I have wanted to write this article for quite some time. My father was diagnosed with non-Hodgkins lymphoma, stage three, in April 2010, completely out of the blue. I say ‘out of the blue’ because he was 58 at the time and was someone whom we, his family, had always considered very conscious about his health. He was in the habit of getting regular check-ups. We never worried about his health too much except for chastising him about smoking less, eating less relaxants and exercising more.
My interaction with that segment of professionals we call ‘doctors’ started in 2010 because of my father’s illness. I was 24 at the time, a barrister, educated enough to battle his disease with him and be his primary caregiver. During this time, I was in touch with oncologists (cancer doctors) from all over the world but he chose to stay primarily in Pakistan for his treatment which his oncologists assured me was the standard and at his age and health he had an excellent chance of recovering. This was reinforced by all doctors. But my father chose to stay.
Shaukat Khanum Memorial Cancer Hospital is the only cancer institute in Pakistan so we went there. We were told that the hospital was not taking any patients that had my father’s kind of cancer, that this was the board’s decision based on internal factors that they could not reveal and above all, that this decision was irreversible. I was told by the doctors of Shaukat Khanum off the record not to seek treatment from there anyway as they did not have sufficient doctors and as a result we would not be getting the best possible treatment within Pakistan.
I have no doubt that Shaukat Khanum is a good hospital and has cured countless people but I found something about these professionals whom we call ‘doctors’ quite baffling. I was also told by an oncologist there that someone very close to her was suffering from non-Hodgkins lymphoma at the same stage and even though she was at the helm of affairs at Shaukat Khanum, she had chosen to take her relative to London for the treatment. So, she suggested, if we had the means, we should do the same. Her attitude towards me was anything but ‘doctor like’. She glanced me up and down in an insolent manner, taking into account my unkempt appearance at the time: I glanced down to my feet and realised that I was wearing the chappals of one of our maids. I was so distracted with sorting out the hospital logistics that preening for myself did not even cross my mind.
Even after all this time, I continue to recall the rude and uncooperative attitude of the lady ‘doctor’. No matter how professional these people are, no matter how high-up they are in their professions, if they lack humanity and are dictated by prejudices of class in their interaction with their patients, what is the point of them being a doctor? Yes, I could afford treatment abroad. Yes, I would take my father to someone else, but what about those who can’t? I couldn’t for the life of me stop the image of her sneering at them from creeping into my mind again and again.
Later, I did discover that there are some professionals who didn’t have quite the same attitude but sadly, there were too many who do in our country. They might be the best in their fields but isn’t a bit of humanity the very part of their profession? It’s like a charted accountant who degrades your submitted financial record. You can probably shrug that off more easily than a rude doctor.
Moving on, my father started his treatment elsewhere and we practically went to war. When I recall that year of my life, I can only remember how hard we tried. I go back again and again trying to pinpoint the mistakes I made. The things I should’ve done differently. I am sure there are some. During this time I met with numerous doctors routinely and I ignored the attitudes some of them wore or the ‘references’ that most of them required for getting early appointments as a necessary inconvenience because my goal was just to succeed at this battle we were fighting with my father’s cancer. For the privileged in this country, it might not be about money, but ‘references’ are to be had.
Watching my strong father crumble under his heavy dosage of medicines took immense strength which I never knew I had. Nothing in life can prepare you for it unless you face this kind of stress, feel it on your skin.
My father went through eight cycles of chemotherapy during which he collapsed many times, had a variety of side effects such as hallucinations, nausea and constant fever being some of them. We had to extend the intervals between his cycles of chemotherapy so he could recover his strength. To say that life ceased to exist outside his treatment, doctors and medication would not be an exaggeration at all. My goal was simply that he should survive the cancer and eliminate it and that’s all I strove for.
After eight cycles of chemo, his PET-scan showed that the cancer was still there and his oncologist simply said that the only other option was stem cell transplant which, within Pakistan, was only possible at a renowned hospital in Karachi. When my brother and I met with the head of oncology there, I nearly fainted when he said that my father should just have had six cycles and not eight and that the cancer should have gone within that period ‘IF’ it was still there. If? If? Didn’t the PET-scan show it as it being there? Upon this he said and I quote “Well the PET scan can be falsely positive due to a number of factors and the doctors here are not trained to read it. Here, we just do a CT.”
I wanted to believe that my father’s disease was not there. All I wanted to do at that time was take my father away from this country to a place where doctors would be ‘trained to read everything’. We immediately flew to Singapore where my father’s best friend had been treated for the same type of cancer.
To cut the very long story of my father’s very short life even shorter my battle with his cancer continued till 2013 in a variety of places. My father passed away in Lahore suddenly when we all, including the doctors, thought he had pneumonia but actually the cancer had spread to his whole body. I don’t know if I messed up in caring for him. He trusted me with his life after all. That kind of trust is impossible to return.
I am continued to be plagued by the ‘professionalism’ of people we call doctors. I know that If I had to do it all over again I would not have stayed in Pakistan for any part of his treatment.
Published in The Express Tribune, September 1st, 2014.
