GOOD MORNING DOCTOR-
FULL STORY
Prof. John Kurakar
(a heart touching experience of cancer
treatment) authored by Prof. John Kurakar
DR.MANJU KURAKAR'S WORDS
25 November 2022, it was a
busy day, Evening I was just chit chatting with my friends in wats app group.
Suddenly my mother’s message popped up in Colgate group, it’s our family group.
I kept scrolling to the days behind in the family group. The memories of each
day began to flood my mind.The dark clouds of uncertainty loomed overhead, as
torrential rains and the threat of mudslides and landslides cast a somber
shadow over the days. In the midst of this, a glimmer of hope emerged – the
memory of my father's face, a reminder of the tears that often filled his eyes.
Yet, beyond the sorrow, he stood as a noble example of survival, a model of
courage who had walked from the dark days to the light, fighting and emerging
victorious. On November 25, 2021, my father, age 69, went to see a urologist
after experiencing a minor urinary infection. Upon examination, the doctor
suggested an Ultrasound scan, as there might be a possible problem with his
prostate gland. For the last two long years, the fear of COVID-19 had kept us
from going home, this year decided to make the journey.
On November 25, 2021, my father, age 69, went to see a urologist after
experiencing a minor urinary infection. Upon examination, the doctor suggested
an Ultrasound scan, as there might be a possible problem with his prostate
gland. For the last two long years, the fear of COVID-19 had kept us from going
home, This year decided to make the journey to home. My father had hoped that
all health concerns could be resolved before the arrival of his children and
grandchildren. A wish that now seemed uncertain. He was happy when he took an
ultrasound scan and found out that there was only a small inflammation of the
prostate gland and it could be solved with medicine. But the radiologist
suspected a abnormality at the end of the large intestine. He decided to see a
gastroenterologist to clear that doubt. Little did we know that the journey
would lead to a dark cave without light. The path ahead was shrouded in
uncertainty, but the resilience and strength that he had demonstrated in the
past gave me the courage to face whatever lay in store.
The gastro specialist who examined my father did not see any problem at first
glance. But he said he could do a colonoscopy. Colonoscopy is recommended for
everyone after age 50. A long tube with a camera attached is passed through the
anus to expertly examine the rectum and colon. December 3, 2021, I was coming
back from my hospital in the evening. My father's colonoscopy report arrived on
my phone, revealing 'Carcinoma Anorectum.' As a maxillofacial surgeon familiar
with the horrors of cancer, I was shocked to learn it was cancer. My heart
raced with anxiety as I struggled with the daunting task of figuring out how to
break the news to my father. The Gastroenterologist took a CT scan that very
day . We fervently hoped it would reveal only the early stages of cancer.
However, when the results arrived, they showed T3 N2 Mx, indicating that the
tumor was over 6 cm in size and had spread to nearby lymph nodes. That means it
was Stage III cancer. The following days were spent searching for the best
hospital and a specialized Gastro surgeon in Kerala. During this time, I
struggled to focus on my patients at the hospital in Pune, as my thoughts were
constantly consumed by my father’s condition. His face appeared in my mind
whenever I treated elderly patients. I rushed to see an oncologist who worked
at my hospital. It became clear that the cancer was far more advanced than
initially thought, having spread beyond the stage where it could be completely
eradicated. Radiation and chemotherapy were now essential. But surgery was
unavoidable. The surgery would be extensive; it would involve the removing the
muscles, lymph nodes, and surrounding tissues of the rectum and anus. Dr. Lekawale,
the Oncosurgeon who did Mch in surgical oncology from RCC Thiruvanthapuram
currently working in a reputed medical college Pune explained this in detail to
me. It felt like darkness was descending on my eyes, my face flushed, and my
eyes filled with tears. The doctor tried to reassure me. I thanked the doctor
and left the cabin. I couldn't bring myself to tell my father about this
treatment approach. Thanks to the timely intervention of my good friends and
Saly chechi, we were able to consult the highly skilled doctors Dr. Pavithran
and Dr. Sudheendran at Amrita Hospital in Kochi. Dr. Pavithran is a professor
of Medical Oncology. Dr. Sudheendran is professor in the Gastrointestinal
Surgery department. He is not only an expert in his field but also a genuinely
kind-hearted person.
