Medical Lessons from the Death of a Poet

“this day’s dose/of viewing history at arm’s length…images leak out of our eyes/and vanish sooner than thought”...how perceptive and poignant.

This must be shared here...

Following is a review of Revathy Gopal`s book of poems published in The New Indian Express.

http://epaper.newindpress.com/
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Fresh and unpretentious, Revathy Gopal’s poems reflect many changing landscapes

BY VASANTHA SURYA

LAST POSSIBILITIES OF LIGHT By Revathy Gopal Writers Workshop, 2006 …when the words did come, There was not a heartbeat between vision and consummation. And the ribald roar of centuries Engulfed her ears, and realities merged And the world revealed itself, And the words came and came, To invigilate the dark arabesques of time…. …And sometimes love, at a seemingly eternal spring…

This extract is from Revathy Gopal’s “Lives of the Poet”. A last flash of insight before this outstanding poet died recently of cancer at the age of 59, it came too late to be included in this beautiful Writers Workshop collection. It ends with a vivid close-up of her yearning to live on, in progeny and in words: … She dreads the pungent air of the garden now Except with her daughters and sons about her, and their children Noisy and fractious, Tumbling about her heels.

Her poems reflect many changing landscapes, follow migrating populations, deconstruct old myths and icons, put them tenderly together again, sail history’s random currents. They also mourn and exult over loved ones lost and found. She refuses to be a disembodied androgynous voice.

Accepting unconditionally her time and place and her own existential niche, Revathy spreads tangible realities before the reader, in fresh, unpretentious poems. They’re like the modest heaps of vegetables and fish for two or three rupees sold by women squatting beneath the regular stalls at the wholesale market. You get some real bargains here, as you shop together for a meal you are going to share with her. We modern urban Indians have cultivated a taste for this fusion literature, suffused with familiar spices, and Revathy’s words, like fingers, pick out for us many curious tastes and textures from the akshaya paatra of our shared consciousness.

Craft and technique cannot be extricated as ideas separate from the substance of each poem. In ‘Cooking Lesson’ there’s an odd sense of words listening, rather than speaking, as a maid kneads the dough and tells her a story of endurance, but doesn’t tell her what the chapati is actually made of. “Somehow we never get that far,” says Revathy, peering in longing and alarm at the chasm between their two lives.

Another poem comments dryly on “this day’s dose/of viewing history at arm’s length…images leak out of our eyes/and vanish sooner than thought”. Poetry becomes the fulcrum to examine other times, other places, other identities, but without distancing herself to gain her perspective. A dust-laden statue of Queen Victoria conjures up “the long tedium of empire”, the shock of being robbed on a Barcelona street ends with a scream recalling Edward Munch’s famous painting, a refugee camp evokes “children first in the breadline/eyes glazed with fever or bright with hope…what hope”. In ‘City Spawn’: “Children get born/ and then,/get done in…Boys strut/become men in rut/in an unrecognisable instant”.

‘Girl-on-a-Swing’ is a small, fierce poem swooping down as though to rescue a girl savouring the last pleasure of her childhood before she “turns a bride, burns as a bride”. You see the occasional fang of a woman who has asserted herself without escaping. ‘Yashodhara’ is her rejoinder to Buddha’s sanyaas: “We prefer the pain/ of being human/ the bonds of attachment/ that you flee/ We prefer the endless cycle of birth and death/ to your inhuman/ and unavailing quest.”

In ‘Earth, Sky, and Trembling Hills’ Revathy’s poetic breath blows close above the tribal, “his body merging with the trees ...the tortured map of this country, allegory, fable, narrative…that can never be wholly told…” as he steps into a world of spiritual devastation. We can almost see the entire village on a railway platform: “straggling lines of women/trail their young, and/ the old men of the tribe/...move slowly…further/ and further away from their homes/…. to that dark, dense jungle/ they call civilisation.” There are some unforgettable love poems, like ‘That Nerve Ends Here’, a delightful complaint about a gossipy crow, and the uncanny, vertigo-producing ‘Life Cycles’: “…Hills slide,/ continents swing/ horizons ebb into the sea./ Sins live on/from unremembered lives/non-existent choices./ ¦ Freedom sings from vast distances.”

VSG -

Very sorry to read about your wife`s untimely passing away.

I guess that`s life.

I do want to mention that doctors and their medical staff all over the world can be extremely careless and insensitive in certain cases. There is no hard and fast rule. My aunt`s best friend in DC was to be operated for a breast removal as a result of cancer. She happened to be an attorney by background who liked to read all the medical nuances that were going to be inflicted on her body. My aunt was with her on the day of operation. They found out that the medical staff had noted down the wrong breast for removal. There was a lot of hue and cry that was raised. And the hospital staff was at the point of being sued for their carelessness. But again, had she not read what was stated in that diagnosis and the follow-up procedure then she would have gone through an agonizing episode.