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COMMENTS (78)
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@ Abu Musa, remember to say that to the next doctor's face when you or any of your family member is ill. You think you can make comparisons with someone with little formal education and training. Your mindset shows that you are closer to the mechanic in terms of what you want to say and hear.
Not taking anything away from the sad loss of the author's father, I think the doctors are unfairly being targeted. You put too much expectations from an overburdened health system where doctors are overworked, underpaid with a lack of service structure and political victimization. Yet you expect standards comparable to the west where doctors working hours are limited to ensure a fresh mind every morning, overtime is compensated, professional development is facilitated and doctors well paid for their efforts. I worked in a western emergency room and have seen patients sitting in a waiting room for up to six hours without a whimper for their turn. If this was Pakistan, even waiting six minutes to be seen would mean bringing the whole neighbourhood and family to the emergency department to beat up the doctor, break the glass and put fire to the ward. It's the sham the way you treat your doctors that the better ones are leaving the country and you're left with what you get.
For them patient is another customer. They treat human beings just as mechanic treats automobiles.
please read my comments above@A. Khan:
I would like to hear what SKMH has to say about this case.
@AW: Ah... the penny drops. Shame about the timing. I certainly hope that the author's motive was genuine and not driven by any ulterior motive. Although SKMH has been started by Imran Khan, lets not confuse the good that it does for Pakistani public with his political career.
Very true!!!! I am passing through the times you already gone through Mahrukh-it requires Hercullian courage to face one's parents terminal illness. I request all of you if you can tell me about a fine thoracic surgeon who can resect the pulmonary metastatis of Renal Cell Carcinoma of my Mom-one year back nephrectomy has been done. She has bilateral multiple nodes in lungs otherwise she is asymptomatatic and healthy. Please every one,I am clueless after I got the answer from Pakistani Drs.
Thank you for sharing your story. I salute your courage and am sure that your father must have been very proud to have a daughter like you. I can empathize because I have been exactly in the same situation as you were. My father was diagnosed with inoperable cancer and despite being in Canada, there were some issues that forced us to air lift him to US. I know the first 6 months of his treatment and seeing him slip was the most stressful thing I have had to go through. And I am a physician. From getting a prognosis that his life is no more than 6 months, to post op complications, we faced it all. All I can say that Allah has been kind and dad is still with us after 1.5 years and on the mend for now. We were lucky to get excellent care upon our return to Canada. Suffice it to say, cancer takes it's toll, on the whole family and I can not imagine what you must be going through. My prayers for your father, you and your family. Please remember, you are brave and strong and a wonderful human being to have fought so hard for your father.
I am a medical student and the way you depicted everything seems to be very close to reality which we see everyday. It is no wonder as medical profession is also a part of declining Pakistani society. Unfortunately most of our professionals are serving abroad. It's also true that now there is lack of humanity and ethics in this profession. Most of people are attracted to it only because of money it pays, so making everything a money-making machine definitely leave no ethics.
Mahrukh,
First let me wish that you find all the strength to face this situation, and may your father's soul rest in peace. Your dad got pneumonia due to weakened immune system that happens due to many reasons, including chemo treatment and lymphoma.
I am a cancer survivor, was diagnosed with a rare form of blood malignancy. Fortunately, I had been living close to Stanford University with the world renowned medical facility. Doctors diagnosed it at a very early stage, when I had complained of sleeping problem, possibly due to international travel I was doing. Primary care physician was the critical person. Something reading your story, it was not the case. Possibly because many primary care physicians there push pills or mixture to take, which is probably right for 99.99% of the time. However, for those .001% where the problem can be serious, primary care at least in New Delhi is totally absent, even including renowned hospitals.
My primary care physician immediately arranged the appointment with hematology and bone marrow transplant clinic. Next morning I was seen by a battery of specialists, and was surprised to hear the words that they can cure me. The would do the stem cell transplant given the number of siblings I have in India, they were confident that at least one will be a matched donor. Two of my sisters matched, one came over to donate the stem cells and a journey after the transplant began. And now it is over 14 years long journey already.
I am surprised why the specialist did not recommend stem-cell transplant at the first diagnosis.
Cancer is a family disease, as they used to remind me during the treatment period here at Stanford. You and your brother did everything. You rightfully trusted the doctors who turned out to be, I hate to say, incompetent or uninformed of all the options. Please do not blame yourself, your dad would not have wanted you to blame yourself either.
With all my sympathies.
I read with empathy and sympathy all the stories told---mostly sad but let us consider Mahrukh. This young lady has touched a nerve in us and thus the reactions. Mahrukh displays four reactions---mostly unsaid but they are there all the same!
1) Psychological Pain. The sudden reaction of a loving daughter seeing her father being diagnosed with a deadly disease which was correctly diagnosed and staged.
2) Financial pain. For my daddy i will do anything. If Lahore is not good enough, let us go to Karachi and further on to Singapore and back.She sails between hope and despair and meets doctors of all shades. She herself appears to live in denial. Her daddy is going to be OK!
3) Pains of existence. I will sacrifice my professional obligation for my father. She could not have worked much over three years her daddy was sick.