Manu and I soughtmultiple opinions from various doctors. Both of us found that
the treatment approaches recommended by the doctors in Pune and Mumbai were
consistent with the one suggested by Dr. Sudheendran at Amrita. When my father
learned about this treatment plan, he sat in silence. Mom mentioned that he had
been quietly shedding tears. The doctor recommended an MRI scan. After leaving
doctor's office, my father asked Mom whether this treatment was truly
necessary. The MRI confirmed that the cancer was indeed at Stage III. Given the
tumor's size, chemotherapy would be required to shrink it sufficiently for
removal. While waiting in Dr. Pavithran's room for chemotherapy, we could hear
cries of pain coming from the nearby observation room. I worried that my father
might not be able to withstand the chemotherapy. Dr. Pavithran explained that
chemotherapy alone wouldn’t be sufficient to reduce the tumor and that
radiation therapy would also be necessary. However, before starting radiation,
Dr. Pavithran wanted to assess whether the cancer had spread to other parts of
the body. He suspected that a small cyst-like lesion in the liver might be
cancer spread. To resolve this suspicion, he recommended a PET scan, which
scans the entire body to check for cancer cells.
The PET scanresults were reassuring in that the rectal cancer had not spread to
other parts of the body. However, another problem was discovered: there was
another tumor in the throat, indicating thyroid cancer. Learning that there was
another type of cancer in the body devastated us.
We didn’t see anytrace of fatigue on my father’s face; he appeared cheerful
despite the circumstances. Moncy Uncle and Rashmi Aunty from Thrissur were with
us, and they asked, “How can your dad be so cheerful even after everything he’s
going through?” Their question both surprised and puzzled me. My father
responded “If I become fearful, the next generation will also become fearful. I
don’t want anyone to call me a coward.” He added “we are all role models for
the younger generation”. There was concern that the throat tumor might have
spread to the lungs. To rule this out, a biopsy was performed through the lungs
(EBVS), a procedure that was extremely painful. Even now, the memory of the
doctor who conducted the biopsy and the associated instruments haunts my
father's nightmares.
By God’s grace, thebiopsy results came back negative, indicating that the
thyroid cancer had not spread to other parts of the body. This was a tremendous
relief. He was referred to the Radiation Department by Dr. Pavithran for
radiation treatment. Dr. Haridas is friendly and compassionate expert who takes
the time to address his patients' anxieties and concerns, offering thorough
explanations and support and under his care, the radiation treatment lasted for
25 days. He mentioned that radiation might only reduce the tumour by up to 20%.
I chose not to tell my father this, as I didn't want to undermine his
confidence. Instead, we placed everything in God's hands and trusted him
completely. It was crucial to attend every session of radiation without missing
a day, as missing even one session would result in losing an entire cycle.
Radiation required utmost attention and punctuality. The first few weeks of
treatment went by without much difficulty. Along with radiation, he also had to
take chemotherapy pills. Each day, as he took five pills, he would secretly
consume honey and candy to avoid nausea and vomiting, which caused me great
sadness. Despite this, he kept his sadness hidden, managing to maintain a
cheerful demeanor and playfully interacting with everyone
When the finalcycle of radiation happened, things took a turn for the worse.
The cancer cells and surrounding tissues became severely inflamed and turned
into painful sores. He experienced unbearable pain along with severe diarrhea,
which was more than he could endure. Even after completing radiation, the sores
took over two weeks to heal. Seeing my father, who endured this pain with a
brave face and continued to smile and talk to everyone, was heart-wrenching for
us. He might have thought that enduring this pain would help eliminate the
cancer through radiation. We chose not to tell him that radiation could only
reduce the tumor by 20% to prevent him from losing his positive energy and
spirit.
Every day, I hadthe support of my college friends and colleagues. Through Dr.
Pushkar Gawande,I came to know about the Rasayu Ayurveda Cancer Center. His
wife Dr. Poonam Gawande is working at Rasayu Ayurveda Cancer Center Pune. We
were looking to avoid surgery, and decided to start Ayurvedic treatment.
