In the quiet moments of illness, I witness love and loss unfold.

I usually place the beds of relatively sick patients closest to my workstation. While I can monitor all the patients, except for a few female beds behind curtains, this arrangement helps me keep a closer eye on those who are more ill, particularly those receiving chemotherapy.

Directly in front of my counter lies a 50-year-old gentleman recently diagnosed with primary CNS lymphoma. I admitted him a few days ago with altered consciousness, left-sided paralysis, and several neurological deficits. He is unable to speak or swallow, cannot change posture, and is mostly drowsy.

Before falling ill, he was a businessman who earned a decent living. As the sole breadwinner of his family, he supported three young children, all studying at different top universities in the capital. His earnings ensured the family lived comfortably, with good food and fine clothes.

Three months ago, he developed personality changes. At first, he was misdiagnosed with clinical depression. Later, scans revealed brain lesions. A top neurosurgeon performed the biopsy, and the cost of MRIs, CT scans, PET scans and hospital stay reached nearly 1.5 million PKR. Complications after the biopsy meant a prolonged stay in a private hospital, further increasing expenses. Health care in Pakistan is cripplingly expensive, especially in the private sector.

Within weeks, the family’s finances began collapsing. With tuition fees, utility bills, and no second income, they were overwhelmed. Eventually, they had no choice but to come to our hospital, where they could benefit from a government-funded patient support program. Here, their admission costs were minimal, and chemotherapy was almost free.

On their first day, when they wheeled him in on a stretcher, the wife and son looked around uneasily. Their appearance set them apart, elegant clothes, graceful demeanour, but their expressions betrayed disappointment. This was not the environment they were used to.

I took them aside, reviewed their reports, examined the patient, and explained his condition, treatment and possible side effects in detail. The wife was somewhat hesitant to admit him here and had reservations. She asked, “Where will the chemotherapy take place?”

“In this ward,” I replied.

“In these conditions?” Her disgust was clear.

She pressed further, “Are there any other options?”

“Yes, there is a private ward upstairs. But I would not recommend it there. I want him under my supervision. If a reaction occurs, it may be difficult for the staff to manage. Our nurses here are highly experienced with chemotherapy.”

They still inquired about charges, but soon realised they could not afford a private room. Though reluctant, they accepted treatment here because they were out of options.

We began with steroids, which improved him slightly. He refused a nasogastric tube, so he survived on a few spoonfuls of food daily with aspiration precautions supplemented by IV nutrition. Later, chemotherapy started. His consciousness fluctuated; some days, he managed to whisper a few words. His family, initially uneasy with the environment, grew more accepting. His children visited in the evenings, while an attendant stayed during the day.

I often notice him while doing paperwork. A few days back, I saw his youngest son resting his head on his father’s chest, while the patient, half asleep, gently stroked his son’s hair with his one working arm. It broke my heart.

One evening, when his friends visited, he cried silently. His wife told me that he was always the liveliest person among them. How painful it must be for him to feel so helpless in front of those with whom he once shared laughter, meals and his best moments of life, both in terms of finances and physical health.

After seeing him, I cannot help but reflect on how cancer patients are left without support when they fall sick or go through difficult times, especially when they have nothing material to offer in return. Even those who initially want to help eventually begin prioritising their own well-being, finances, and families. That is just how life is, I suppose. This man once received treatment at the best private hospitals in the city, even for minor ailments. He was the life of every gathering, enjoyed his hobbies freely, and ensured his children studied at top universities in the capital. Yet now, at the moment he needs others the most, all he got was a single visit from friends.

Every day, when I speak to him in the morning, the only word I catch is “Ghar,” home. His voice is so weak I must lean closer to hear. I reassure him daily, “Just eat two more spoons, and then I will send you home. Just two more spoons.” But inside, it breaks me, he is younger than my father.

His family surrounds me with questions every day. I try my best to be patient; I know their struggle. At first, they admitted him here only because no other hospital had a bed. But after his first cycle, they told me, “We want to continue here. Your care is much better.” That felt like an accomplishment.

When my consultant came for rounds, he asked about the family’s plans for further treatment and whether they were exploring other options. I explained that they were not considering any other alternatives. He did not say much in response, but I caught a faint smile on his face, which earned him a quick, disapproproving side-eye from me. He knows, as I do, that patients who come to our hospital, even those we refer elsewhere because of limited beds, often return. They come back for the same level of care they experience here and are hesitant to seek treatment anywhere else.

I often feel overwhelmed, and there are days when my consultant becomes the target of my frustration. He, however, remains calm. He tells me, “You are doing a great job. We are helping many patients who have nowhere else to go, and this is a great accomplishment. Do not give up.” His encouragement makes me proud, though I often reflect on the bitter irony: Health care has become unaffordable for so many. Even families with decent means are drained by the lengthy cancer treatment. They often come to us after undergoing expensive surgeries, biopsies, prolonged hospital stays, costly imaging, and numerous blood tests during the diagnosis phase. By the time they receive their diagnosis, they often have little money left to afford cancer treatment like radiation or chemotherapy.

Government hospitals, overcrowded and resource-limited, are still doing commendable work. Doctors are overworked, managing dozens of patients every day and collecting funds for medications that are either unavailable or not covered by the Sehat card. Despite the challenges, they continue to persevere.

To be honest, doctors and nurses working in these setups do not earn much, mostly just prayers, but even then, they face criticism when patients cannot get beds.

We are exhausted beyond imagination, but we try to remain patient each day. Thankfully, our families, colleagues, and seniors are supportive; otherwise, we might have collapsed long ago. Many days, I feel impatient and on the verge of tears; I can be irritable and complain, but my consultant always provides support. He never dismisses my concerns as invalid.

My parents are also very supportive. They do not pressure me to socialise or make me meet their guests. They do not expect anything from me when I get home and never scold me if I decline to do something. They see how hard I try to answer every call, respond to each message, and reach out to patients for admission if I suspect they are not doing well. They appreciate my efforts very lovingly.

What keeps me going are those prayers. Patients pray for my parents, my family, or even my future children. They call me their angel, hug me and proudly introduce me to their family members, saying, “This is our doctor, such a nice doctor.” That love carries me forward, even on the hardest days. Their love encourages me to keep going every single day.

Some days, I wonder how long I can continue. But then, I remind myself of a poem I read in childhood by Emily Dickinson.

If I can stop one heart from breaking,
I shall not live in vain;
If I can ease one life the aching,
Or cool one pain,
Or help one fainting robin
Unto his nest again,
I shall not live in vain.

Dedicated to all cancer patients who are resilient and courageous beyond imagination, and to all the supportive caregivers who do their best to show kindness in a world that is not always kind to them.

Damane Zehra is a radiation oncology resident in Pakistan.