4) Spirtual pains. In her darkest moments she must have got angry with God. Why my daddy?
I am sure when the end came she faced the situation with dignity and poise worthy of a loving daughter. How much her father loved her one can only guess but i for one would like to say her father was blessed. Thank you Marukh for sharing your experience with us. I am proud of you.
I have history of same disease(age (45), i was diagnosed NHL at stage 4 in 2009 and took six cycles of R-CHOP and got complete remission on bone marrow biopsy, cancer relapsed in 2011. I took six cycles of 6 cycles second line chemo-FCR followed by quarterly mabthera-rituximab 700mg maintenance for 2 years.
In 2011 a doctor in shifa advised 8 cycles but i spoke to a relative in USA and he advised not to take 8 as protocol is 6. Thank god it saved as 8 cycles would have damaged my bone marrow for life.
It is always good to double and take two doctors opinion before starting cancer treatment.
I must say that I am also among the highly mismanaged NHL Case
I apologize on behalf of our profession but when i joined medical school half of my class mates did not even deserve to sit there . Imagine these guys in all the hospitals across pakistan . PMDC is toothless and there is no fairness in our society in general and among our colleagues there is no accountability . Therefore i left pakistan and working overseas .
Can you please forward your email address please @careful reader:
Dear Mahrukh, I am sorry to hear your story.Let me give you a different perspective of treatment in Pakistan! I am myself a medical doctor and practicing medicine abroad for the last 17 years.My brother, who would be 2 years younger than me , in his 40s was diagnosed with NHL, 3 years ago. we had the option to bring him abroad for treatment! however being aware of good reputition of Shoukat Khanum hospital, I directed him their way,where he was received, greeted fully diagonsed and treated with respect and dignity. My brother with stroke of luck is completely cured and free of disease and has many follow ups again in SKMH since! I can not thank them enough and i must add, they did not chrage anything for his teatment and it was completely free. As you are aware SKMH is a charity based hopsital and have limited capacity, they can not provide treatment to all referred patinets, not only because of finanacial constrains but because of pure logistics of it!! as it is the only proper cancer hospital for 180 million people, which is rediculous in this day and age!! but then its Pakistan, where Governments are run by Crooks and Mafias, who have no interest of common people in mind! As for as I am aware,SKMH has a cut off age criteria for treatment and I believe it is 50! I can understand why they have that criteria, as they have to limit the number of poepole, thay can treat, they simply can not provide treatment to every patient that is reffered to them, which should be understandable!! I agree, there is no othet place in Pakistan for standard cancer care, including Agha khan in Karachi! I also agree that Doctors in Paskistan do not have training how to communicate with patinets and relatives in distress!! they lack common basic training in that area!!I suppose it reflects the society in General, where humans are not being treated with dignity that they deserve. I hope you will bring your sad experience to help people in need and in such sitiuation, that would be a great tribute to your late father and may his soul rest in peace. NB. there is nothing wrong in wearing your maid's shoes! i am surprised you eevn mentioned that! My own opinion is that there should be no personal servents at homes as I consider it a form of slavery, one should do every thing with their own hands!! there is no personal servents in any civilised western world despite the wealth!! Dr Saif Khan
It is sad to hear that your father lost a battle with an already known very aggressive cancer that hardly spares anyone. I am a doctor but I left Pakistan at a very senior post because our being subjects of the health departments meant an everlasting struggle to cement our places against a greedy buereaucracy where any clerk had the means to put you up for transfer to the remotest part of the country without any regards for your own circumstances. In the end it meant huge amounts of money changing hands along with some political backing.
I assure you that our doctors are one of the best I've seen abroad. Only if they would have been left to concentrate on their profession instead of daily trips to the secretariat, will we see a better standard of care and time for their patients.
Drag the doctors to the court; after all you are a lawyer. On a side note. Smoking kills.
I admire your fortitude. Non-Hodgkin's Lymphoma is difficult to treat and needs a combination of chemotherapy, monoclonal antibodies, immunotherapy, radiation, and stem cell transplant. The basic issue is competence; the attitude of the doctors, hospitals is its manifestation. No doctor/hospital would ever admit that they lack the competence/capacity to interpret the scans, PET, CT, MRI etc. They don't have the heart to. So what if the patient dies a miserable death? This problem is there in the West too. But the incidence is far lesser. Common phenomenon in the subcontinent.
@Sunil: Is there any truth to the gossip that cure for Cancer is already found but is not being released ...because the present trying to cure medicines are so profitable ..?
Firstly, i'm sorry for your loss. Secondly, i'm wondering why you've chosen this particular time to speak out against Shaukat Khanum Hospital. Your sister, Maiza Hameed is an a PML (N) MPA who is on TV every day. You belong to a family that has always had a strong political background. I can understand what a harrowing ordeal it was for you & your family but i'm questioning the timing of the publication of your article.
I dont know who told that SKMCH is the only Hospital wqho treat cancer. There are ,to my knowledge at 8-9 Hospital In Pakistan which give treatment of cancer and have very competent Oncologist Doctor.These are
SIUT Karachi Shifa International Hospital, Islamabad Agha Khan University Hospital , Karachi ziauddin Oncologt Centre Karachi Kiran Hospital Karachi Atomic energy ONCOLOGY centre , JPMC, Karachi
There are more Atomic Energy centre in the country who give the treatment of Cancer.
