Amirtha Mohan (1951-2016)

Chapter 1 - An obit for Amma 

Oct 3 2016

Our vehicle motored on to  Brindavan Street, minutes after we started from our Kodambakkam flat, with me beside the driver and my parents in the rear. This was a familiar experience over the last few weeks, from the time my mother was diagnosed with Stage-4 endometrial cancer and we moved to Kodambakkam to be closer to the city hospital, to which we needed to travel regularly for treatment. This journey was familiar, except for the fact that this time the vehicle was a hearse, the destination was the crematorium, I carried a pot full of smoke, and my mother was on a bier.

Yes, a bier - over which the person who had brought me up for over two decades was lying lifeless. Hours earlier the soul had left the mortal coil. After bossing over numerous vital organs for three months and yet being deterred and held back by the counter-punches of modern medicine, the tumour finally invaded the alveoli in the lungs. There was a finality about this invasion as the doctor gave up feeding chemo bottles to mom's already frail body, and instead advised us to embrace the might of nature. After five unconscious days on oxygen support and strong doses of morphine to kill pain, my mother finally decided to give up her ghost on a Monday morning. The end was barely noticeable - given her heavy breathing in the last days, I made a mental note of the fallen decibel levels during my sleep in the wee hours of the morning. When I finally woke up at 6:40, there was a deafening silence in the room to confirm the painful truth. Quite akin to a chugging train grinding smoothly to a halt at the last station.

At Rameshwaram temple in 2012, in the city of her birth. Great reminiscence for mom, returning after 35 years.

Any modicum of truth regarding my mom would still sound an exaggeration - stuff which obituaries are made of. She was not a leader or a reformer, and did nothing extraordinary in her life. Yet, in a society where there is a clear demarcation between 'housewives' and 'working women', she was someone who excelled in both roles concurrently for decades. Her 8 AM - 3 PM college job enabled her to be at work when I was at school, and don the hat of a housewife once I was back. Of course, that she pulled this off for years is also thanks in no small measure to Dad, who partook in household activities dutifully. Her 35-year old teaching career, cheerful family life, and materialistic successes point to fulfillment and completion in life. What did not materialise though, was her wish to see and play with her grandchildren.

She was extremely knowledgeable about Tamil and English literature, regularly whipping up quotes from memory to befit the situation. Unfortunately I was not good enough to latch on to her Julius Caesar quote which she mentioned on being diagnosed with cancer and pulmonary embolism. She continued to read The Hindu and help me solve the MetroPlus crossword till a month before her passing, when a tumour-induced stroke robbed her of clear vision and interrupted blood flow to her brain.

Three years back, she casually asked me one day - "Naanga ellam pona aprom engala nenachu paapiya? (Will you think about us after we are gone?)". This was out of the blue, and I do not remember how I tackled the question. Quite possibly I dismissed it - given her robust health, and her family history where almost no one yields before 80, I had always envisaged me taking care of her as an old grand-mom with a frail frame. Sadly that was not to be, and all I could afford as a quid pro quo for her lifetime service to me was three months of helping her cope with cancer. In her Obit ad on The Hindu, I promised to carry her legacy forward to the generations to come.

An asymmetry in the relationship between parents and children is the rule of nature. Children are the raison d'être of a parent's life; however when the former grow up, it is exceedingly difficult for them to prioritize parents over their professional careers and the welfare of themselves and the succeeding generation. Any opportunity to serve parents, to create fond memories, and to keep them happy must be cherished.

Chapter 2 - A struggle unto nowhere

Mom has touched the lives of many relatives, colleagues and students over her lifetime. It is my desire that some value be created out of her failed battle against cancer, by documenting her struggle. Of course, this is going to get lost in the huge deluge that is the Internet, yet I write this in the hope that patients with similar history and symptoms are benefited somehow.

Where it all began...

My mom had abnormal vaginal bleeding in August 2015 - the month I got married. A biopsy detected a 'benign endometrial polyp'. A gynaecologist observed her and suggested removal of the uterus and the ovaries (hysterectomy), and warned about the possibility of cancer failing to do so. Downplaying the risk of cancer and to ensure unhindered participation in the wedding celebrations, she chose to postpone operation by two months. The operation eventually took place on 15th October 2015, and she was discharged from the hospital after five days. There was no cancer in the removed organ, so we believed we had successfully cured the cancer through early treatment. The next few months passed without incident; however in March 2016, mom started to have a 'vomitting sensation'. This was basically a huge noise of her trying to vomit, but no contents were spewed. This did not affect her appetite in anyway, or for that matter, anything else in her daily lifestyle.

