A few weeks back, a young male from Afghanistan visited us in the oncology clinic. He was in his late 20s and came with a translator to facilitate his consultation. He was not very fluent in either Urdu or English but could still understand most of it. He seemed very anxious and perplexed in the initial assessment room. I observed him closely and noticed that there was no family member accompanying him, except the translator who had only come to do his part of the job.

I started taking his history, which dates back to a few weeks before when he noticed swelling in one of his testicles. Having a very strong family history of various cancers, he immediately got alarmed and came to Pakistan for workup and treatment. Later on, he was diagnosed with a germ cell tumor. His tumor markers were within the normal range, and imaging showed no signs of disease elsewhere in the body. He underwent a unilateral orchidectomy, and his histopathology came out to be a non-seminomatous tumor, with all the risk features negative.

I felt relieved after viewing his reports because it was a relatively simple case for me. I work in a country like Pakistan, where people usually present with advanced-stage cancers, and we have to offer them some kind of treatment because it becomes inevitable to treat them.

As a junior doctor, most of the time, I avoid giving my verdict in front of the patient before consulting my attending because I never want to give a contradictory or conflicting statement that doesn’t match with my senior and could confuse the patient later on. But sometimes, the patient and their attendants bombard you with so many questions that you have to give them some kind of overview about the diagnosis and treatment plan in very simple words, just to build rapport with a patient or with the intention to reduce their anxiety levels.

Now, this young gentleman had come all the way from Afghanistan, on his own, just in the hope of getting standard treatment, which was not possible in his own native country. I am really in awe of those courageous people who try to get their treatment in such times of inflation and political turmoil when even getting a visa is really expensive and cumbersome.

This young boy had heard a lot of negative stories about cancer patients’ dismal prognosis and painful treatment from his friends and family. As I finished my documentation, he started asking me every kind of question. His first question was, “Why do all cancer patients die?” I asked him about the people he saw dying from cancer, and he gave me a lot of examples from his family members who had died of various types of cancers, and that too in our hospital. I told him that every kind of cancer is different, every patient’s stage and type of cancer is different, and the prognosis depends a lot on the stage at which the patient presents and the aggressiveness of the tumor.

His next question was, why do some people benefit from cancer treatment while others do not? I told him that everyone is different, and we can never predict which patient would respond to which medication in which manner because our knowledge is limited, and we cannot play God.

Now his anxiety level was much reduced, but he started asking about his case. I told him that he had a very early-stage tumor with almost no risk features, and it was only limited to one of his testicles that had been removed now. I called my urology colleague to ask about his chances of fertility and the details about the option of sperm banking if we opted for chemotherapy. My urology colleague reassured me that there was very little chance of infertility.

That guy was listening to most of my conversation with my colleague, and he was getting impatient now. He asked me if he could be spared from chemotherapy, and I said maybe. But let me discuss it with my senior. Now the color on his face was back, and he told me that you are the first doctor who has given me some kind of hope, otherwise, I was really worried. He begged me to save him from chemotherapy, and I told him that we would try our best but let us explore all of our options.

When we discussed with him the two options to choose between either one cycle of adjuvant chemotherapy and strict surveillance, he opted for the second option. He was beaming with joy when he was leaving the clinic, and he even shook hands with me and hugged me, although we are part of a conservative society in which shaking hands or hugging a female is considered inappropriate. He thought that I was the one who saved him from chemo, and I was so happy in his happiness that I hugged him back. I prayed to God that his disease never ever come back and that he live a long and healthy life with a lot of happiness.

Damane Zehra is a radiation oncology resident in Pakistan.