Don't think about what you could have done or not. Cancer is a terrible illness, my grandfather was diagnosed with cancer and he went to one of the best hospitals in the United States. His cancer went into remission and he was finally 'cured'. But the quality of life was never the same and he passed away after a few years. He was never the same after his ordeal, and suffered a lot even after beating cancer.
Allah does not but a burden on you more than you have the strength to bear. He's in a better place without pain and that's what matters :)
@Sunil: a very thoughtful post.
@Author: my deepest condolence to ou and your family for your loss You did your best and you need to wipe the guilt off. While the Doctors should have shown empathy, I doubt you would have felt much better if the final result ended up being what it was.
@R.Subramanian: Wish you all the best. I know ow stressful it is when a parent is fighting he battle fore their life. My mother had uterian cancer in 1995 and by grace of God she is still with us but I remember at the time how stressed out we all were.
I will try to reduce your feeling of a perceived guilt. With time, we are becoming immune to medicine and treatments etc. That itself is very dangerous indeed. And diseases are mutating without our knowledge. You did everything you could. I am sure if your father could meet you again, he would tell you the same. You can adopt a healthy lifestyle, donate in his name to cancer patients, and find solace in your religion. But i guess you are already doing that, and much more. Just one thing. If you can edit your article, please clarify that you are objecting at conduct of one individual doctor in SKMH, and not the whole institution.
Doctors or lawyers, bad apples exist everywhere and the commoners pay the price for the shambles of the systems (justice or healthcare).
I think you should name those doctors so that they can be held accountable.
I have also been "treated' by renowned orthopaedic surgeons very "professionally" and was on the verge of getting amputated but thanks to Allah I discontinued their consultations and went to AKU and got well.
People beware of these "highly qualified" orthopaedic surgeons 1). Dr. Gen naseem ul majeed 2). Dr. Aslam
Mahrukh , I will be very interested in knowing how you feel when the PTI chief keeps bringing his. "Ideal" hospital in his speeches and how that is a "model" of doing things correctly ..?
Due to the polluted and contaminated environment I fear that Pakistan is on the cusp of a cancer epidemic.
It is sad to read here, one of the many cases. And it is true the doctors are all after money (-most of them. My close relative had an operation to ease urinating but due to medicines he lost the memory and is now bedridden since many months.,
My heart felt sympathies to the writer for her suffering and condolences for loss of her father. A lot of valuable and objective comments have been made by some of the commentators, which should be helpful to people in similar predicamtent. Another aspect of management (education) of disease that has not been touched, is also very important. Prevention of a disease is the key to its suffering. This is a life long struggle which starts even before we are born. ( not that we can do very much about that). The points that I would like to focus on are: impact of environment and our personal responsibility to our health. The environmental control , eg pollution: ie air, water, food, chemical and communicable disease are responsibily of the government. (Yes these also sow the seeds of cancer) The most benefit we can get with our health is, if we take personal responsibility of it. The author correctly pointed her advise to her father, not to smoke, and exercise regularly and control weight, which if followed by her father,could have reduced the risk of the cancer.
Finally, personal education about scientific principles of health is every bodies responsibilty. It is not good enough for me to delude myself that I am healthy if nothing hurts, Or that it will not happen to me. Remember disease (even Cancer: starts tens or even twenties of years before it starts hurting, then it is too late to fight it effectively)
@A. Khan: I thank you for your reply and would like to wish you and your father all the best. He survived a deadly disease and long may he live. Please do not misunderstand me---i expressed surprise and not criticisim. Indeed i have visited SKMH many years ago (i beleive it had just been bombed). I was impressed in every way possible. I know the history of the hospital very well and the trials and tribulations of Imran. You may be surprised to know on landing in Lahore my taxi driver did not know where the hospital was but when i mentioned Imran,s hospital he retorted by asking why i had not mentioned that first. Such is the genious of the man. The young lady has lost her father and she is expressing her anguish at the turn of events. Surely she deserves to be heard. The very fact she has expressed her feelings is a form of catharsis. I hope i have set the record right.---with kind regards.
I can relate to your father. I am 54 years old with a diagnosis of hodgekins lymphoma. Stage 3 modular sclerosis. I has a relapse of the disease after an initial ABVD treatment.
I was refused treatment in Shaukat Khanum, and went through the exact same experience as you described. Dejavu. Infact my wife and I had donated to the hospital since it was being constructed and I went through the same treatment, although I also went to the top of the hospital administration only to get the rejection of the treatment.
I have daughters your age, and they have been a source of strength and support along with my wife while I get treatment in the US. The fact that we have been together has been the most critical part of my taking on the challenge. While I am lucky to get the best possible treatment, and have been feeling better lately, nothing has been easy. Faith has been the most important aspect in riding out my challenge.
