goal of providing exceptional dental care and specialized training in 8 Departments, affiliated with Maharashtra University of Health Sciences, Nashik, and approved by the Dental Council of India. The institution is recognized for its excellent academic standards and competitive student performance. The vision behind creating this dental college and hospital was to develop future clinicians, educators, and researchers in the field of dentistry. The college features a modern facility with a built-up area of 120,000 sq. ft., including a clinical hospital section designed to optimize patient flow and minimize movement. Equipped with cutting-edge technology, the college offers aspiring dental professionals, state-of-the-art tools and resources, fostering a quest for excellence. It is located in a region with a significant patient inflow from numerous surrounding villages and towns, SDCH Pune provides an ideal environment for students to gain practical experience and engage in hands-on learning. With its comprehensive infrastructure and commitment to high standards of education, the college stands out as a leading institution for dental education in Pune. TREATMENT IN PUNE CHAPTER 10 77 Prof.JOHN KURAKAR My daughter regularly discussed my health issues with her colleagues. She would mention to her coworkers that traveling with a urine bag was causing significant distress for her father. One day, a colleague at her college told Manju that her father is a urologist and the chief doctor at ACE Hospital in Pune. Her colleague also mentioned that she had already informed her father about the issues Manju's father was facing. My daughter visited her colleague’s father, Dr. Suresh Patankar, who is the owner of the highly reputed ACE Hospital in Pune. This hospital is known for its emphasis on urology. ACE Hospital is a multi-specialty facility renowned for its state-of-the-art infrastructure and comprehensive medical care. Equipped with the latest technology and sophisticated medical equipment, the hospital aims to provide all-encompassing healthcare services under one roof. The Urology Department at ACE Hospital excels in delivering high-quality surgical and treatment options, including a range of laparoscopic and invasive procedures.Dr. Suresh Patankar handed over some medications to Manju for me. He advisedme to visit him in person after a month. After taking the medications for a month, I went to Pune to see the doctor. He appeared to be around 70 years old. From the very first glance, it was clear to me that he was a person of great humanity and dedication. Dr. Suresh Patankar is not only a renowned surgeon and clinician but also a dedicated researcher and academician with significant contributions to medicine, particularly in urology. His commitment to advancing healthcare has led to notable reductions in healthcare costs, benefiting society at large. As a distinguished educator, Dr. Patankar is a teacher of exceptional caliber, with substantial contributions to medical education. His relentless research spans modern technology, surgical techniques, and the traditional Indian system of medicine. He actively promotes holistic healthcare to address common health issues arising from modern lifestyle challenges. Dr. Patankar stands out for his unique qualifications in Ayurveda, yoga, and contemporary medicine. 78 GOOD MORNING DOCTOR In his nearly four-decade career as an urologist, Dr. Patankar has pioneered several groundbreaking surgical procedures and is the founder of ACE Hospital in Pune. His work has earned him numerous accolades, including the prestigious National Award for "Innovation in the Medical Field" from the National Indian Medical Association, presented in Chennai on August 4, 2018, by Dr. Ravi Wankhedkar, President of IMA, and Hon. Justice Subramaniam. Dr. Patankar's innovative work has earned him national recognition for its societal benefits. His research spans a wide range of medical disciplines, including basic sciences, surgical techniques, and drug development. His innovations, which include novel drugs for treating kidney stones and enhancing wound healing, and his proprietary surgical techniques in urology, have earned him numerous international patents. Additionally, he has authored books on herbal medicine research. At ACE Hospital, a team of skilled urologists is employed, and offers Ayurvedic treatment options. The hospital's founder, Dr. Suresh Patankar, treated me with exceptional compassion. He took the time to discuss my urinary issues thoroughly with every doctor in the Urology Department."Let's explore every possible way to assist him," Dr. Patankar directed his colleagues, observing my condition closely. "The urine bag must be changed immediately," he added. Following this, a series of tests were carried out, with the bladder scan being the most crucial among them. The bladder scan uses ultrasonic reflections to distinguish the urinary bladder from surrounding tissues. It is a non-invasive, portable tool used for diagnosing, managing, and treating urinary outflow dysfunction. Cystoscopy, on the other hand, allows a healthcare provider to examine the lower urinary tract for issues in the urethra and bladder. Through the cystoscope, surgical tools can be introduced to address certain urinary tract conditions.During a bladder scan, the urethra is first cleaned, and a thin, flexible tube called a catheter is inserted into the bladder. A liquid containing radioactive material is then passed through the tube to fill the bladder, allowing you to feel a sense of fullness. The bladder is subsequently scanned, 79 Prof.JOHN KURAKAR and images of both the bladder and kidneys are captured.During the test, you might also be required to urinate.. If the doctor needs to assess how the bladder empties, images will be taken both when the bladder is full and after it has been emptied. There is a small risk of developing a urinary tract infection as a result of the procedure. The bladder scan test helped determine how much urine was retained and how much urine was normally being expelled. The doctors also taught me how to perform Clean Intermittent Catheterization (CIC). Individuals with bladder control issues may need to perform self-catheterization to effectively empty their bladders. This process, known as clean intermittent catheterization, involves using a catheter (a thin tube) to drain urine at regular intervals throughout the day. It is often required for people with specific medical conditions that impair their ability to urinate