However, according to the experts at Rasayu, delaying the treatment was not
advisable. It was not possible to avoid surgery through medication alone.
Nonetheless, we chose to complete one cycle of Rasayu’s treatment. Along with
chemotherapy and radiation, we completed a cycle of Rasayu’s treatment. We
heard that organic turmeric has cancer killing effect. The main active
ingredient in turmeric is curcumin or diferuloyl methane. Laboratory studies
have shown curcumin has anti cancer effects on cancer cells. Recognizing the
potential benefits of turmeric, we decided to incorporate turmeric into our
treatment approach as well. We learned that the Kottakkal Ayurveda Hospital
also had cancer medicines and decided to try that too. By mid-January 2022, my
father’s chemotherapy and radiation were completed.
After radiation, atwo-month recovery period was necessary before surgery to
allow the radiation wounds to heal. Knowing that there was a break before the
next examination provided us with some relief. However, the prospect of the
daunting APR (Abdominoperineal Resection) surgery continued to weigh heavily on
our minds. During this time, our journey was fueled by the search for the
inspiration from those who had triumphed rectal cancer and APR surgery. In the
two-month interval, the Tumor Board recommended the removal of the thyroid. The
sudden recommendation of another surgery terrified us. Following Dr. Haridas's
advice, we consulted Dr. Subramania Iyer, the Head of the Plastic Surgery
Department. Dr. Subramania Iyer is a highly renowned plastic surgeon, known for
performing the first successful double-hand surgery in India. Despite his
achievements and accolades, he is equally noted for his humility and grace. We
approached him with a lot of mental stress and doubts. We arrived his OPD at 12
noon, but were able to see him at 5:30 PM only due to the high volume of
patients. All our worries and mental struggles dissolved once we met him. The
thyroid issue had been present for the past 10 years. It had not been
troublesome at that time, but the surgeon advised that it was best to remove
it. The fear of potential damage to speech function was what initially made my
father hesitant about the surgery. However, the consultation with Dr.
Subramania Iyer instilled a lot of confidence in him. The thyroid surgery was
performed on February 8, 2022. He was discharged from the hospital just two
days later without much difficulty. The plastic surgeons are experts in
performing aesthetically pleasing surgeries, and even now, the scar from the
surgery is barely visible. It was indeed a beautifully executed thyroid
surgery. My father’s voice even gained more clarity.
After some time, wereceived the report of the thyroidectomy, which confirmed
Follicular carcinoma.It was established that the cancer was present in the
entire thyroid gland. Dr. Subramania Iyer advised that to prevent the cancer
cells from spreading to other parts of the body, a radioactive iodine therapy was
necessary. We were initially disheartened, thinking that there was no end to
the treatment. However, Dr. Subramania Iyer reassured us, saying that a single
session of radioactive iodine therapy would be sufficient. We were relieved to
hear that it required just one dose. With a small sense of relief, we went to
the Nuclear Medicine Department to meet Dr. Shanmughan. Dr. Shanmughan is a
highly efficient doctor, but due to his busy schedule, he had limited time to
address all our concerns. Ideally Radioactive iodine therapy will be given one
month after thyroid surgery. Ideally, radioactive iodine therapy is
administered about one month after thyroid surgery. This interval allows for
the depletion of residual thyroid hormones in the body and enables TSH levels
to rise, which enhances the effectiveness of the therapy. However, due to the
need for APR surgery within a strict one-month timeframe, we faced a
challenging situation. Before the APR surgery, it was crucial to replenish
thyroid hormones to ensure normal metabolic function and prevent potential
complications. Balancing these requirements was certainly a complex task for
us. We then learned about the R-TSH injection, which could potentially address
this issue. Each injection cost around one lakh rupees, and taking two
injections was required to increase TSH levels. We spent two lakh rupees within
three days on R-TSH injections. During this period, we were advised to avoid
iodine-containing foods, fish, and iodized salt. After that, we underwent the
radioactive iodine scan. The scan report revealed that a few thyroid cancer
cells remained under the bed of the thyroid gland. To completely eliminate
these cells, additional radioactive iodine treatment was needed. Although this
treatment seems straightforward, it causes significant psychological stress for
those who experience it. The isolation, living in a small room for two days
without seeing anyone, and the food delivered through a small window can be
distressing for anyone. After consuming the radioactive iodine, a significant
amount of radiation is emitted from the body, which is harmful. There is a risk
that close individuals could also develop cancer from this exposure.
