I had been trying to write this story for a long time. The topic is so heavy that it took a great deal of courage and emotional strength to finally put it into words. This story is not about a patient; rather, it is about a caregiver.

I met Mrs. N. in 2020. She travelled from Gujranwala to Islamabad (a distance of 223 kilometers) to begin her treatment. Mrs. N. was in her late 50s and used a wheelchair. She was accompanied by her daughter, who was around 25 years old and wore a strict veil. During our conversation, I learned that Mrs. N. was a widow and that her daughter was her eldest child. The daughter was well educated and had recently gotten married. Due to arthritis and obesity, Mrs. N. was unable to walk, which is why her daughter brought her to the appointment in a wheelchair.

Mrs. N. had a large breast lump which, upon examination, was found to be extensive, involving multiple axillary lymph nodes. It was unclear how long it had been present, as she had been ignoring it for some time. Eventually, when she realized the issue was more serious than she had initially thought, she sought medical attention. After further evaluation, she was diagnosed with locally advanced breast cancer, confined to the breast and axilla, with no evidence of distant organ involvement. Despite its advanced stage, it was potentially curable with aggressive and prolonged treatment.

Unwavering support

In her case, extra care and courage were essential. Even as a new bride who had relocated after marriage, I observed her daughter remain a constant pillar of support throughout the entire course of treatment. Mrs. N. underwent chemotherapy, followed by surgery, radiation therapy, and later hormone therapy. She was a timid person who required extensive counseling and frequent reassurance. Despite the long commute and her mother’s weight-related mobility issues, the daughter brought her to every single appointment. Whenever she sensed that her mother was experiencing side effects from chemotherapy, felt unwell, or needed medication adjustments, she was always present, without hesitation.

The treatment lasted more than one and a half years. Even after its completion, Mrs. N.’s morale remained consistently low. There was a striking contrast between the emotional resilience of the mother and that of the daughter. For nearly two years, the daughter postponed planning her own family because she was the sole caregiver for her mother.

About a year after completing treatment, the disease relapsed. By then, the daughter was pregnant with her first child, and her pregnancy was complicated. She developed preeclampsia and pregnancy-induced diabetes, yet she continued to support her mother through every medical visit.

This time, Mrs. N. was diagnosed with stage IV breast cancer. Another round of chemotherapy was initiated, but the disease continued to progress. Around the same time, the daughter delivered her first child (a healthy baby) without any complications. I remember feeling immense happiness for her. It felt as though God had placed a small miracle in her life, a quiet reward for her courage and persistence. Still, she continued to struggle with several post-pregnancy health issues.

The weight of two lives

Despite everything, the daughter continued to bring her mother to chemotherapy sessions from Gujranwala. The disease progressed despite second- and third-line treatments, and the course remained complicated. Each time a new chemotherapy regimen was started, Mrs. N. would briefly improve, only for the disease to worsen again. This cycle continued for another year and a half.

After all chemotherapy options were exhausted, she was started on oral targeted therapy. Hospital visits became less frequent, but the daughter remained in regular contact with me. We stayed connected throughout this period, and much of her care transitioned to online consultations, where I monitored her blood tests and overall condition.

The daughter now carried two lives on her shoulders. Her own child was growing, and exhaustion had become a constant companion. Her mother was bedbound and required palliative care. She transformed her mother’s room into something resembling a hospital suite, managing everything with remarkable precision. Over time, she became as skilled as a trained nurse. Mrs. N. remained bedridden for months, yet she never developed a single bedsore, a testament to the daughter’s meticulous care, frequent repositioning, and unwavering attention.

Over the years, I noticed the daughter slowly changing. She began losing weight. Her once-vibrant complexion faded, and she no longer sounded as lively as she once had. Yet I never once heard her speak about her own fatigue, her struggles, or the weight of raising a child without any additional support.

The silent toll on caregivers

To be honest, I have witnessed many such caregivers over the years, particularly those tending to patients requiring prolonged palliative care, or those for whom treatment did not work. Many of these caregivers seemed to have stopped living their own lives altogether. Their existence appeared reduced to fulfilling responsibilities, day after day. Some remained hopeful, postponing their own dreams in the belief that their loved ones would eventually recover. Many young people delayed marriage, left jobs they loved, or abandoned promising careers. Some returned from abroad to care for aging parents. Others devoted themselves entirely to comforting their loved ones, ensuring they passed away with dignity, surrounded by family.

Yet many caregivers resembled wilted flowers, emotionally drained, carrying unresolved grief and trauma from witnessing prolonged suffering. Many lived on the brink of collapse. Some cried openly in front of us; others swallowed their tears. Many appeared to have lost their sense of vitality, as though life itself had dulled within them.

Whenever a patient’s attendant informs me of their loved one’s passing and thanks me for the care provided during those difficult years, I find myself overwhelmed with emotion. They ask me to pray for the deceased, but I find myself praying even more for them, aware of how much they have silently endured.

I am reminded of a poem by the Urdu poet Waseem Barelvi, which begins with the line “Main ne muddat se koi khuwab nahi dekha hai” (I haven’t had a dream in a very long time).

I translate and dedicate this poem to all the emotionally exhausted caregivers of cancer patients across the world, especially those enduring prolonged illness.

I haven’t had a dream in a very long time
of a night filled with the fragrance of blooming roses
of the sun dissolving into drops of dew
of longing sounds rising from moon-like grains of soil
of staying behind in a village far from the city
of singing songs somewhere in fields and gardens
of leaving home at dawn and returning late at night
of the sweet tinkling of flowing streams
of branches laden with chirping sparrows
of innocence that sparkles in beautiful eyes
of a face that smiles while reading a poem
of belonging to someone and losing myself in love
of being called someone’s, and appearing mad with love
I haven’t had a dream in a very long time.
Please place your hand over my eyes
so that I may sleep for a while.

Damane Zehra is a radiation oncology resident in Pakistan.