I don't hold anything against either Shaukat Khanum or it's doctors. They are a fine institution. I think my treatment was meant to be elsewhere. Cherish your father and his memory and don't be a hostage in your state of mind due to individuals or institutions. More than ever, be an agent of change in our country. Your article is a first step, take it further. May Allah Talah grant you the strength and fortitude to weather this challenge and make a difference.
well it was best decision taken by SKMCH to refuse to start treatment of your dad as they had no means to treat the kind of cancer your dad had. my cousin diagnosed with the last stage of intestine cancer. he got treated in skmch, couldn't survive but still billlion thanks to skmc.
Any ideas on how to give contact info short of posting my email address without getting spammed? Perhaps I will make a new email address
Sorry to hear about your loss. Cancer is cruel. A friend's father died of it. They sold everything but could not save him. A cousin died of breast cancer. She had similar story. She died before her last chemo session. Another family friend's son in law is suffering from it. A colleague's father is on the last leg. I have seen so many failures in the treatment that I have lost the faith in its treatment.
Oh! There are so many things going on in the article and in the comments that it is a challenge to address them all. I am going to pick on a subset of things -
First, there is no denying the pain and suffering you all went through, but it was almost inevitable. The doctors could have (by their behavior) made you feel better but not by much. Your primary sorrow was a suffering loved one. It will do well for you to remember however that you were approaching the doctors for their competence in science rather than counsel for grief. So, when times are tough, and truth is told, absorbing it is very difficult. And we shoot the messenger. But, if I were in your shoes, I'd rather be told truth by my doctor than be placated. I wonder if their blunt truth telling made you feel worse.
Second, no two cancers are alike, no two treatments are alike. What we have learned from the decades of dealing with cancer is that every cancer is unique, not only because the cancer is unique but also because the patient is unique. And by this I mean we are unique not merely philosophically and psychologically but also biologically, genetically, immunologic-ally, and molecular-ly. What diseases we have, how treatments work on us, and how we respond to them is different from person to person. And what is more, it is not known (and may be impossible to know) how we differ from each other.
Third, attitude matters but not much. You adopted an attitude of 'going to war' against cancer. As has been the narrative for over four decades. We are only now beginning to understand how poorly framed is the philosophy. Somehow, the use of going to war gives us a generally false confidence that we can actively do something to get well. It is like an ant deciding to go to war against a bulldozer. Statistically, bulldozer will always win. Occasionally, it might miss the ant who will live to fight another day. Metastasizing cancers like your father's do exactly that they metastasize, they morph, they change their molecular and genetic structures, they find niches where drugs cannot reach, they ... All this might sound creepy, but it is almost as if they are live within your body independent of you. And, we do not yet know enough of them. One of science's best chances for future treatment options for cancer is the human immune system itself, something that we ourselves know so little of. Science is hoping to 'set a thief to catch a thief'. Will it succeed every single time, who knows?
Finally, doctors are people too. Please spare a thought for their emotions. Day after day, patient after patient, death is the most frequent gift they receive for their efforts. More tears have been wiped by your doctors than they care to remember and wish to wipe.
That is the way it goes. In the meanwhile, it makes sense to be less sure of science, and lesser sure of the doctor's capability to deliver us from our suffering. When it comes to cancer, the dice are still loaded against man.
@Dr.M.M. Khan: Please don't go by one person's narrative of SKMH. Everyone has there own experiences. My father was treated there for pancreatic cancer ( whipple procedure if anyone is interested) in 2004. And Alhamdolillah, he is still with us today.
We paid for the treatment as we could afford to, but whilst there, we saw many poor people were being treated for free. Even the accommodation for relatives was arranged.
I am surprised that being a doctor, you have never bothered to visit Pakistan to see the good work being done at SKMH and other hospitals. Don't let your view of SKMH be skewed with one post by an obviously aggrieved person.
Cancer treatment is not an exact science. Not all individuals will respond to treatment the same way. Reading the article and other posts, I would think that people everywhere expect a 100% survival rate. Unfortunately, medical science has not advanced that far yet.
@careful reader: How exactly does one contact you ? You didn't a name or any contact details.
Have you ever wondered why Pakistan is in the doldrums 24/7 ...it is because of people such as that Lady Doctor you encountered at SKH .You did your best and even thought you might think so 24 years old is just a kid ...and for you to have risen to the task is something to be proud of ...Inshallah maybe you will do something for the poor of Pakistan ..who have no one to turn to .
You talk of cancer? I personally know a case where a "renowned", US certified MD mistook a pnemonia spot on the lung as TB and without tests started treatment with a medicine that ultimately caused renal failure. The elderly person was forced to live his rest of the life of hemodialysis because consultants did not clear him for a transplant at SIUT. I lost my father to another renowned, but local consultant that could not differentiate Left Ventricular failure and pnemonia! It was too late when he realized his mistake when the case went to overdrive in the form of ARDS. Your story was a bitter reminder for me too dear
As a part of medical profession, misdiagnosis is far more common than we would like to acknowledge. But having said that why didn't the author attempts to seek litigation if her father was administered 2 extra cycles, which can cause a tremendous amount of damage to the patient as well. Usually MRI are done along with PET, what baffles me is the doctors who happened to be experts ion their respective fields chose to over look this. Cancer is an unpredictable condition, no matter of which type. Yes in Pakistan, and else where patient care is taught but not the soft skills on how to deal with patients. Call me a devils advocate, but why are only doctors to be held at a higher standard, not other professions. It is all about the money in the end. The new breed of doctors being trained in Pakistan also worries about money not much about interaction.