We brought myfather to the isolation room with a box full of motivational
books, fruits, and a mobile phone. Only he knew how he managed to endure two
days alone in a room without seeing or speaking to anyone. Food was delivered
through a small window, and the isolation, reminiscent of what COVID-19
patients experienced, was a pain he recalled vividly. After two days, he was
discharged. The joy he felt upon seeing my mother outside the isolation ward
was indescribable. Since it took about two weeks for the radiation to
completely leave his body, he had to continue living in isolation for that
period. We booked two rooms at the Amritha Guest House, preparing one room
specifically for him. The enforced distance between even close family members
took a toll on his mental well-being. Despite the emotional strain, my father
kept his spirits up and persevered.
On March 18, 2022,we had the second MRI scan. This scan was to determine how
much the tumor hadreduced after chemotherapy and radiation. According to Dr.
Haridas's prognosis, there would be a 20% chance of reduction. The noise of the
first MRI scan was unbearable for my father, but after our continuous
encouragement, he agreed to undergo the MRI scan again. To our amazement and
with divine grace, the tumor had reduced by 50%. Whether it was due to
chemotherapy, radiation, the benefits of Rasayu, the effectiveness of Kottakkal
Ayurveda medicine, or the potency of turmeric, we did not know. We preferred to
believe that it was the work of a higher power.
With this report inhand, Manu and I rushed to meet Dr. Sudheendran. We went to
find out if, giventhe improvement, surgery could be avoided or perhaps made
less extensive. However, the result was disappointing. The doctor said that the
surgery had to be an APR and there was no possibility of changing this. With
heavy hearts, we left the doctor's office and encountered a nurse who
specialized in colostomy. She explained about the surgery and the
post-operative lifestyle, and introduced us some colostomy patients living as
role models. Among them was a couple who had recently delivered twins. Their life
was a marvel to us. Mr. Shiju, 35 year old, had lived with a colostomy bag for
last 15 years and was a vibrant, youthful individual. He had achieved
everything he wanted in life. Meeting him, we quickly became his admirers.
Since Atul Kurakar was studying at Amrita Dental College, Georgekutty Uppapan
and Sally Chechi were living close to the hospital, they provided significant
help and support to my father and mother. Georgekutty Uppapan’s presence was a
great comfort to my father. The date for the APR surgery arrived. It was on
March 22, 2022. We were then busy preparing for the pre-anesthesia fitness
(PAC) check-up. After thyroid removal, it was crucial to take medication to
manage body weight. Maintaining a euthyroid (normal thyroid hormone) state is indeed
essential before proceeding with any surgery. This is because proper thyroid
hormone levels are critical for the body's metabolic stability, wound healing,
and overall physiological balance. Inadequate thyroid hormone levels can lead
to complications such as poor wound healing, increased risk of infections, and
other systemic issues. The endocrinologist prescribed Thyroxine 125 for my
father. On March 20, 2022, my father was admitted to the hospital. We hoped
that the time until March 22 would pass quickly. To ease my father's anxiety,
we visited Changampuzha Park. The cool breeze in the park provided a brief
respite for our minds. Later, we went to St. George’s Church in Idappalli,
where we felt that not a single tear shed in the churchyard would be in vain.
We felt an overwhelming sense of divine presence and a complete faith that an
invisible force would guide us.On March 21, we went through the pre-surgery
tests. In the afternoon, My father was given medications to clear his bowels.
After drinking the solution, his stomach was thoroughly emptied ten to fifteen
times. To distract him from worrying about the surgery, we created several
important videos, including topics on environmental conservation, the poet
Changampuzha and water conservation. We focused on keeping my father engaged
and entertained.
