How time flies!!

Today the 26th February 2008.

Exactly one month after what happened to Sunder. Since morning my mind is not ready to function. Just can't imagine how quickly time flies. Although it was 10.30 at night by the time I received the news that he was critically ill, my mind keep going the various things that he would have felt and thought about on that day. Except that he is no longer amidst us, nothing has stopped in the past one month, life has been going on as if nothing has happened. Sometimes I still feel that he has just gone on a long tour and will be back very soon. Then I remind myself that this is not true and then there is a fresh bout of tears.

Spoke to Amma last night and she is also on the same boat. Each one of us is trying to put up an act of being brave for the sake of the others.

Sometimes I feel that at this point in time I am having all the good things in life. Rohan is doing extremely well in school in his studies and extra-curricular activities. His teachers are complimenting him left, right and center. He brought out the house magazine for which he earned a lot of accolades. He is singing a song in the assembly today. Next week the final exams are starting and I am sure he will perform up to his capacity. We are in the process of shifting to our own house. A lot of shopping going on for that, but amidst all this as if God does not want me to enjoy everything together at one time, he has thrust this upon me, and there is a dark corner at the corner of my heart where I still moan the loss of my dear Sunder.

I never realized I could be so attached and emotional. I always had a hard exterior and a feeling that I was very practical. Looking back now, I think of the ways I used to bully him. Being the first son in the family he was always Patappa's pet. He would get away with everything. Every time we went to play, I had to become the elder sister and look after him and invariably, he would get into something and hurt himself always on the head. When we got home, I would be scolded by Patappa, for not looking after him. I would get so bugged with him that I would twist his arm till it hurt him. His end was also through the hurt in his head and I feel guilty that I did not look after him.

There is not a single day that I don’t think of him and cry. Truly, blood is thicker than water. Thought if I write down my feelings, I may feel better, but I really doubt if I can really feel any better from his loss. This is irreplaceable for life and nothing can really make me feel better. Maybe if I were closer to my parents and could visit them more frequently, I may feel the loss a little less, but I doubt if I can ever come out of it. The thought of the fact of traveling 24 hours to meet them and the fact that I cannot spend much time with them makes me feel more helpless and lonely. I really God gives us the strength to face and overcome what he has thrust upon us.

Letter from a grieved father to his other children

My dear children,
Sunder’s sudden death has devastated every one of us. As Vidya says it was a Tsunami; our Dr. Durairaj described the type of Leukemia that struck him as an Atom Bomb from which he could not have recovered at all.
However, this unforeseen tragedy should not lead us to forsake God; nor should we believe that HE does not exist. As you will note from the several near tragic episodes that I shall be narrating in this letter, God does exist and He is as loving and merciful as He appears cruel. All of us should, therefore, continue to have faith in Him and seek His blessings in whatever we do.
I consider it appropriate to list down the following events in our family only to show how the Lord has showered His mercies on us:
1. Way back in the 1930s there was a small pox epidemic in Bombay; your grandmother was also a victim. Thousands perished but Patimma survived, though she suffered blindness for the rest of her life. She was a gracious lady who lived her full life and joined her husband in heaven within just 3 weeks after his death (a couple Made for each Other!).
2. In the Indo-Pak riots of 1947, your Patappa escaped from the jaws of death. That indeed was a shining example of the Lord’s mercy. Within three days of his leaving Lahore in his Ford car, jam packed with several of his colleagues and subordinates, the Remington office where they had all taken refuge, was attacked by the Pakis and an elderly Punjabi Cashier, who adamantly chose to remain behind, was killed.
3. In 1964 Patappa was, once again, rescued from death by the Lord from a virulent attack of Tetanus.
4. In 1974 Vidya escaped death when she fell from a running train! What a providential escape!. Was this not God’s mercy? I cannot forget Delhi Athimbar (Venkittu Athan’s father) telling me, ‘Chandru, it was your father’s daily Pooja that saved your child’.
5. In 1988 your own mother came back alive after a nasty asthmatic attack which developed into, more or less, a hemorrhage. I was away in Bangla Desh at that time!
Children, what is destined to happen will happen, however much you might try to stop it. The ways of Destiny are inscrutable. As the learned Sri Gopalakrishna Iyer, the Vedic scholar, said the other day every human being comes in to this world with a return ticket. Sunder’s time on earth was over, so he left. Had he survived he would not have lived a normal life any more. God was merciful enough to take him away so that we do not see him suffer. Let us therefore console ourselves that Sunder did not live to suffer and thank the Almighty for His benevolence and mercy in this respect.
I shall conclude this letter with one of your Sita Patimma’s sayings :’your prayers and your good deeds are like your Provident Fund. They are credited to your account in God’s books. They will come to your aid when you need them.’
Love,
Daddy
20/02/08

