Till the Last Breath . . . (2 page)

Arman Kashyap had stacked up medical degrees from premier medical colleges, but he was best known for his degree in attitude from God knows where. He walked the hallways of GKL Hospital with a confidence not seen in doctors three decades older and much wiser. His peers said he was arrogant because he belonged to a family of remarkable doctors and extraordinary businessmen. His father was the country’s leading heart surgeon, his mom, a sensitive and highly popular psychiatrist amongst rich, bored and horny housewives, and his older sister, a paediatrician whose average day was littered with appointments with celebrities—medicine and excellence ran in his blood.

But the arrogance didn’t stem from his impressive background. He just knew he was that
good
.

And he knew he wasn’t just a jerk. Had he been one, he would have worked in the chain of hospitals his father had amassed in the last twenty years. He would have been sitting pretty in a corner office with a few brilliant doctors working under him, doing whatever he would have asked them to. But he didn’t choose to be that, instead he chose to work out
the grind and prove his worth every minute of every hour in a hospital where he held no influence. He had earned every bit of the reputation that he had got himself in the last three years. His sincere good looks—he stood at six feet, had short hair and wore expensive rimless spectacles—and savage drive to succeed had helped.

‘So, you look like you made someone’s life hell today,’ Zarah said as Arman approached her.

‘Hell? Guys like him make their own lives hell and come here with diseases which I have no intentions to diagnose or treat. It’s a waste of resources,’ he said and added with an evil smile, ‘I was praying he wouldn’t wake up. Wouldn’t that have been so much better?’

‘You wished he would die?’ she asked, shocked. Just a few weeks had passed of her internship under Arman and she was still trying to come to terms with the genius doctor’s behavioural eccentricities. Arman knew he wasn’t the best boss or the most cooperative of colleagues to have. But he believed it was other people’s liability to accept him for what he was. He was, after all, a rare genius.

‘Don’t you think he should die? A guy who cracks a competitive exam to a good engineering college only to drink and smoke himself to death. Should
he
live? Or should the people who die on the streets be given that chance?’

‘Well, they can’t afford it,’ Zarah retorted, trying to outsmart him.

‘I don’t care about them. But the guy on that bed doesn’t deserve to live,’ he answered. ‘Imagine what his parents must go through. Disgrace.’

‘As if you get along with your parents.’

‘How was it when you were growing up, Zarah? Did your parents tell you what
not
to do? Don’t meet that guy, don’t stay out that late, and
please
don’t get less than 95 per cent
in your examinations? And when did that stop? When you got through medical school in Delhi and they had no idea what you were studying and how much you should score? When they couldn’t make sense whether 657/1230 meant good marks or bad?’

‘Well, more or less,’ she responded.

‘Imagine that, only three times as bad. The hospital mails them details of every case I work on here and they keep telling me what to do. The patient coughs up blood, my dad calls; a seizure, my mom calls; and someone slips into a coma, my sister calls! It’s a crazy house,’ he explained. ‘As if saving assholes like him was not enough, I have to answer to every damn question that my parents pose.’

‘Is that why you don’t work at your parents’ hospital?’

‘I don’t work there because I think I deserve better than that.’

‘I hope I start to understand what you mean some day, sir,’ Zarah said and flicked her hair behind her ear.

‘And that’s not even the worst part. The worst part is—they are
never
right!’

‘That’s funny, sir.’

‘You have to stop calling me “sir” first. It makes me feel, well, old,’ he said. ‘Anyway, we have a new patient. Pretty standard case. The good thing is that the girl is like you, only younger. She got admitted into medical school last year, found something wrong with her hands and diagnosed it herself. Impressive, isn’t it?’

Looking at her face, he knew Zarah didn’t know what to make of what he said, whether he was genuinely impressed or was being sarcastic. Anyway, he always felt something was wrong with Zarah. She was way too reserved for the way she looked. At five feet seven, she towered above even a few male doctors. She didn’t have a shred of fat on her body,
probably because she smoked a lot. But her lips, the lightest shade of pink, didn’t leave any telltale signs of her smoking habit. Neither did her chocolate-coloured exotic skin, which was smooth and velvety. To be honest, the first time Arman saw her in her white doctor’s coat and the three-inch heels, he thought she wasn’t from India at all. Maybe Brazil. Or Chile. Or Uruguay. Some place not India. Usually, the prettier female doctors were outspoken; Zarah, on the other hand, was reserved. It was intriguing. Maybe she was a perfect case for his mother, the acclaimed psychiatrist. In her mother’s words, she was
damaged
.