That morning, March 22,
2022, began at 5 AM as we prepared for the day and awaited the call to the
operating room. Despite my father's attempts to lighten the mood with jokes,
our underlying anxiety continued to grow. At 7:30 AM, the wheelchair came to
take him to the pre-op room. I stayed with him while the anesthesiologist
checked him one more time and ensured everything was in order. My father
changed into the OT gown and was wheeled in on a stretcher. He closed his eyes
and surrendered everything to God. I was left with a deep sense of uncertainty,
wondering if I would see him again. We were instructed to wait in the waiting
room. The waiting was excruciating, with every minute feeling like an hour. Sally
Chechi also stayed with us. By noon, we hadn’t received any updates from the
operating theatre. Hunger and thirst were non-issues; the tension was
overwhelming. Unable to bear the anxiety, I decided to take a walk. As if sent
by divine intervention, I saw Dr. Sudheendran passing by. I called out loudly,
"Sir, how is my father?" Dr. Sudheendran had eight surgeries
scheduled that day, and no doctor could handle eight surgeries simultaneously.
The surgery for my father was conducted by Dr. Binoy and Dr. Vijhay Ganesh,
under the supervision of Dr. Sudheendran. However, Dr. Sudheendran, in the
midst of his busy schedule, seemed to have momentarily forgotten about my
father. When I asked Dr. Sudheendran, he couldn't provide a clear answer at
that moment. However, he immediately went to my father's theatre. We waited
anxiously, and our fear grew when we couldn't see my father.
At 9 PM, Dr.Sudheendran called me and informed that the surgery was completed
but that there had been some difficulties. He said stitches were being placed
and that my father would be moved to the ICU in about half an hour. By around
10 PM, my father was moved to the ICU after a 12-hour-long surgery. As I
waited, my anxiety intensified. Dr. Vijay Ganesh, a final-year MCh student,
called us in and provided a detailed explanation of the surgery, even showing
us the removed tumor. I was so overwhelmed that I struggled to find words. When
we went into the ICU to see my father, we found him with his legs elevated and
bound in stockings. Seeing him in this state after waking from anesthesia was
disorienting. Manu broke down in tears upon seeing him, and none of us could
sleep that night.
After waking fromanesthesia, my father requested for water in the ICU. After
such a long surgery, the minimum wait time for drinking water is six hours.
None of the ICU nurses gave him water. On March 22, World Water Day, he was
frustrated that he couldn't get even a drop of water. He expressed his
frustration to the nurses, who later informed me of his discomfort. When I saw
my father in the morning, he was visibly upset about not having received water.
I tried to comfort him by explaining that the delay was due to the extended
duration of the surgery. Despite the challenges of the procedure, I reassured
him that it had been completed successfully, which seemed to bring him some
relief. Shortly afterward, a nurse, with softened heart, moistened a cloth with
water and gently soothed his lips.
On the morning ofMarch 23, at 7 AM, Dr. Sudheendran visited the ICU to check on
the patients whohad undergone surgery the previous day. After such a lengthy
and complex procedure, the doctor had assumed my father would still be
unconscious and had not approached his bed. When my father greeted him with a
"Good Morning, Doctor," Dr. Sudheendran was momentarily shocked. He
hurried to my father's side and asked, "How do you feel now?"
Expecting a different response, Dr. Sudheendran was surprised when my father
replied, "I am fine." My father then mentioned, "It would have
been nice to have some water." Realizing that my father was in good
spirits despite the long and serious surgery, Dr. Sudheendran ordered some
biscuits and lemon juice for him. However, due to hospital protocols, my father
had to wait an additional four hours before receiving the lemon juice. Seeing
my father's strong will to recover, Dr. Sudheendran was pleased and decided to
transfer him to a regular hospital room that evening.
From that day until the end of April, we spent every day and night in the
hospital room. During this challenging time, Dr. Vijay Ganesh was like a
guardian angel, a son, and a sibling, constantly by my father's side. He took
on the crucial role of caring for my father, administering medication to his
wounds, and addressing our concerns about the colostomy bag. For days on end,
Dr. Vijay was always nearby, helping us understand and manage the situation
with unwavering support.