We consulted general practitioners, gastro-enterologists and cardiologists. All tests came out to be normal, and doctors erred by mistaking the sensation for an usual stomach upset. Three months went by, and mom slowly started to have other complications, in particular, serious breathlessness and exhaustion. Finally a GP referred us to an oncologist, Dr Ayyappan, who hurriedly admitted her in Apollo Speciality Hospital, Teynampet, and subsequently confirmed the cancer with biopsy. My mom had stage-4 cancer, which had metastasized from her endometrium (lining of uterus), to the peritoneum, omentum, and multiple lymph nodes. Organs like the liver, kidney and pancreas were fine, but there were  dangerous pulmonary emboli - clots blocking blood flow to her heart and causing breathlessness. When queried about the outlook, the doctor said she could die anytime due to a large embolus, and if at all she survived that threat, she would die of cancer in a year or so.

Our doctor, Dr. SG Ramanan, suggested chemotherapy. This meant injecting bottles of medicine into her veins once in three weeks. Besides, anticoagulants were given to inhibit abnormal clotting. I ensured mom got adequate exercise by walking regularly on the terrace. The condition of her heart greatly improved over the next two weeks, and we successfully thwarted the threat of embolism (didn't recur till her end). However, five weeks later, on a Sunday morning, suddenly I found her slightly uncoordinated in her walk. Her steps were out of balance, and her eyes were not looking alright. Another hospitalization ensued, and she was diagnosed with acute stroke in the occipital lobe, and many infarcts (dead tissues) due to lack of adequate blood. How did she develop a stroke and new clots in spite of being on anticoagulants? The doctors did not know.

The final days

A week later, it was time to go for a PET-CT scan to gauge the impact of the three chemo doses. Great fear and anticipation, as you'd expect. All came to zilch, as the doctor broke to us the sad news that the chemo was not working and the tumour was progressing faster. Especially, lung complications arose, and her alveoli started to shrink. In the following days, her body became very frail. One day, she lost her balance and fell while trying to sit on a chair. There was hardly any reaction from her. She kept looking around without feeling the pain of the fall. The fall was so smooth and painless like the glide of a thermocol sheet. I was pained at the depths to which my cheerful and kind mother's health had plummeted.

The lung complications grew, and she found it difficult to draw her breath. Phlegm clouded her lungs, which she had to spit every ten minutes in order to breathe. Her last hospitalization happened; we consented that the docs should not take her to the ICU or put her on ventilator support, as this would trouble her body further, yet not provide any lasting cure. With no hope of a recovery, I requested the doctor to ensure she was on adequate morphine - a painkiller - so that she dies without pain. Slowly, the phlegm started to diminish her lung capacity; the lack of blood supply ensured she lost her consciousness, her skin started to form black patches, and finally the heart stopped beating on a Monday morning.

In summary, 65 years of life, a few months of hardship, a painless final week, and a seamless departure.

Appendix: Cancer - where questions galore

What is cancer? A group of abnormally growing cells in the body. Cancer is an umbrella term used to refer to many diseases. That is, there are substantial differences in the medical prognosis and treatment based on where in the body the abnormal cells are present. In no particular order, I list some of my queries and understanding on these mysterious diseases.

1. It is widely touted that cancer is curable if detected early. However despite detection and surgery at a non-cancerous stage, mom died less than a year post-surgery. How did the 'uterus' cancer return with a vengeance, to someone with no uterus? Shit happens, docs say.

2. Do not blindly trust a biopsy result. Serious mishaps happen. Sometimes a biopsy may be done on one tissue which is perfectly normal, while there are other cancerous tissues in the same organ. At others, the same biopsy may be interpreted differently by two different pathologists, and their skill and experience is key. Never hesitate to go for a second biopsy/opinion, or to have a word with the pathologist. The pathologist's decision more or less decides the line of treatment, but his/her role is often downplayed or ignored by the patient's family.

3. During my stay at Apollo Hospitals, I had a chance to attend a talk by Dr. MA Raja. No amount of regular screening can keep you away from cancer, I learnt. Except for cervical cancer, which can be detected using Pap smear tests and cured completely - this nasty cancer strikes women between 30 and 50. Yet even otherwise knowledgeable people do not opt for this test believing they would not be affected.

4. An irritatingly repetitive plug: 'Smoking causes cancer.' That's not precise; smoking only increases the risk of getting cancer. Only one-fifth of all cancer cases are attributed to smoking. Whether even this is a 'cause' in the true sense of the word, or a convenient excuse for the doctors, is anyone's guess.

5. A cancer ward is definitely a disgusting place to spend time. I happened to read a discharge summary where a 38-year old was diagnosed with advanced colon cancer, after complaining for three weeks of abdominal pain and "altered stool behaviour". Oops, that must ring a chord for many of us. The "butterflies in the stomach" have a whole new meaning now.

What wrong did those babies commit to be subjected to chemo treatment at that age? What about that schoolgirl, who developed a cancerous lump on her chin from nowhere?  Or the other teen who felt sickly and weak often enough to trigger a doctor's earnest suspicions and an early diagnosis? It's saddening that clarity on such and many other questions elude the best in this field.