Time by Shahzad Shamim (guest writer)

Illustration / Photo-credit: Saniya Kamal
[inspired by Dali's 'persistence of memory']

“How much time do I have?”

Very few fortunate brain tumor patients (such an oxymoron) had the sad opportunity of asking this themselves. Most of the time the question was asked by someone from the family. But the question always came up, so it was by no means unexpected. But much earlier than I expected. Or liked. How I dreaded answering it.

He was 35, tall for his ethnic background but still short for the global average. Brownish, medium weight when I first met him, but much lighter now after all the ‘treatments’ he had received. He was part of the country’s shrinking educated, middle class, an engineer working for a local firm, apparently doing really well. With him used to be his wife, a pretty girl, a few years younger and a mother of two, a boy and girl, neither older than three. The wife hardly ever participated in the discussions. I once met his parents too, but they too did not talk much. He did all the talking. When we first met, in my tiny Neurosurgery clinic a few months ago, he appeared anxious, no… terrified. 

After his surgery, there was obvious relief, perhaps as a consequence of the mistaken assumption that the worst had passed away. Now once again, I see him in a different mood altogether. He was neither anxious, nor afraid. He was tired.

"How much time do I have?”

I knew the answer. I could answer the question, without answering it. Or, I could choose not to answer the question, even when answering it in detail. That is my privilege as a physician.

So, how am I to answer this all-important question? Do I tell him that he has a rapidly enlarging brain tumor, which has recurred despite all forms of ‘advanced’ treatment that decades of research have arrived at? Decades of research worth a billion dollars, which benefited a generation of researchers, students, universities, and of course, numerous drug company workers. But has the research benefited any patients? Only a very few, giving them a few more weeks to live….or a few more weeks to die.

Do I tell him that it should not matter to him anyway because in a few weeks time, he will lose all perception of time, persons, and even reality.

Or do I tell him to go home. Go home and start preparing for the final journey, to a place, which may or may not exist, depending on his belief. Go home and tell his wife that he loves her…that he loved her. And then tell her about all the loans he had to take to afford this treatment hoping that he would one day return it all, but will now have to pass on to his wife. She will need to find an extra job. Her children will have to cancel their plans for vacations, or their desire for one. He lost this gamble and his wife will have to pay for it. But then he knew the stakes were high. His doctor had told him there might be a treatment. Might.

Do I say go home to his little boy and girl, hug and kiss them, before he stops recognizing them. Give them his life’s worth of experience and advice. He has learnt so much in his life and it is all stored in his memories. Now that he will lose his memory, the information has to be transferred elsewhere. And when I do tell him how much time he has left, do I look him in the eye? Or on his forehead just below the scar I gave him for a surgery that now seems unnecessary. Even ridiculous. Such an expensive procedure rendered futile by my colleague in histopathology. But I had ‘scientific evidence’ to support my decision. Not decision… recommendation; perhaps it is the same for this too is my privilege as a physician.

One of the greatest scientific minds ever, Einstein, defined stupidity as, ‘repeating the same actions and somehow expecting different results’.

Einstein should read some of today’s ‘scientific’ papers.

Einstein also advocated that time is relative. I understand this now, for this patient's remaining time just cannot be quantified. Can you compare few weeks of independent, healthy life with a few months of totally dependent, vegetative state? Which one is longer?

"How much time do I have?”

Death is an event, but dying is a process, which starts when I answer this question. When I don’t, the process does not start. I cannot delay death, but I can delay dying.

Time is indeed relative. And I certainly do not have time for this.

I smile at him, and tell him to see the oncologist who sent him to me.

I leave the room.

[from Narrative Medicine]

CREDITS:

About the Author: Dr. Shahzad Shamim is a practicing Neurosurgeon with primary interest in Neuro-Oncology.

About the Reviewer / Editor: Dr. Rija Rehan, AKU MBBS Class of 2015, is a budding psychiatrist. She's also interested in performing arts, astronomy, literature, singing badly and celebrating the many beauties of life. 

Illustration / Photo-credit: Saniya Kamal, AKU MBBS Class of 2018, is curious about life, the universe, and everything in between. She hopes to become a neurologist, pursue art, popularize meta-fiction, conquer the world and stay happy.

Editorial Note: This is from a series collected as part of the Narrative Medicine Workshop at AKU on January 20^th, 2016. The editorial work was performed by The Writers’ Guild, an interest group at AKU, with the purpose to promote love of reflective reading and writing, within and outside of AKU.

DISCLAIMER: Copyright belongs to the author. This blog cannot be held responsible for events bearing overt resemblance to any actual occurrences.