Blessing in Disguise

If God had answered our prayers and returned Sunder to us, then the prognosis does not look very appealing. It would have been hell for both of us. Firstly, we are not aware of the brain damage that had taken place during those crucial minutes. Just imagine a well-built and happy-go-lucky boy being at the mercy of others.

Treatment of AML is usually divided into 2 chemotherapy phases:
remission induction
post-remission therapy (consolidation)
Remission Induction

This first part of treatment is aimed at getting rid of all visible leukemia. It usually involves treatment with 2 chemotherapy drugs, cytarabine (ara-C) and an anthracycline drug such as daunorubicin (Daunomycin) or idarubicin (Idamycin). Sometimes a third drug, 6-thioguanine, is added. This intensive therapy, which usually takes place in the hospital, typically lasts one week. How intense the treatment is may depend on the person's age and on other prognostic factors.
In rare cases where the leukemia has spread to the brain or spinal cord, chemotherapy may be given into the cerebrospinal fluid (CSF) as well.

Most of the normal bone marrow cells as well as the leukemia cells will be destroyed by the treatment. During chemotherapy and the following couple of weeks, the patient's blood cell counts will probably be dangerously low, and drugs to raise white blood cell counts, antibiotics, and blood product transfusions may be used to help protect against complications. Usually, the patient stays in the hospital during this time. If induction is successful, no leukemia cells will be found in the blood, and the number of blast cells in the bone marrow will be less than 5% within a week or two. Normal bone marrow cells will return in a couple of weeks and start making new blood cells. If one week of treatment does not induce remission, the process may be repeated.

Consolidation (Post-remission) Therapy
If remission induction is successful, further treatment may be given to try to destroy any remaining leukemia cells and help prevent a relapse. The options for AML consolidation therapy are:
1. several courses of high-dose cytarabine (ara-C) chemotherapy
2. allogeneic (donor) stem cell transplant
3. autologous stem cell transplant
4. High-dose consolidation chemotherapy differs from induction therapy in that usually only cytarabine (ara-C) is used. The drug is given at very high doses, typically over 5 days. This process is repeated once or twice. When examined four years after this treatment, about 40% of young patients (younger than 60 years) will not show any signs of leukemia. In older adults, this number is around 15%.