‘Can you check her up and get her forms done?’ he asked her and gave her the file. ‘She is here for a few tests. We will admit her to the hospital in a day or two.’

‘Right away, Arman.’ Zarah took the file from his hand and started reading through it. ‘It says in this file you were her external consultant? I didn’t know you do that.’

‘It’s a special case,’ Arman responded with a straight face, ‘and it will be better if you keep it to yourself.’

Pihu Malhotra. Age 19.
Arman saw Zarah’s eyes rivet on the file. She didn’t move a muscle.

‘Is there a problem?’ he asked.

‘She has ALS? As in Lou Gehrig’s disease?’

Arman could sense the shock in her voice—a definite marker of a young, inexperienced doctor. He had expected it. When he had first heard about the case, he had felt the same thing. Shock. Disbelief. Pity.

‘Yes, why do you look shocked?’

‘Isn’t it something that afflicts people over the age of forty? She is just nineteen.’

‘That’s what makes it interesting. Have you heard about Stephen Hawking?’

‘The super-genius scientist? The wheelchair-bound physicist who can’t talk any more?’ she asked, just to be sure.

‘Yes, the same guy. He was diagnosed at the age of twenty-one. Doctors said he had three years. It has been forty years since then. His disease was progressing slowly. Hers, on the other hand,’ he pointed to the file, ‘is progressing at a faster rate. She was diagnosed one year back and she might not make it through the next three months.’

‘What do we do? There is no cure, right?’

‘No, there is not. I am on the research panel trying to find one. Let’s see what happens. We will decide when the right time comes,’ he said and got back to his work. He had no intentions of indulging in a ‘poor girl’ type conversation with Zarah. Clearly, Zarah was stunned and her face contorted to signify the pity she felt for the nineteen-year-old dying girl.

Zarah had studied to be in the
noble
profession and save lives and get people healthy, but she never really had the heart to overlook the pain of sick people in the first place. It reminded her of her own angst. She felt sorry for Pihu, and for the bastard who lay in the room with a damaged liver.

Pihu looked at the tall stacks of books lined up in front of her. Her lips curved into an embarrassed smile. She looked around and hoped nobody had seen it. Examinations were around the corner and everyone was stressed out and high on caffeine. Pihu was high on anticipation. She had finished the course. Twice.

Pihu’s parents were ecstatic when she had cracked the All India Medical Examinations and decided to go to Maulana Azad Medical College, one of the best medical colleges in India. Pihu had smiled, shaken hands and hugged. She knew it was just the beginning. School never offered her the opportunity to bury herself in course books the way she had always wanted to. The course was never a challenge. The entrance examinations were a necessary evil. She knew she would sail through. When news broke out in her hometown that her AIR (All India Rank) was third, cunning pot-bellied owners of coaching institutes had flocked to her place, wanting her to advertise their highly qualified staff and fully air-conditioned classrooms with a picture of their most illustrious
student—Pihu Malhotra. A few days later, she was in the local newspapers. Her parents’ dreams were fulfilled. Hers had just taken root.

These were the first set of exams in her college.

‘You don’t look tense?’ Venugopal asked as he underlined his book with a fluorescent marker.

‘I am okay,’ she said, barely suppressing a chuckle.

She had the book
Human Anatomy
open in front of her. She had read it twice. She itched to read something else. Her eyes had been on the book on pathology lying on the side. A second-year student was sleeping on it. She wanted to peep in, worse still, whip it away from under the senior’s head, but she didn’t want to come across as a nerd.

‘You have finished the course, haven’t you?’ Venugopal asked suspiciously.

‘Yes,’ she said and blushed. ‘But I still have to revise,’ she added.

‘But when? You spent all the time with us. When did you get the time? I didn’t see you study!’

‘Promise you won’t tell anyone?’

‘I won’t,’ Venugopal asked and adjusted the spectacles on his hunched nose. Obviously, he wouldn’t. Pihu knew that. Venugopal and Pihu were destined to be friends after the first roll call in their class of 335 students. Their roll numbers were consecutive, since Venugopal’s full name was P. Venugopal where P stood for something unpronounceable for north Indians. They were partners in dissection and had cut open their first corpse together—it’s the sort of thing that binds two doctors together for the rest of their lives. Kind of what it means for two engineering students to have the first peg of whisky together. Other than that, they were very similar. Middle-class families, dads in government service, mothers
as housewives and CBSE toppers of their own regions. In a parallel universe where north and south Indians got along, it was a match made in heaven.