After several days, a discharge was written, and we hoped we could finally go
home. But that very morning, things took a turn. We were devastated to find
that the wound, which we had hoped was healing, had started showing pus
drainage, a sign of infection. We were left in a state of complete dismay. The
Gastrosurgery team realized that they could no longer manage the case and
referred it to the Plastic surgery department at Amrita Hospital. Plastic
surgeon Dr. Sandeep came to examine my father and explained that the infection
could not be treated with medication alone and that my father would need to
undergo another surgery. Due to the previous radiation treatment, the tissues
inside the abdomen had been necrosed, making it difficult for the wound to heal
properly. Consequently, a VAC (Vacuum-Assisted Closure) dressing was applied
for 21 days to help the wound heal. During this period, my father had to
undergo surgery three more times. Due to previous radiation treatments, the
tissues inside my father's abdomen had become necrotic, which impeded proper
wound healing. To address this, a VAC (Vacuum-Assisted Closure) dressing was
applied for 21 days. During this time, my father underwent additional three
surgeries. His suffering was immense, yet his courage and pride were evident at
every turn. It was truly remarkable to see him navigate the corridors of Amrita
Hospital, carrying the cumbersome VAC machine and urine bag. Dr. Sudheendran’s
words, "You are a brave man, you are inspiring to us," reflected the
deep respect and admiration for my father's remarkable resilience.
On April 9, 2022 myfather's 70th birthday, he was in so much pain that even
contemplating a birthday celebration seemed impossible. However, at 9 PM that
evening, Dr. Vijhay Ganesh from the gastroenterology department, along with his
colleagues and the hospital's nurses, arrived at your father's room with a grand
cake. It was almost unbelievable to your father, as if it were a dream or a
reality. In that hour of joy, amidst the pain, my father was able to experience
a moment of happiness, as if he were surrounded by benevolent spirits. Dr.
Vijay remarked, "I brought the cake during a break in the operation out of
my love and care for my Acha." Dr. Vijhay used to address my father as
‘Acha’(means father in Malayalam). This moment of 70th birthday celebration
turned out to be one of the happiest my father had experienced in his 70 years.
Throughout the hospital stay, the bond between my father and Dr. Vijhay Ganesh,
along with the exceptional care provided by Nurse Merlin, was particularly
significant. My father greatly valued their support and affection. Nurse Merlin,
a beloved figure in the Gastrosurgical department, was especially cherished by
my father for her compassion and dedicated care. Dr. Sandeep's expert
treatment, combined with my mother's intense care and my brother’s constant
encouragement, helped our father to navigate through this challenging period.
By May 2022, father was discharged. However, due to the ongoing complexity of
medical procedures, he faced urinary retention issues, making it impossible for
him to urinate naturally. Consequently, he had to stay at the Amrita Guest
House since he couldn’t return home until the problem was resolved.
It was afrightening period. During one of the stays at the guest house, my
father developed a cough. After coughing, he discovered that a large part of
his intestine had protruded 8 cm from his abdomen. He felt as though he was
losing his balance. With immense courage, my mother took him to the OPD. After
I called, Dr. Vijay rushed to the hospital. Dr. Sudheendran reassured my
father, carefully repositioned the protruding intestine, and recommended using
a supportive belt for his abdomen. Extended stays in the hospital led to severe
sleep deprivation and resulting mental health issues for my father. Despite
seeking solutions from various departments such as Neurology and Podiatry and
consulting Psychologists, we were unable to find effective relief. Even after
trying medications from the mental health department, the problems persisted,
and his mental distress only increased.
We consultedseveral urologists at Amrita Hospital for my father's urine
retention problem, but the issue remained unresolved. Recognizing that the
hospital environment was worsening his agitation, we decided to move him to our
hometown, Kurakar Gardens in Kottarakara, with his urine bag. I hoped that
being at home, surrounded by flowers and familiar surroundings, would provide
him some comfort. Unfortunately, this change did not bring significant relief.