Very sad to know about your big loss. The problem you have presented is very common and is multi dimensional. Doctors is only one dimension. The bigger problem is that in our country health has never been a priority. Even very basic facilities and medications are not there. And the doctors who are well trained leave this country. I hope being part of this profession that we can improve things make it a worth living country. But please the profession has nothing to do with the wrong doing of few people.
Dear Mahrukh, I share your loss and would proudly like to have you as my daughter. You did your best. You are right in almost all your comments. Your late dad had a serious illness and became a health customer in Pakistan. In your desperation to do the best for him you went from post to pillar but could not buy " health". Some diseases are by their nature are deadly but that does not mean that the patients or the relatives should not be treated with dignity esp. in such circumstances. The doctors in Pakistan have a tendency to be patrionising towards each other and in between lines it has happened in your father"s case. I cannot comment on CT and PET scan. I have spent my professional life in Norway(35 years) as a consultant and can speak with a bit of experience. We would have diagnosed your Dads case, staged it and informed him of the treatment options. This would be a consensus decision and not a indvidual one. Of course your dad would have had the right to have a second opinion but hardly in Norway unless the consensus opinion was divided which is hardly ever the case. The family is informed only after the permission from the patient.The patient is followed through out his illness first by the oncology dept, latter on by the palliative dept. and the family is always given counselling---after all they suffer more than the patient. After the inevitable the family is asked for a feedback so that we could do better next time. From beginning to the end the patient is in the centre and we are there for him. Please accept my condolences.
I must say i was surprised to read about Shaukat Khanum's Hospital because when Imran is Norway he compares it to the best in the world!
I have gone through similar trauma in my sister's case.The Doctors have no empathy with the patients and their families.Really sorry state of affairs.May Allah keep everyone away(including our enemies) from these hospitals and Doctors.Be strong and may your father's soul rest in peace. Aameen.
I lost my mother to cancer - i did my very best but realized that when the time has come no doctor can do anything.....
I am so terribly sorry for your loss. Please accept my heartfelt condolences, may his soul rest in peace InshAllah. May you continue to stay strong.
My sincerest condalences for your loss. Being a doctor myself, I believe that a professional doctor must show tremendous empathy and understanding of the patient's and their carer's ordeals. So your father and you shuld have had a very indepth education of his illness, treatment options and prognosis. However, each hospital has its policy of intake and admissions, obviously based on its expertise, manpower and capacity to accommodate the presenting patients. As you mantioned yourself, that SKMCH is the only cancer institute in Pakistan. I have no doubt that they must be under tremndous pressure, due to very high demand, and therefore must have their own waiting list and admission policies. So when they refused to treat your father, they must have had their reaons. However, they should have done a better job of explaining the reasons for declining the offering of treatment. What I don't udnerstand is that you have chosen to name the hospital that declined the offering of treatment but have opted to not to take names of the hospitals where your father did receive the sadly unsuccesfull treatment!
May Allah bless his soul.
I can truly understand your feelings about the so called doctors, their attitude, the Chemotherapy, Radiations , Religious Rituals and everything that could be done for saving our loved ones. I know this because I also lost such battle two months back when my only sister diagnosed with the 4th stage metastasis in her Brain after recovering from Breast Cancer (which we were told by the doctors that its curable and in its early stage).
"Nothing in life can prepare you for it unless you face this kind of stress, feel it on your skin."
God Bless Her soul, she died 5th of this August at age of only 34.
Very sorry for your loss but also thankyou for sharing the ups and down of your ordeal in fight aganist cancer and raising the issue of lack of humanity,permeated into our society.
May Allah almighty bless his souls and grant him eternal bliss and peace.
I am an MD and standard of treatment is not that awful as you point out. Yes the medical staff is frequently rude but you should not forget that patients are very unruly in Pakistan. I have seen this kind of cancer treated frequently in Lahore in government hospitals (yes govt hospitals). The success rate for this lymphoma is not 100% even in the US. Some types are so aggressive that no amount of treatment can cause remission. My aunt had cervical cancer and she went to the US/Canada for treatment where her children live. Doctors assured her there that it was 'treatable' but she died during treatment.
Very sorry to hear this. Just across the border India treats thousands of Hoskins cases many from abroad.
It's sad & Hope as a professional person you wont treat your clients as the lady Doctor did, Divine truth is that your father was given that much time in the world GOD bless you
I have a very strong heart and still I had teary eyes while reading, Mahrukh i am sure you have earned heaven ,caring ones parents is the greatest good deed , you did your best, May Allah give you best of rewards , InshaAllah amen, I went thru same
I feel so sad for your loss. May his soul rest in peace, ameen.