In the past three months, they had become the best of friends. They never kept anything from each other. They didn’t have to, since they led simple lives. Simple people with simple desires. They had nothing to hide. They had never partied, never smoked, never drank. Neither of them had stayed out of their houses after eight. They never felt the need to.

‘I had gone through a few books before I joined college,’ Pihu said.

‘You had? Which ones?’

‘Anatomy. Physiology. General Pharmacology. A few others.’

‘A few others? That’s like the whole course,’ Venugopal gasped.

‘I always wanted to read them ever since I started preparing for medical entrances. That’s all I have ever wanted to do.’

‘You’re crazy. Why would you?’

‘I have always wanted to be a doctor. Ever since the time I was a little kid. At first, I thought I liked the candy my paediatrician gave me! But slowly, it became an obsession. I used to fake illnesses as a kid so I could go to the clinic and hear the doctor talk about various medicines and cures. It’s everything I have ever wanted to do. Haven’t you?’ Pihu purred and batted her eyelashes shyly.

‘I have always wanted a career. And being a doctor was one,’ Venugopal responded. ‘But you’re awesome. You will be a great doctor.’

‘Thanks.’ Pihu blushed. ‘So will you.’

‘I hope so. But why didn’t you tell me before? You could have taught me. I am struggling here.’

‘I can still teach you,’ she said.

Venugopal pushed the book towards her, rested his chin on his knuckles and commanded, ‘Teach.’

‘I didn’t want you to think I was a freak,’ Pihu said softly.

‘I don’t need to tell you that.’ Venugopal laughed.

Pihu always thought of Venugopal as a sweet, well-mannered guy. He was from Chennai, Tamil Nadu, and barely spoke any Hindi. Pihu had spent the first few weeks forcing him to talk in Hindi and laughing her head off. Somewhere between the lectures on human lungs and lymph nodes, Pihu knew she had found a friend for life. She loved the way he cursed the Delhi food, complained about the egregious hostel canteen’s sambar and how he pronounced ‘mall’ as ‘maal’. Their bond strengthened over countless meals of butter chicken and shitty sambar, and arguments about which tasted better.

Pihu stared at the books again wondering what had gone wrong. Fear clouded her mind. A million possibilities battled each other and she cried. She had read about ‘hypochondriasis of medical students’, a condition in which medical students diagnose themselves with diseases they don’t have. It stems from the paranoia one suffers from after obsessing over different symptoms throughout the day. But she knew for a fact that she wasn’t imagining things.

She had left the examination hall thirty minutes before the scheduled time. She knew all the answers. She had wanted to write them. The pen was in her hand, and the answers in her head. But her hands had cramped. It wasn’t the fear of the examination; she didn’t know what it felt like to be afraid of an examination. There was something wrong with her hands.
It wasn’t the first time she had felt it, but she had chosen to ignore it earlier.

She had tried moving her hand in vain. After struggling with intermittent pain and the lack of sensation for half an hour, she had started to write. She had written three beautiful answers when the pain and the lack of sensation came back. She had tears in her eyes. She didn’t know what was wrong with her hand. Every page from every medical book she had read came rushing back to her mind. Her head hurt. Tears streamed down her face. Half an hour before the exam ended, she left the hall, tears in her eyes and strange cramps in both her hands.

‘Why haven’t you been picking up your calls?’ Venugopal asked, worried and flustered.

Venugopal had been calling her for quite some time now. Pihu had disconnected all calls till she asked him to join her in the library.

‘There is something wrong with me,’ she explained. ‘I had not given it too much thought earlier, but I know something is definitely wrong with me.’

‘Yes, I know. You study too much,’ Venugopal suggested and smiled.

‘It’s not that. It’s the examination.’

‘What? You did well, right? Everything you taught me was perfect! It was like you knew the questions beforehand. You are teaching me everything from now on!’ he chortled.

‘I didn’t write anything after the third question,’ Pihu said, tears flooding her eyes.

‘Hey … Hey … Are you crying? What happened? Were you nervous? But you knew everything, didn’t you?’

‘I knew everything.’

‘Did you blank out?’ Venugopal asked, concern writ across his face.

‘NO! I knew the answers.’

Shhh.
The librarian asked them to be silent.

‘Then what happened?’

‘I couldn’t write. My hand … I had no control over it,’ she said and broke down in small sobs. Venugopal looked puzzled. He took her hand in his palms and applied pressure at a few points. He asked her if she had any sensation in her hand. Pihu could feel the warmth in Venugopal’s touch, but she knew something was wrong.
Why can’t I feel it!

‘Can you feel my touch?’ Venugopal asked.

