'LOCKED-DOWN'- to become incurable!

'LOCKED-DOWN'- to become incurable!

It is not seldom that I see children coming from far flung places with tummy protruding with huge mass, large disfiguring neck swelling or ghastly propping eyeballs due to cancer. With a lone state government cancer hospital and alone single faculty in medical oncology , we have been assigned to cater a population of twelve crore in one of the poorest Indian State, Bihar. Here such extreme presentations are common, unfortunate stark reality. Sonu was brought to me in mid February by his grandfather. A six year old child, stunted and wasted, with shrivelled skin, couple of bones dangling from his gaunt torso, weighing just twelve kilogram. Peep beneath his ragged shirt revealed reason of his forbidding plight. A large football size gleaning, throbbing tumour made more grim by dilated veins stretched to their limit. Wailing child was tugging his grandfather to go back home. His grandfather flashed from his pocket a plastic bottle filled with reddish brown liquid. It was Sonu's blood in urine.

Sonu' father is a migrant labourer in Punjab and his mother at home often coughs with tuberculosis. They waited at home with growing belly for last three months, abandoned to God's will and optimist about His ability to heal. Only when frequency of red urine increased with frantic night cries by gnawing pain, his grandfather decided to see someone more able outside their village. With a similar child treated by us last year from his village , his neighbour coaxed him to seek our help.

With scan showing Classical advanced Wilms' tumour, we started his weekly chemotherapy from spare medicines available at our disposal. We cajoled his grandfather not to resign to fate as this scourge will disappear soon with just few weeks of chemotherapy and surgery. He can be healed, can be cured. By forth week, the lump had reduce to one-third and playful glee returned on Sonu's face, now sitting merrily on his grandfather's lap gobbling bananas.

Nation wide lockdown was declared in March last week and everything came to a standstill. Outside roads wore deserted look with no public vehicle in sight. Our Outpatient numbers dwindled to less than one forth in a week .Amidst unprecedented confusion, many patients chose to stay home, some due to fear, others due to compulsion and few due to reluctance. With crashed morale and wilted enthusiasm emanating from helplessness, I also lost track of patients whom I assured before to get cured with chemotherapy. I felt dejected and despondent as the country went into spree of successive lockdowns to combat the pandemic. My melancholy rose every time I thought about the kids who were left stranded in their cancer journey, midway, unanticipated, with tumour in their bodies reviving back to life with vengeance and undoing all our valiant attempt to subdue it before.

In May, a kid struggled to push himself inside my clinic with bloated abdomen. Weak, pale and haggard. I would have easily missed him as someone I did not know until his bald pate exposed his recent history of chemotherapy exposure. He was Sonu. His grandfather reluctantly entered next, with guilt and remorse written all over his sullen face. For an instinct I forgot the precarious prevailing lockdown and he became the subject of my reprimand and revulsion. Wilms' tumour was drilled into my head during training, as a curable disease by my esteemed mentors before. I just could not fathom how callous and laggard his grandfather could be to undo all our effort and shove his grandson to this unredeemable plight of non- curability.

Tears welled in his eyes, then in mine, when he told that they had to rush back home in Nepal as Sonu's mother had convulsion and was left alone to fend for herself as neighbours abandoned her fearing corona. He later tried thrice to return back here travelling 200 kilometres, but decided against twice as no vehicles were allowed to ferry across the border and once, he did manage to cross it but was refused entry into city as cops did not allow anyone to violate the order of 'complete lockdown'. What made his next attempt desperate was when Sonu coughed up blood a week back. His chest X ray now flaunted large 'cannon ball' metastasis, the reason for his blood in cough and adjudication of his fate. Sonu was made incurable by lockdown, without getting infected with COVID. Neither he nor his tumour could understand why this forced lockdown was all about for and who benefited from it!