Manu accompanied his father and mother to Mumbai. While Manu's presence was a
great comfort, my father continued to struggle with sleeplessness. Manu took
him to Dr. Seemantini, a mental health specialist in Navi Mumbai. After
reviewing my father's medical history, Dr. Seemantini identified the root cause
of his sleep issues. She explained that the mind has a limit for enduring
sorrow, and once that limit is exceeded, it can no longer cope, leading to
significant mental distress. Just like physical ailments, mental health issues
can be treated and healed. Dr. Seemantini's diagnosis and treatment successfully
alleviated father's mental health problems.
Due to somecomplications related to the colostomy, we decided to consult Dr.
Rajesh at Apollo Hospital in Mumbai. Dr. Rajesh, known for his gentle and
attentive approach, was taken aback by my father's medical history. He
reassured my father with the comforting words, "The elephant has gone;
only the tail is left. Don't worry, the tail will also be gone soon”. Dr.
Rajesh's reassuring words brought great comfort to my father. He told him,
"You are very close to the goal," and recommended seeing Dr. Salil
Patkar to begin post-chemotherapy treatment. Dr. Salil Patkar, a compassionate
medical oncologist, proposed a treatment plan consistent with Dr. Pavithran’s
approach at Amrita. This plan included six cycles of chemotherapy over two
weeks, with daily doses of 500 mg of Tab Capecitabine. The medication caused
significant discomfort for my father, including nausea, vomiting, leg cramps,
pain in his legs, skin irritation, and general weakness. Despite these severe
challenges, my father’s resilience and mental fortitude were truly remarkable.
As one issue wasaddressed, another problem seemed to emerge. The urinary
catheter placed on March 22 needed frequent replacements, yet my father
continued to experience urinary retention. Walking with the urinary bag proved
very difficult for him. After extensive searching, we discovered a leg bag for
urine that could be strapped to the leg, which provided temporary relief for my
father. We consulted several urologists in Mumbai regarding the urinary
obstruction, but none were helpful. The search for a solution continued,
leading me to learn about Dr. Anupama Patankar’s father, Dr. Suresh Patankar,
in Pune. After 20 years of service at BJ Medical College, Dr. Patankar founded his
own Urology hospital, ACE Hospital, in Pune. He is renowned for his innovative
treatment methods and ongoing research in urology. Dr. Anupama Patankar is
Professor in Department of Prosthodontics in our hospital, Sinhgad Dental
College Pune Dr. Suresh Patankar’s approach seamlessly combined modern medical
practices with Ayurvedic treatments, showcasing a holistic understanding of
health. From the moment we met him, it was clear that he was the right doctor
for my father. Dr. Patankar, a gentle and compassionate specialist, seemed to
be around my father’s age and demonstrated profound empathy and consideration.
Upon meeting my father, Dr. Patankar, with a smile, asked, "Don't you want
to remove the urinary tube?" Thanks to his effective treatment, the tube
was successfully removed within a month. However, complete urinary voiding was
still challenging, so he recommended Clean Intermittent Catheterization (CIC)
to help drain residual urine. This procedure requires meticulousness and
hygiene, and it is usually difficult for most people to learn. It demands
patience and mindfulness. My father quickly mastered this technique and
continued it for approximately four months. By November 2022, as a result of
Dr. Patankar's ongoing expert care, he was able to completely void urine
normally and discontinued the CIC. The joy on my father’s face, reflecting the
resolution of each problem, was immense. As Paulo Coelho aptly puts it, “And
when you want something, all the universe conspires in helping you to achieve
it.”
It’s crucial forolder adults to exercise caution when entering the bathroom to
avoid accidents, such as slips and falls. Anti-slip mats are essential for
safety. Unfortunately, due to the application of oil on his legs, my father
slipped and fell in the bathroom. Hearing the commotion, my mother rushed from
the kitchen, kicked open the locked bathroom door, and found my father lying on
the floor. With great presence of mind and strength, my mother helped my father
get up and quickly called Manu, who works as a system manager at SBI Navi
Mumbai. Manu promptly took my father to Apollo Hospital in Navi Mumbai. An
X-ray revealed a fracture in his shoulder joint, casting a shadow of despair
over us. The hospital doctor immediately recommended surgery. We consulted Dr.