Another approach after successful induction therapy is a stem cell transplant. Patients first receive very high doses of chemotherapy to destroy all bone marrow cells. This is followed by either an allogeneic (from a donor) or autologous (patient's own) stem cell transplant to restore blood cell production.
It is not clear which of the 3 treatment options (high-dose chemotherapy, allogeneic transplant, or autologous transplant) is best for consolidation. They each have their pros and cons. Doctors look at several different factors when recommending what type of post-remission therapy a patient should receive. These include:
How many courses (cycles) of chemotherapy it took to bring about a remission. If it took more than one course, some doctors recommend that the patient receive a more intensive program, which would involve a stem cell transplant.
The availability of a brother, sister, or an unrelated donor who matches the patient's tissue type. If a close enough tissue match is found then an allogeneic (donor) stem cell transplant may be offered for post-remission therapy.
The potential of collecting leukemia-free bone marrow cells from the patient. If cytogenetic studies show that a patient is in remission, collecting stem cells from the patient's bone marrow or blood for an autologous stem cell transplant is an option for post-remission therapy. Stem cells collected from the patient would be purged (treated in the lab to try to remove or kill any remaining leukemia cells) to lower the chances of relapse.
The presence of one or more adverse prognostic factors, such as certain chromosome changes, a very high initial white blood cell count, AML that develops from a myelodysplastic syndrome or after treatment for an earlier cancer, or spread to the central nervous system. These factors might lead doctors to recommend more aggressive therapy, such as a stem cell transplant. On the other hand, for people with good prognostic factors, such as favorable chromosome changes, many doctors might advise holding off on a stem cell transplant unless the disease recurs.
The age of the patient. Older patients may not be able to tolerate some of the severe side effects that can occur with stem cell transplants. Therefore, this may not be as practical an option for them.
The patient's wishes. There are many issues that revolve around quality of life that must be discussed. An important issue is the higher chance of early death from allogeneic transplant. This and other issues must be discussed between the patient and the doctor.
Stem cell transplants are intensive treatments with real risks of serious complications, including death, and their exact role in treating AML is not clear. Some doctors feel that if the patient is healthy enough to withstand the procedure and a compatible donor is available, an allogeneic transplant offers the best chance for survival. Others feel that studies have not yet shown this conclusively, and that in some cases a transplant should be reserved in case the leukemia comes back after standard treatment. Because most studies of stem cell transplants have involved patients who tend to be younger and in better health, their improved survival might not be due to the procedure. That is, they might have done just as well with standard high-dose chemotherapy . (More of Trial and Error and Experimentation)
Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.
The side effects of chemotherapy depend on the type and dose of drugs given and how long they are taken.

• These side effects may include:
  hair loss
  mouth sores
  loss of appetite
  nausea and vomiting
  lowered resistance to infection (due to low white blood cell counts)
  easy bruising or bleeding (due to low blood platelets)
  fatigue (due to low red blood cells)

Reading all this, at least he did not have to go through all this suffering and we have a picture of a happy and smiling Sunder in front of our eyes instead of a rag-doll, bed-ridden, lifeless member of our family!!! THANK GOD FOR THE SMALL BLESSINGS

Why our Family?