normally. As the term implies, self-catheterization is a procedure that you carry out on your own to manage bladder function. I was advised to perform Clean Intermittent Catheterization (CIC) three times a day—morning, afternoon, and night. I was instructed to record both the normal urine output and the urine volume obtained through CIC, and to review these measurements monthly. In the first month, the normal urine output was at 50%. The doctor noted this as "Good." From the following month, the doctor recommended performing CIC only twice a day. After two months, the doctor assessed my condition as "Very Good" and advised that CIC could be reduced to once a day starting the next month. By then, approximately 75% of the urine was being expelled normally. Eventually, CIC was discontinued. On July 22, 2022, a Urologic Endoscopy was performed. Urologic endoscopy is used to diagnose urinary tract issues and comes in two primary forms. The first is cystoscopy, where the doctor uses a camera mounted on a long, flexible tube to examine the urethra and bladder. This procedure allows for a detailed view of these areas to help identify any potential problems. 80 GOOD MORNING DOCTOR I was concerned about the urine tube and bag, but the doctor addressed my worries with exceptional compassion and care. He thoroughly understood my issues, administered effective treatment, and ultimately removed both the urine tube and the bag. No amount of gratitude can truly express how thankful I am to him. Doctors like Dr. Suresh Patankar, who exhibit such dedication and empathy, are the true pillars of the healthcare field. I pray that Dr. Suresh Patankar and his colleagues are blessed with long life and good health. POURING SALT ON THE WOUND Just as my physical and mental health began to stabilize, another disaster struck, akin to "adding insult to injury." On August 17, 2022, at 1 PM, I fell in the bathroom of Swan Harmony in Navi Mumbai. The fall resulted in a severe impact on my shoulder against a water pipe, causing a shoulder fracture. Unable to get up after the fall, I was found lying on the bathroom floor. Hearing the commotion, my wife rushed to the scene but was unable to help me up. In desperation, she called our son, Manu, who works as a Systems Manager at the State Bank of India’s Global Office in Navi Mumbai. Manu arrived within a few minutes. Together with my wife, he managed to lift me from the bathroom. I was in intense pain, particularly in my left shoulder, which was immobile. Without delay, Manu drove me to the Intensive Care Unit at Apollo Hospital in Navi Mumbai. The hospital was extremely busy, and it was over an hour before I even had an X-ray taken. After reviewing the results, the doctor informed me that I had a shoulder fracture and needed surgery as soon as possible. Following initial treatment, I returned home in the evening to discuss the situation with my daughter. Manu contacted Dr. Salil N a Medical Oncologist at Apollo Hospital, who advised postponing chemotherapy for a few days and to consult the orthopedic surgeon Dr. Sameer S. Chaudhari immediately. Dr. Sameer Chaudhari is an experienced orthopedic surgeon based 81 Prof.JOHN KURAKAR in Belapur, Navi Mumbai, with 15 years of expertise in the field. He practices at both Apollo Hospitals in Belapur and Terna Specialty Hospital & Research Centre in Nerul, Navi Mumbai. Dr. Chaudhari completed his MBBS from MUHS Nasik in 2008, followed by a Diploma in Orthopedics and an MS in Orthopedics from PDY Patil University in 2011 and 2013, respectively. He is a member of the Maharashtra Medical Council and the Indian Society of Hip and Knee Surgeons (ISHKS). Dr. Chaudhari has received specialized training through several prestigious fellowships: Knee and Hip Arthroplasty Fellowship at Sunshine Hospitals in Hyderabad, Trauma and Arthroplasty Fellowship at P D Hinduja National Hospital in Mumbai, Arthroplasty & Adult Reconstruction Fellowship at P D Hinduja National Hospital in Mumbai, and a Fellowship in Minimal Invasive Knee Replacement at ILSAN Hospital in South Korea. Dr. Chaudhari offers a range of services including Revision Hip and Knee Arthroplasty, Primary Hip and Knee Arthroplasty, Functional Orthopedics, Ankle-Brachial Index assessments, and Spasticity management. Following his recommendation, I was admitted to Reliance Hospitals in Navi Mumbai on August 22. Reliance Hospitals is renowned as one of India's top multispecialty hospitals, offering comprehensive treatment and healthcare services with excellent staff facilities and advanced technology. On August 23, I underwent surgery led by Dr. Sameer Chaudhari. He is a highly skilled and compassionate doctor who thoroughly listened to our concerns. His approach and behavior are commendable. At his clinic, the complete setup is available, allowing X-rays and the entire procedure to be conducted during a single visit. He accurately explains the problem and provides all necessary details to the patient. The consultation was smooth, with no waiting time, and the doctor prescribed the required medications during the visit. Dr. Salil N ,the Medical Oncologist from Apollo Hospitals, visited 82 GOOD MORNING DOCTOR me at Reliance Hospitals after my surgery to offer advice and support. I want to express my gratitude to him here. Following the hand surgery, Dr. Chaudhari recommended several days of physiotherapy. Based on his advice, I consulted Dr. Pallavi Patekar, a General Physician in Navi Mumbai. Dr. Pallavi Patekar is an Internal Medicine consultant who completed her MBBS from Topiwala National Medical College and Nair Hospital in Mumbai, and her DNB in Internal Medicine from KIMS (Krishna Institute of Medical Sciences) in Hyderabad. Dr. Pallavi Patekar is a highly skilled Internal Medicine consultant in Navi Mumbai, with 10 years of experience in the medical field. The medications she prescribed proved to be very effective. To conclude this experience note, I would like to share a significant incident during my stay. I was admitted to Reliance Hospitals for my shoulder surgery (Left Proximal Humerus Fracture). However, on August 25, the name of the hospital was changed to Kokilaben Dhirubhai Ambani Hospital. Upon my discharge on the same day, the hospital management chose to honor me with this change.   The doctors and management representatives came to my side to express their respect and explain the significance of this change. I was presented with a momento bearing the new name, "Dhirubhai Ambani Hospital," along with token of appreciation.