I had a teacher in my third year of med school. His name was Dr. T. He taught us pediatrics. At that time, he was the head of the department of pediatrics in the busiest teaching hospital in our city, where I was working. Every day, hundreds of children from far-flung areas are referred to our hospital with complications due to suboptimal treatment received in their local areas, as we lack essential medications in our small hospitals and dispensaries. Health care is the least of priorities in our country.

Dr. T was not only a great teacher but also an excellent clinician who knew how to handle all the pressure of extreme patient load. He saw each child as if he or she were one of his own children. He was always available round the clock for assistance to his residents in the management of those sick children. He was filthy rich and didn’t have any other reason to work this much, but just because of his passion and endless love for children. He has lots and lots of students trained by him, who are now serving in different cities.

In our country, the usual retirement age is 60, which means he was below 60 at that time. He was a very tall and handsome man and always very well-dressed, really authoritative but polite personality. I idolized him literally that one day I wanted to be a doctor and teacher like him. Then after I completed my med school and internship year in 2018, I met him a year later when my younger brother got sick. We took him to his private clinic, and my brother needed to see him only once, and after that, he got better. Dr. T was still the same. We never met again until last year in 2023, when I saw him in the oncology floor corridor one day. I thought he must be with some patient. After he left, I asked the staff, and they said he came for his own consultation. I was terrified, and when I looked into his medical records, I found out that he had been diagnosed with Metastatic CA rectum. He had liver, osseous, and pulmonary metastasis and had received multiple lines of chemotherapy at some outside facility. He came to see us because his PET scan showed progression and impending cord compression at some spinal level due to metastases, thoracic, I guess, I don’t remember exactly now.

I was so disturbed by his diagnosis that when he came again on the radiation day, I talked to him about the radiation treatment, steroids, pain management, and all of his treatment plans, but I couldn’t tell him that I was his student. He didn’t recognize me after all those years maybe because I looked quite different from med school now. I don’t know why I couldn’t tell him that I was one of his students.

Later on, over the period of one year, we did his palliative radiation therapy for multiple cervical, thoracic, and lumbar vertebrae and many other osseous Mets. I made his radiation plans myself, God knows how many. But I am sure of one thing I have always seen him smiling. I never saw him complaining of pain. As he was quite a well-known and famous doctor in the city, and obviously, he didn’t want other people’s pity, he would always come at 7 a.m. in the morning, and he was always the first person to get treatment. He maintained his dignity throughout the treatment. I don’t know if I should call it dignity or whatever because I don’t know the accurate word for this.

I just want to share what I felt throughout his treatment. On my first encounter with him, when I saw that his disease was progressing on a lot of chemotherapy and immunotherapy, and he had literally metastasis all over his body, I was only worried about the chances of him developing brain mets. I have had sleepless nights, dreading with the thoughts of him developing different kinds of possible neurological deficits, Actually now when I think retrospectively, I know this feeling. I was afraid of him getting bedbound or dependent on someone. I was afraid of seeing such an intelligent man feeling helpless or having memory problems or any kind of neurological deficit. I never wished that he ever get the news that he has a few months to live, although being an experienced physician himself, he must be familiar with his disease progression and all possible outcomes.

I shared my thoughts with my friends at that time that throughout his treatment, I’ve been afraid of listening to the news of his demise one day. He was fighting bravely, but I was struggling to accept that he would be going to leave us soon. I’ve cried a lot of tears just praying for his life. But I also prayed that, Dear God, please don’t make him paralyzed or dependent on someone before death.

A few days back, I listened to the news of his sudden passing away in his sleep. I became disturbed for many days, but I didn’t cry a lot this time because now I was at peace knowing that he had transitioned into another life without pain and becoming dependent on someone else for a long.

Finally, I’ve learned that oncology doesn’t always require exploring the best treatment options for our patients according to their health, comorbidities, and financial status, but the thing that is of utmost importance is our empathy and the sincerity of our intention with which we treat our patients. I know how much we pray and try, we can’t save anyone because we don’t have the outcomes in our hands except the effort we can do for our patients. It was a miracle that he lived for this long with such extensive disease and maintained his quality of life as well. I’ve also learned that sometimes God accepts our prayers in a different way, and we can’t realize his mercy and his plans due to our limited intellect and foresight. Transitioning into another life in a pain-free state is far better than being in pain and living a life dependent on someone for years.

The last thing I have in my mind is that how much we try, we can never ever control our sensitivity, how much we try because that is an integral part of our humanness. I still regret all my meetings with him when I wasn’t able to tell him that I was one of his students. That is how much I adored him, how much I loved him. How important he was to me and how much I had prayed for him. I wish I had spent some quality time with him not as a treating physician but a loving student who had considered him like a fatherly figure for years. I wish I had told him that during all of his treatment, I didn’t feel myself once as a knowledgeable oncologist; I was just a fearful kid who had felt the thought of losing him at any moment. I have decided that from now on, I won’t hesitate to share my feelings with a loved one. I’ll just let my tears flow next time without thinking a lot, I will not judge myself for feeling my feelings, I’ll face my fears and still try to do whatever I can, for my patients in the best of my ability.

May he rest in peace always. Amen.

Damane Zehra is a radiation oncology resident in Pakistan.