Sameer, an orthopedic surgeon in Navi Mumbai, who was very courteous. Following
the doctor's advice, surgery was performed at Reliance Hospital, where the
shoulder ball (humeral head) was fixed with an orthopedic plate and screws. To
improve the range of motion, physiotherapy was necessary. After a month of
physiotherapy, my father was able to raise his left arm up to shoulder level.
As I was deeply immersed in the process, reflecting on the difficulties, pain,
tensions, and dark, hopeless days we had endured over the past years, I
suddenly received a call from my mother. Hearing her voice was like witnessing
the sky clear after a storm, bringing a much-needed smile to my face.
By God's grace, myfather is able to convey a powerful message to the younger
generation: "Success is determined by your own confidence and fortitude. A
hero is an ordinary individual who finds the strength to persevere and endure
despite overwhelming obstacles”. He showed that cancer is not the end of life
but a battle, and one must see themselves as a warrior. "Cancer is just
one chapter in your life's book, not the whole story. It is merely a page in
the book of life, not the entire book. Don't lose hope. Even though the sun
sets behind the mountains, it rises again with renewed energy the next day.
Never let your faith in God and your inner confidence waver. Just like the
phoenix rising from the ashes, you must transcend this chapter of cancer and
soar high."
Dr. Manju Kurakar
"GOOD MORNING DOCTOR ""
Prof. John Kurakar
Good Morning Doctor’An autobiography ofProf. John KurakarA -heart
touching
experience of cancer treatment.
CHAPTER 1
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 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 undergoing 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 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 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.
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,
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.
“GOOD MORNING DOCTOR”
Prof. John Kurakar
chapter 2
An autobiography ‘Good Morning
Doctor’
(a heart touching experience of cancer treatment) authored by Prof. John
Kurakar
CHAPTER 2*
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.
"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.
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
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 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..
GOOD MORNING DOCTOR
CHAPTER 3
ARRIVED AT AMRITA
MEDICAL COLLEGE.
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-in-law, 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 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 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 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 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 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 examinations 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 well-educated 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 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.
GOOD MORNING DOCTOR
Prof. John Kurakar
(a heart touching experience of cancer
treatment) authored by Prof. John Kurakar
CHAPTER 4
BEGINNING OF THETREATMENT
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 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 function 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
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 cancer 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 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.
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. 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 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.
GOOD MORNING
DOCTOR
Prof. John Kurakar
(a heart touching experience of cancer
treatment) authored by Prof. John Kurakar
CHAPTER 5
NUCLEAR MEDICINE & THYROID TREATMENT
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
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 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 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 motivation 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.
GOOD MORNING DOCTOR
Prof. John Kurakar
(a heart touching experience of cancer
treatment) authored by Prof. John Kurakar
CHAPTER 6
UNDERGOING A MAJOR SURGERY
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 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 post-surgery 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
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 February 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.
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.
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 undergone 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.
GOOD MORNING
DOCTOR
Prof. John Kurakar
(a heart touching experience of cancer
treatment) authored by Prof. John Kurakar
CHAPTER 7
PLASTIC SURGERY DEPARTMENT TOOK OVER THE TREATMENT
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 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 (Vacuum-Assisted
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 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.
GOOD MORNING DOCTOR
Prof. John Kurakar
(a heart touching experience of cancer
treatment) authored by Prof. John Kurakar
CHAPTER 8
I HAVE BEEN DISCHARGED, STILL UNABLE TO GO HOME
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 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 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 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.
GOOD MORNING DOCTOR
Prof. John Kurakar
(a heart touching experience of cancer
treatment) authored by Prof. John Kurakar
CHAPTER 9
FURTHER TREATMENT IN MUMBAI
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 institute 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 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 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 tablets 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.
GOOD MORNING DOCTOR
Prof. John Kurakar
(a heart touching experience of cancer
treatment) authored by Prof. John Kurakar
CHAPTER 10
TREATMENT IN PUNE
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.
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.
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, 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.
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
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 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
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