Our family comprising my parents, myself, the eldest daughter, a brother, 3 years younger to me, a sister, 1 year younger to him and a kid brother 12 years younger to me, were a happy, fun-filled, close knit group of 6 till the 26th of January 2008. Each one of us was busy in his / her own field; the sense of satisfaction the each one is safe and doing well was the binding force.
On Republic Day 2008 we were totally shattered by a Tsunami. My brother, just 36, slipped into coma following a massive cerebral haemorrhage; he never recovered and passed away on the 28th January. The first question that came to my mind was: why us? why he? He was a soft spoken, obedient son, a caring brother, a loving husband, a doting father to an 8 year old, a pure vegetarian and a fitness freak with clean habits, who spent a good amount of time in the gym. Our family has traditionally enjoyed longevity. My paternal grandfather and grandmother lived till they were 96 and 86 respectively. My maternal grandfather lived till the age of 70, while my maternal grandmother is now 77. Why did my brother succumb at 36?
On that fateful Saturday afternoon my brother had an excruciating headache. He skipped his lunch and asked his wife to just give him oats kanchi to drink. After drinking this he vomited and experienced dizziness. My parents were called and they rushed to his apartment. He was lying down and seeing my father said, "Appa take me to hospital". Meanwhile some neighbours had collected and had called up the nearest medical facility. One neighbour was good enough to escort him. At the hospital, just a kilometre away, the doctor at the casualty section examined him and said the blood pressure was "normal". Meanwhile the headache increased. He was put on drips and taken to his room on the upper floor for further treatment. However, on the way itself he collapsed and became unconscious. He had suffered a cardiac arrest (as revealed by the doctor later). The doctors rushed and revived his heart. However he never regained consciousness. A CT Scan was taken. The findings were (a) large, diffused intra-cerebellar bleed along mid line, (b) the bleed shows extension into the ventricular system (4th ventricle) causing hydrocephalus and (c) generalized cerebral odema. Blood count was very low. The Neuro physician told us that the blood platelet count was too low. The WBC was too high and Haemoglobin too low. 'No surgeon will touch him in this condition. He will bleed to death if operated in this state', said the Neuro.
He was immediately shifted to the best hospital in town in an ambulance equipped with life support systems. Arrangements were made to increase the blood platelets. To reduce the pressure on the brain, an incision was made to drain off the fluid retained inside. This was an emergency and an extremely risky operation. Doctors declared a 48 hour critical period. They said he was 'brain dead'. The brain should be activated for any further action. The blood platelets did increase to a reasonable level, internal bleeding also stopped; however the brain continued to be inactive.
The sentence was pronounced; he had leukemia……Something vaguely called ‘acute pro myelocytic Leukemia’. This is something that is seen only in Hindi Movies. The hero is taken to the hospital where is pronounced to have the deadly disease, but even there the hero lasts for 3 to 3 ½ hours and movies generally have a happy ending!! That was not to be in our case. We contacted and brought every expert in the medical fraternity to the ICU where he lay. His case was circulated to every known oncologist in India and the U.S. but the answer was the same viz. treatment will be effective only if he comes out of coma, whatever has been done so far is correct and the best. They said that the next 24 hours could be the deciding factor. The doctors had little hope and asked us to start praying for a miracle.
Within the next 12 hours, all our relatives, friends and well wishers from every corner of India joined us. Every hug and every tear that we shed when we saw them made us mentally stronger and bound us together. We were hopeful that the multiple and collective prayers would pull him out of the abyss he had fallen into. Prayers were conducted in every known temple, gurudwara and masjid. Candles were lit in churches. Each person was trying to implore the attention of his devout God. All faith merged into one to fight Lord Yama. All this kept our spirit of fighting alive. We wanted to snatch him back from Yama.
Since the 24 hours were up, we were asked to give our consent for removal of the life support systems We refused and literally fought with the medical team demanding to know why he could not be revived. When they told us that he was brain-dead, we refused to believe it and got an EEG done. We asked the doctors to wait through the night and conduct a second EEG after a 24-hour gap for look for progress or deterioration. A born fighter, my brother would not give up; he provided us every opportunity to try and hold him back and keep the life support systems on. Alas, minutes after the EEG procedure was done, his blood pressure came down drastically and no amount of medication worked to stabilize it. He breathed his last at 10:15 that night, blissfully unaware of the waves of emotion that he had unleashed. The tearful goodbyes that we bade him and our efforts to console our parents, siblings and relatives is a scene that will stay embedded in my memory for life. No parent, sibling, wife or child should ever have to undergo such an irreparable loss and trauma.
His cremation was attended by his innumerable friends, classmates, subordinates, peers and bosses. None could believe that he was no more in their midst.
Now on retrospection, how could he have lived looking and feeling healthy if he had such a disease? He had absolutely no symptoms of the disease. Only a week earlier he and his family had gone out on a picnic with their circle of friends, where they played a lot of badminton and did some tree-climbing etc. Obviously a person with leukemia would have shown some stress and signs of tiring. He returned to Bombay from a business tour on Friday the 25th and suggested to his younger brother that they both traveled to Poona on the latter’s motorbike on that fateful Saturday! Such a jolly good, carefree boy; should the Lord snatch him away at such a tender age? I have tried to glean every bit of information on Leukaemia but have not been successful. All sites tell me that the symptoms are tiresomeness, lack of stamina and strength, sore throat and cold like symptoms; but even for these we need time for treatment, isn’t it? One day you land up with a fever; you do not rush for a blood check immediately A common cold generally is said to last for a week, if it does not get better by then, you think of further remedies. Some of the unanswered questions are: Did we neglect overt symptoms, if any? Has any one experienced anything like this? If so, will he/she share his/her agony/experience with us and thereby help us come out of the feeling of guilt/ helplessness?