‘I am scared,’ she said. She picked up a pencil from her neatly arranged geometry box. She tried to write her name on the piece of paper in front of her. She couldn’t control it. Venugopal watched in horror as she scribbled. It wasn’t the usual curvy, artistic font she used to write in. It was hardly legible. It looked like she was using the wrong hand. ‘I can’t control my hand.’

‘Let’s see a doctor?’

‘I wanted to be a surgeon,’ she said and put her head down on the books. She cried.

‘C’mon, Pihu. You don’t know what it is. It could be something as simple as Vitamin C deficiency. There are cases reported where Vitamin C deficiency causes paralysis. Even if it’s not that, there could be a million other innocuous reasons! I think you’re overreacting,’ Venugopal assured her.

‘What if it’s not an
innocuous
reason? What if it’s something more?’ she asked, her voice breaking off in sobs.

She looked at her hand. Pale and useless.
Stop being so negative! Maybe it’s not that bad. This can’t happen to me. Maybe Venugopal is right.
All the possible causes for the symptom started to shadow her mind. She was freaking out, her tears were uncontrollable. What was it? Stroke? Nerve injury? Poliomyelitis? Botulism? Spina bifida? Multiple sclerosis? Guillain–Barré syndrome? All of a sudden, it looked as if
she could have every disease she had read about till now. The deadlier the disease, the more convinced she was about its possibility. Sleep evaded her that night as she looked up every possible cause of her problem. By next morning, she had a list of eighty-nine possible causes. She scheduled herself for a plethora of blood tests the next day.

Venugopal had a horrendous next exam. Pihu and Venugopal had spent the night looking over all the possible causes of Pihu’s loss of control of her hand. They narrowed it down to twenty types of blood tests and visited a pathology lab at night, rather late for them. She didn’t want to trouble him, but he had insisted. Pihu waited for him outside his examination hall the next day with her blood test results in hand.

Her blood work was clean, eliminating eighty-eight possible causes.

‘I never thought I would be the first person I would have to diagnose,’ Pihu said on the phone.

There were no tests left to be done. Blood tests ruled out pathogens and other common diseases, breathing tests to check the lungs, MRIs to rule out any neck injury, electromyography to check the nerves in her hand, a head MRI to eliminate other conditions and nerve conduction studies to sum up the rest.

‘You can never be too sure,’ Venugopal said from the other side of the phone.

‘I wish I didn’t have to,’ she whimpered and heard the rustling of pages. ‘Are you still in the library?’

‘No, I am not.’

‘You
are
. Go out, Venu! The exams just got over. Go out and party with the guys.’

‘Not without you. I want you to be here,’ he said.

‘I don’t think I am coming back,’ Pihu responded.

‘You can’t talk like that. You haven’t even seen a doctor, yet. You have to be positive.’

‘He must have read the same books that we have. I am sure of what I have, Venu. I can’t be in denial,’ she lied.

‘You mean to say that experience counts for nothing? See a doctor. It could still be something else,’ he argued.

Pihu didn’t want to pursue it any more. She knew he was going through denial. A certain part of her was going through the same. Except for this call, she had not stopped crying since the time she discovered what she was afflicted with. She had cursed the unfair balance of nature. What she had was not something she deserved. She had cried and pored over the reports again and again, hoping there would be a mistake. She wished she was wrong in her self-diagnosis. She could be. She was only a first-year medical student and she wasn’t supposed to diagnose it correctly in any case.

‘Are you going to tell them?’ he asked.

‘I think I will let some doctor do it,’ she said. Her eyes watered up. She heard the flipping of papers from the other side. ‘I will talk to you later. The signal is cracking up.’ She disconnected the call.
I hope I am wrong about this.
She sighed. The tears returned and they never stopped during the three hours it took for her to reach her home from the college hostel. All her dreams washed away in an instant.

Once home, she stood in front of her parents, complaining about the strange sensations in her right arm. Her mother started to ask her about the examinations. Dad asked her if she was eating right. It took her an hour to make them take
the cramps and the loss of sensation in her hand seriously. Her mom suggested stress. Dad suggested infection. ‘Delhi’s water is riddled with parasites and germs. You’re almost a doctor, you should know,’ he said. She insisted on seeing a doctor. Her dad smiled at the irony. Pihu knew what he was thinking about. He had imagined her as a doctor. Something that Pihu knew would never happen.
I hope I am wrong
, she sighed.

On the way to the hospital, she tried to be her chirpy self, even though all she wanted to do was cry. Maybe she was wrong. The doctor in the hospital asked her a few questions and prescribed her some blood tests.