I believe in forgiveness and not hating anyone, no matter what. But, ultimately, we are all human. I believe in karma, and we should not hurt or push people to their limits so much that they become damaged beyond repair. I’ve seen cruel people end up in miserable lives. Some people excel at concealing their sorrows, while others struggle. But we indeed reap what we sow. Those who are cruel to others and do bad things to them will eventually face the consequences of their actions, which may not be in this world.

One of my friends loved a colleague of hers. He promised to marry her. This boy’s mother did her best to separate them. She did not want my friend to become her daughter-in-law. She was very proud of her only son, who was ordinary, but she believed he was the only well-qualified doctor in the city. But if he had promised my friend and was sincere in his intentions, he would not have ghosted her.

Both of them worked at another hospital. I’ve met him once. To me, he seemed so ordinary. I’m not sure what my friend saw in him, but perhaps love is blind. She was serious about that guy and told her parents that she liked him. In the end, the guy backed away, leaving my friend heartbroken. She took a long time to get over him, and I remember a time when she appeared lifeless.

All of this happened approximately three to four years ago. Now she is happy and settled in her life.

A few days ago, my senior oncologist summoned me to his room and showed me an MRI scan of multiple brain metastases. He explained that the scan was of a middle-aged teacher with stage four breast cancer. He was preparing for her whole brain radiation therapy. He showed me the scan and asked my thoughts on hippocampal sparing in that case, as she was a teacher.

Hippocampal-sparing radiation is a treatment that limits the amount of radiation delivered to the hippocampi during radiotherapy. Whole-brain radiation therapy can damage the hippocampus and cause cognitive decline, so avoiding it during whole-brain radiotherapy can help maintain memory function. Although stage four cancer with brain metastasis already has a poor prognosis, we do our best to slow or stop the cancer’s rapid progression.

Because the metastases were numerous and spread across multiple areas, I did not believe it was appropriate for hippocampal sparing. To give her good control, I suggested that we proceed with whole-brain radiotherapy without hippocampal sparing. My consultant agreed, and as I left his office, I saw the doctor I had once met with my friend—the one whom my friend loved with all her heart.

Being a colleague from the medical fraternity, and having already made eye contact with him, it was unprofessional and impolite to simply ignore him and walk away without greeting him. So, after greetings, I asked him why he’d come to oncology. Was everything OK? He explained that he had come for treatment for his mother, who had recently been diagnosed with breast cancer. Unfortunately, the cancer had spread to the lungs, liver, and brain.

I was sorry and saddened by the news. I noticed that his mother was the woman whose scan I was discussing with my consultant. I took her to the examination room to meet her and speak with her for reassurance, as she was my colleague’s mother.

She was a middle-aged woman with no neurological deficits at the time. She was unaware of many details regarding her diagnosis and treatment. I was sad, but I tried to cheer her up and reassure her that everything would be fine soon. Her son thanked me and looked embarrassed. I was concerned for him and wondered what else I could do. He was an only son with no one else to care for his mother, and the news of her cancer, combined with the prospect of a poor prognosis, had left him vulnerable and weak. I noticed that he looked paler than usual.

I just tried to make him feel better, suggesting that perhaps the systemic treatment (chemotherapy) might work in her case as she was young and in good spirits. I felt bad for him because I knew what he was going through was difficult and stressful.

Over the next few months, I watched his mother deteriorate. She was brought to the emergency room unconscious after having a seizure. She was admitted, and her condition worsened. Despite extensive counseling, I have seen him in denial. Despite being a qualified doctor, he was helpless. Every day, he would take me to a corner and ask the same questions about what else could be done in his mother’s case.

I couldn’t help but give him the same answers over and over. He did not want hospice or palliative care, but his mother was not awake. I was saddened to see him becoming more helpless and hopeless by the day. She ultimately died, leaving him alone. I know he contacted my friend one day to ask for forgiveness. She was sad to learn about his story and his mother’s painful death. She forgave him, but can she forget what she went through at his hands? I do not think so.

Sometimes, I wonder why we wait for words of forgiveness until it’s too late. We are only on this planet for a short time, and yet we do not hesitate to hurt someone, to make them cry so hard, or to crush someone’s soul. Sometimes, I wish we would remember that we are not invincible, but rather mere humans who cannot even guarantee whether or not we will be alive the next moment, and that we should be a little more thoughtful before breaking people’s hearts as a result of our actions.

I now understand why forgiveness is regarded as one of the highest virtues because I have realized how difficult it is to forgive. It is excruciatingly painful. It takes time to work through the phase of soul-crushing pain and disappointment, but it also brings peace and closure.

Damane Zehra is a radiation oncology resident in Pakistan.