I am currently working as a senior registrar in the oncology unit of a trust hospital. We admit both oncology and hematology patients in the same ward, meaning we care for patients with solid tumors as well as those with blood cancers. Our hospital has only one oncology ward, which has ten beds. Since it is a trust hospital, most treatments are provided completely free of charge. I love working here because I appreciate that we treat our low-income patients with the same level of care as we provide to those in private setups. I find it satisfying to see patients receiving chemotherapy, antibiotics, intrathecal chemotherapy, and having bone marrow biopsies at no cost.

Being there for people who cannot give anything in return is an honor for me. In our facility, there are only two doctors: my senior, who is a qualified medical oncologist, and I, serving as the senior registrar. Our team consists of just four members: a consultant, a senior registrar, a highly qualified oncology nurse, and a clinical pharmacist. Additionally, we have access to an ICU, diagnostic and interventional radiology, pathology labs, a blood bank, and all the resources needed to provide our patients with the best possible care.

Although I enjoy working independently, many moments throughout the week make me extremely sad. Being the only doctor on duty, I find myself sitting at the counter all day. During my initial days, patients would occasionally look at me with curious expressions since I was new. However, many patients, who have been admitted for a week or two, are now familiar with my face and seem indifferent to my presence. I now feel like I have merged into the background.

More than half of Ramadan has passed, and the excitement for Eid is building. Most of the patients admitted here come from far-flung areas, and there is a palpable sense of longing in the air. They all wish to return home and complete their chemotherapy in time to plan for their Eid celebrations.

We have a 14-year-old boy who has been admitted for treatment. He comes from a very poor family and is from another city. He has been diagnosed with acute myeloid leukemia, which is a type of cancer that affects the blood and bone marrow. Currently, he is being treated for neutropenic sepsis (a life-threatening infection).

Leukemia has impacted his left eye, resulting in complete blindness. When he arrived, his eye was severely swollen, with the eyeball protruding due to significant edema around the orbit. Fortunately, the chemotherapy has been effective, and he is doing much better now. Although he is blind in his left eye, there are no outward signs of this condition; the swelling has completely subsided, and the eye appears normal, despite the lack of vision.

He was admitted for chemotherapy, after which he developed neutropenic sepsis and became so ill that he needed to stay in the ICU for several days. After stabilizing, he was transferred back to the ward, but his blood counts have not improved. We are transfusing him with packed red blood cells and platelet units daily. He has frequently complained of pains and insomnia. Unfortunately, no analgesics have been effective for him, and despite trying various sedatives every morning, he reports that he has only slept for about an hour.

As the days go by, he is becoming increasingly restless and irritable. However, his innocence keeps his frustration mostly contained to shedding tears and repeatedly asking us when he will be discharged. Unlike many other patients who may get grumpy, throw tantrums, or refuse to eat, he simply cries or asks a lot of questions at times. In between, he finds moments of peace and watches YouTube videos.

His desire to go home is growing stronger every day as Eid approaches. Unfortunately, his blood counts are not improving, and we are transfusing him daily. On Monday, he pleaded with the consultant to discharge him. Our consultant is a very patient and logical man. He explained to the patient that the antibiotics he is receiving three times a day are extremely expensive, with a single dose costing almost 10,000 PKR. Additionally, he is receiving GCSF injections free of charge, which are also quite costly. The consultant advised him to take advantage of this opportunity for as long as possible. When it comes to money, those with limited resources often compromise on their wishes. The patient understood the doctor’s reasoning, but he still felt unhappy, and a tear or two rolled down his face.

On Tuesday, he asked the same question: “When will I go home?” He received counseling again and seemed to settle down for a while. His blood counts had improved slightly, which allowed us to tell him that we might discharge him soon. However, on Wednesday, his blood counts declined once more, and his sadness deepened.

Today is Thursday. As I entered the ward, I noticed him looking toward the door repeatedly, filled with anticipation. After an hour, when I went to check on him, he told me he felt perfectly fine, and his pain had disappeared. Although he claimed not to have a fever, the charts indicated otherwise. He mentioned that he had slept for 5–6 hours the previous night and felt improved, though he had somehow forgotten to eat breakfast. He asked if the senior oncologist would visit today, and I nodded in agreement. I could tell he was very hopeful that he might be discharged.

After I reassured him, he had breakfast. When the senior doctor made his rounds and reviewed his charts, noting his consistently low counts, he informed him that he wouldn’t be discharged today. The doctor mentioned that he might have to stay until Sunday or Monday. Despite this, he was adamant, insisting that he could receive the transfusions and antibiotics in his hometown, regardless of the cost.

As the oncologist approached his bedside and gently patted his shoulder to offer comfort, he took the doctor’s hand and said, “Ab aik or minute bhi nahi raha jata” (I can’t muster the courage to stay here for even one more minute.) Tears filled his eyes, and this moment broke my heart. He was pleading to be allowed to go home today.

My consultant is very rational and brave; he never lets his emotions overwhelm him. However, I feel as if that moment affected him too. Perhaps this is just my assumption. He is very wise; he winked at me and said, “Agar counts improve ho gaye thore kal, to kya kehti ho tum; mera khyal hai hum discharge kar skty hen na?” (If the blood counts improve a little tomorrow, what do you think? I believe we might be able to discharge him.) Then he looked towards the nurse and said, “Han, aisa karo, kal bhej dena; mera khyal hai kal bhej sakte hain.” (I suggest you send him home tomorrow.)

Next, he instructed his attendant to take him outside in the sunlight. “Chalo, jaa ke isko dhoop mein bithao bahar,” he said. Just to make him feel a little less gloomy; maybe the sunlight will help lift his spirits. He wiped his tears with his hands and was pacified for a while, perhaps just for today.

I know the blood counts are too low, and we have to keep him for another day or two. I keep thinking about how I will calm him again tomorrow. What if my senior doesn’t come in, and his innocent questions break my heart? What if I lose my composure and start crying in front of all the patients? I know I have to handle the situation somehow, but his innocent face and tearful eyes are not leaving my mind.

I am thinking about what I should do tomorrow to cheer him up. Should I give him an Eid gift, bring him gaajar ka halwa (a delicacy made from carrots), or read him some inspirational stories to boost his morale? I need to ensure that my emotions don’t overpower my judgment and that I handle the situation thoughtfully. I certainly don’t want to get scolded by my consultant if he finds out that I didn’t manage the situation appropriately.

I pray he recovers soon, celebrates a wonderful Eid in his hometown, and that I can see him healthy and fit enough to see us for his next chemotherapy session. Amen.

Eid Mubarak to everyone who is celebrating!

Damane Zehra is a radiation oncology resident in Pakistan.