I have a similar story and if anyone can give any type of useful advise it would be extremely helpful. Basically we're from Punjab and my grandmother who is in her early 60s has been diagnosed with acute leaukemia. As you know this spreads fast. Firstly she was just unwell so we took her to a normal hospital, who revealed about the cancer and said it has spread roughly 50% in her body and needs to be treated quick. Shaukat Khanum rejected us, and there is no other cancer hospital except private institutions. Out of desperation although we can't afford it AT ALL, we went to one in Lahore however they also rejected us saying she's old, or its not going to work. Are doctors not meant to treat you regardless & try and save your life? A family member in the UK same age had got cancer twice and treated and became better and in Pakistan...we are being rejected and told treatment is useless...wonder why this country is like this, instead of helping us doctors are making it much worse! We cry and pray to Allah everyday as we are loosing hope. Please do dua for her. We only have prayers left & belief in Allah that she will be cured, In'sh Allah.
Sad to hear about your father's death, but whatever mentioned about Shaukat Khanum hospital is totally wrong and baseless. My wife also had same kind of cancer and she also tried to get trestment in SKMH but was politely refued as they mentioned that this kind of cancer is onsidered a very low level cancer and could be treated anywhere in pakistan, and they have so many patients in waitlisting that they cannot give a date for the next 6 months. Anyways, my wife passed away after one year due a sudden spread of cancer in the whole body. But there was no falt of SKMH.
I want to provide this link http://www.chakru.com/narsipura-subbaiah-narayana-murthy-free-cancer-treatment/ so that it will be helpful for somebody who is trying alternate treatment for Cancer. After speaking with several people I came to know Ayurvedic and Siddha medicines are giving good result cancer treatment.
sad to read,materialism is at its peak.
At present my mother is having Cancer, I took my mother to Madras Cancer Institutein Adyar. Chennai, they said they can't do anything now, the cancer has spread everywhere (including liver and kidney)... as a last hope I am giving Ayurvedic treatment for my mother. Now my mother has taken the medicine for the past 4 days, the pain and cough has reduced alot.. And also I am planning to take my mother to another cancer doctor in Chennai tomorrow. Praying God to save my mother.
Hi, Please no way feel that you didn't do enough. You were blessed with looking after your sick father, which is so rewarding. Why some people survive cancer and others don't, it is part of Allah's master plan. I myself was in Pak visiting when I was diagnosed with breast cancer, and I had the option of returning to Canada as that was where I was born raised, but I chose to remain in Lahore and have my surgery and treatment. Personally I would not recommend chemo upon my own enemy, it is a cocktail of heavy industrial strength metals which are cardiotoxic. I did not complete my entire chemo treatment in Lahore, even though the doctor insisted. Even today 6 years later, I do not take the medication prescribed by my oncologist, because if something only makes me feel worse why take it. I must say that the doctors in Lahore who completed my treatment were the best. They are so much more knowledgeable as compared to doctors in Canada. In Canada, they spend 2 seconds with you and you're out the door, because they need to bill the govt and the more patients they can see the more they can bill. Personally I would go to India or China rather than the West for something that could not be treated in Pak.
Same story but the difference was that I got only 29 days in this cancer battlefield and after that I lost my whole world. Sometime I think my father realise that I was weak, young and alone boy who should be playing in a play ground rather then running on the floors of hospitals, so that why he let it go.
I am an American medical graduate and a Oncologist/Hematologist having done my training at a premier American cancer center and university. I am an American board certified practicing clinician. To help people like yourself who were in a tough situation not knowing what the ideal cancer treatment would be, I have in the past reviewed medical records and reports from family members of friends or others who needed help. If you are interested in starting some sort of organization where free advice is given to cancer patients in Pakistan as a public service either to the patient or patient's family or an oncologist in Pakistan, then please contact me. My time is limited but the intention to help other Pakistanis is sincere.
Really sad story. But I must say that the daughter tried everything she could to help her father. She should not blame herself for anything. In a country like Pakistan, it's very hard to trust doctors as they don't accept their in-competencies. May God grant your father high status in the Heavens. Amen
For heaven's sake, why didn't you think of coming across the border to India ? There are at least 2 dozen hospitals here that routinely treat Hodkin's with a rate of success comparable to the best hospitals in the world. Costs would have been lower than in Pakistan. There were several hospitals that did stem cell transps in Bangalore alone, the city where I trained. And it was 2010 - CAT and PET scans ? Did nobody think of doing an MRI ?
@Author: Knew three people personally with exactly the same ailment: Non-Hodgkins Lymphoma. One, a Saudi national who had treatment at Northwestern Hospital in Chicago, did not survive. Another, a Pakistani who had treatment in London at the Royal Marsden Hospital, did not survive. Also, please note that King Hussein of Jordan had non-Hodgkins lymphoma and had treatment at the Mayo Hospital in Rochester, Minnesota and didn't make it. He was just couple of years older than your dad at the time of his passing away. Strange are the ways of Providence that we humans cannot always reckon with certainty. That the Pakistani doctors, just as our society in general, need to be more compassionate in attitude and understanding, is a given and one cannot argue with it. My sympathies and condolences to you.
