Thursday, December 4, 2008

Ramu's story

I am writing this true story purposely because Ramu and his father really taught me the importance of persistence and patience. We tend to write off so many patients ,thinking it is too late to help them. But this case luckily proved us all wrong.
When Ramu first came to us, he had a huge growth involving the eye.The eye had been completely destroyed and the tumour was hanging out of the orbit. Surface areas were sloughing and bleeding.
He was being treated in LNJP Hospital and was sent for support as he could not afford treatment. I had little hope that we would get a satisfactory result. The tumour was diagnosed as Rhabdomyosarcoma. The delay in treatment was not entirely their fault. They had gone to the district hospital when the tumour was very small. Ramu was admitted but they took their time doing investigations and getting the reports. In the meantime there was a strike by the class IV employees and they were discharged without treatment. Then Ramu and his father went to Allahabad where again after some tests which took a further month after which he was referred to Delhi.
In all this waiting ,valuable time was lost.By the time Ramu came to Delhi the tumour was huge.
Ramu's father was a farmer from a small village. They had no money and no relatives in Delhi. Since Ramu was admitted, the child was at least getting food and a bed to sleep on.
Surgery was ruled out at that stage and chemo-radiotherapy was advised to reduce the size of the tumour. Chemotherapy had a very marked effect and in three cycles the tumour really reduced in size.It was responding to treatment very well. Then Radiotherapy was commenced and this caused a further reduction. The shape of the eyeball became visible.
Between the chemotherapy cycles Ramu and his father stayed on the pavement outside the hospital.
To sustain the two of them Ram Bahadur,Ramu's father started plying a cycle rickshaw. He used to call me Didiya and his main complaint was that Ramu was naughty and would not study. Ramu was like any other 12 yr.old boy. He was always cheerful and during that entire year and a half I never heard him cry or complain. That pair really taught me a thing or two about resilience. They never thought even for a moment that the outcome may be unfavourable. Or maybe at such times ignorance is bliss.
Then came the surgery and the predictable shunting from one department to another. This time it was between the eye department which had to perform the surgery and neurology which had to assess whether there was any intracranial extension of the tumour. This drama went on for about 2 months. I was afraid that precious time and advantage given by radio and chemotherapy would be lost. Though I don't like to interfere in the treatment at all,this time I approached Dr A. Grover in Ganga Ram Hospital and requested him to see Ramu.He called him to the general OPD and after examination took an opinion from the neurosurgery department and posted him for surgery within two days. Dr.Zia Chaudhary was the associate ophthalmologist who took particular care of Ramu. The entire contents of the orbit were removed alongwith the eyeball which was completely destroyed by the tumour. The surgery was uneventful and went off well. This was followed by six cycles of chemotherapy , starting about a month post op. Ramu's entire treatment in Sir Ganga Ram Hospital was free as Dr.Grover admitted him in the general ward.
After the chemotherapy was over Ramu was fitted with a prosthesis giving a good cosmetic result as you can see from the photograph.
Ramu has now gone back to his village and is doing well.

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