I empathize with your predicament. The hubris and arrogance of haughty doctors is deplorable. I have told my students that in deference to their grades, the most important criteria for entering medical should be if they have been touched by the milk of kindness or not.
Ahmed
I am really surprised at the standard of cancer treatment in Pakistan. One of my very close relative was diagonised with non Hodgkins lymphoma 3/4 stage in 2011. She had nine cycles of kimo and then radio therapy. Why no radio therapy was not advised in your father's case? Two biopsies were taken one at the beginning and one after nine cycles of kimo.
Let me assure you, as far as cancer goes, it the blind leading the blind. Even biopsies are not very conclusive. Regards.
I can understand frustration the author felt about her father's cancer. My wife too suffered from the same type of cancer which is quite aggresive and usually the patient passes away in 3-5 years. It is very difficult to look at a person who is deteriorating fast and the the person is gone you wonder if all that could have been done was done. In our case the doctors were very competent but I am not sure if the doctors today could be so. All I can say to the author that you were a very good daughter and you and your brother took good care of him so do not fret. God bless you and your family
Very sad and sorry to read this.
Please do not torture yourself.
You did your best. I am sure your father knows this.
I am sorry for your loss.
I wish we could fix pakistan!
I feel sad for your loss. I have been through the same kind of ordeal with my mother who had late stage ovarian cancer. she made it to the best possible prognosis u get anywhere in the world for that stage of disease. The doctors helped us loads and we got her best we could afford in karachi. Its just that sometimes we, the families, are not lucky like this case of my mom. I am a scientist and i work on cancer studies myself. If your father was smoking heavily, was not excercising enough and was on relaxants, these are all danger signs anyway. There is a chance you made mistakes. But dont be too hard on yourself bcoz you did try your best. You will come out of this guilt phase one day and will look back with satisfaction on the quality time you and your father spent together, rather than what you could have done differently. As for the incompetent doctors at Shaukat Khanam or elsewhere, i think even in that too, you did what you thought best at that time. ThEre are good and bad people everywhere. My experience in karachi was very good overall. May your father rests in peace.
This is really weird. My mother suffered from fourth stage non-Hodgkin's lymphoma too. She was diagnosed in 2010 as well and she got her entire treatment for it done from Shaukat Khanum. She is doing very well now as can be expected from all recovering cancer patients.
Dear sister,
My deepest sympathies for your loss. My elder brother was diagnosed with brain cancer (glioblastoma) on January 2nd, 2009. He passed away on June 27, 2009 in Ottawa, Canada.
He was "treated" at the Cancer Centre that is associated with the Ottawa Hospital. He died early because one of the doctors administered excessive levels of radiation, due to which, his brain was damaged. All they did was simply apologized for their mistake.
There are doctors here in Canada that have similar unethical practices as anywhere else in the world, including Pakistan.
When ethics simply become rules, rather than the character of an individual, be they doctors or experts in any other profession, arrogance and narcissism then forms their character.
Following rules 7/24 produces a rigid personality that has no emotional connectedness to the external world. In other words, they lack "practical wisdom." This is where lies the problem.
Khalid Jan Ottawa, Canada Researcher in health and ethics
Same story of chemotherapy with my aunty, even she asked doctor if you do this i will die. ( breast cancer) We made decision and take her to india where they says you don't need chemotherapy and they took some procedures, now she in a very good health thanks Almighty he guided us good.
Mahrukh - you did whatever you can do, and your father should be proud with you and your family.
Agrees, when patients becomes customer.
I am sorry for your father's loss and for the difficulties you had to face as his primary care giver. As a specialist physician in the US, I can only apologize on behalf of the docs in PK who show no empathy or compassion towards their patients. The class consciousness that permeates throughout Pakistani society has unfortunately also found its way in the medical profession. Of course there are many structural issues that have to be addressed such as availability of technology and medicines, the knowledge, skill, and expertise to use it by healthcare providers, comprehensive reform of the way all of it is financed and delivered, to name just a few. But that having been said, physicians everywhere should remember the Hippocratic Oath that they take and treat their patients with the dignity and compassion that they deserve.
You did not mess up in caring for him. You did your very best. You should be proud for what you did for him, and I am sure he would be, more than you can imagine.
Sorry to hear about your loss, and perhaps you can use your experience to someone help others going through the same experience? This article is a great start... what comes next?
"Watching my strong father crumble under his heavy dosage of medicines took immense strength which I never knew I had. Nothing in life can prepare you for it unless you face this kind of stress, feel it on your skin."
I feel you there. The wounds from the pain of having seen a loved one go through the treatment of Cancer are still raw and they hurt every time I hear of someone fighting the same battle. There is no reality bitter than the one that for every cancer patient, if they have the means they would rather not get treated in Pakistan. I hope this was not true. I wish our loved ones could be with their friends and family, while going through a treatment which makes you feel worse before it can make you feel any better. and more than anything else, I just wish Cancer never existed. I wish you strength and peace every day and I wish your father is in a better place and free of all pain now. God bless.
What a harrowing tale ! God gave you the fortitude and perseverance to see this through.