Point is, in current day and age, whether you are familiar with the medical nuances or not, it`s important to review and analyze all the details of a medical report or diagnosis. In fact, I believe that one should make sure that one invests the time to dissect the results with the physician. These retards are paid for the services they are supposed to provide. They`re not doing any favor to anyone. In the US, these horrible creatures charge a hefty sum and create redundant invoices to be paid by the insurance companies. Once they know the patient is insured, then they know how to misuse their cash cow and make the insurance companies repent for insuring the patient.

You may like to explore the American Cancer Society`s www.cancer.org web page provided you still have any questions and clarifications. I have a lot of respect for this group and have also been a long time supporter of this organization that has a huge emphasis on creating awareness.

I wish you all the best in your life`s journey.

Regards.

Re: # 12
I`m not saying it was her fault!gastritis can be managed. I don`t know what would have happened if she had been investigated earlier. I have to say though, that given a metastasis to the breast is highly unusual, it sounds like she had cancers in both the uterus and the breast, which were probably oestrogen receptor positive?

Re: # 7

dear nb,

Thanks for your mostly valid observations.

Before the Ct scan of abd/pelvis, the patient has to drink that damn coloured liquid to the extent of one and a half litres. How is this possible for a gastritis patient WHO VOMITS AT THE DROP OF A HAT (sorry for bringing in the hat!)?

The cancer was very aggressive and hence three months prior treatment could have meant a lot to the patient.

Regards
V.S.Gopalakrishnan

Re: # 5

dear bjkumar

You are one of those learned and keen types as I have observed, and I have noticed from your earlier comments that you admired my wife`s writings immensely.Thanks. Yes, no cancerous demise can diminish the value of her expressed thoughts.

Regards
V.S.Gopalakrishnan

Re: # 4

Dear harimau,

i salute your wide knowledge. thanks for your comments.

in revathy`s case, the first problem was the lump in the breast. the surgeon who handled it WAS a pure cancer specialist in that body-section. when the uterus problem cropped up soon thereafter, we followed the `proper channel` procedure - carrying the uterus sonography report to him - which was disastrously cut short by non-referral to a gynaec along with advice loaded with false hopes.

Hope the position is clear.

Regards
V.S.Gopalakrishnan

Re: # 3

dear Zina,
your comments are valuable and medically very perceptive. thanks.

for breast/uterine cancer, AVASTIN is the MAB (monoclonal antibody)
that is prescribed.

regards
V.S.Gopalakrishnan

Re: # 1

dear Farzana,

Thanks. You and Revathy had a close bonding and your thought wave-lengths were marvellously identical.

I do believe that doctors do a difficult job. However, where life-threatening illness has to be handled, very great care and caution should be exercised by them and team-work always helps.In Revathy`s case, this did not happen.

Regards
Gopal
( V.S.Gopalakrishnan)

Just a few more comments-
There is no superspeciality in breast surgery in India-this would have been a regular surgeon, but I agree he should have sent her to see a gynaecologist, who would have probably wanted to do a D and C much sooner.
She should still have been able to have the CT abdomen/pelvis despite the gastritis. And yes, Ibuprofen, which would have caused the gastritis, does often need to be prescribed, but there hare alternatives and precautions that can and should be taken.
Also, I agree she should have had a full body scan-it`s not particularly expensive. I think most practice guidelines do recommend it.
In spite of all this, I do think your wife never really did have a chance. If there was extensive metastasis (and localised spread?) by September, finding it even a couple of months ahead would not have made a big difference....unfortunately.
This article must have been very hard to write. I hope you can get back to a semblance of normal life soon.

Mr. Gopalakrishnan:

Thank you for sharing your thoughts with us.

Regards.

Gopal,

Perhaps because of our desi training, we treat doctors (and sometimes our teachers) as authority figures who have to be respected and who must remain unquestioned. Since most doctors follow the rules of ethics to which they have taken oath and most diseases are routine diseases – it works out fine mostly. Unfortunately, cancer is anything but routine. And doctors are individuals with the shortcomings of the same. Sometimes they get overconfident, sometimes they become negligent due to other distractions and sometimes they have simply not kept up with the latest research. A wrong diagnosis or treatment plan can then result.

In many ways the internet has become a great equalizer which empowers the patient to do research on own and ask more questions from the doctor.

Cancer treatment has come a long way yet it is the human body’s ability to fight off diseases which is the true marvel. Not much is understood regarding why some people can resist longer whereas in others, the disease progresses very aggressively – as it seems to have done in the case of your late wife. It is human nature to try to second guess – saying.. “if only I had done that one thing different…” the truth is – there is no sure way to know and Monday-morning-quarterbacking is not of much use. The amount of “risk taking” that a doctor would consider acceptable is very much up to the individual doctor. In reality, no doctor can truly predict the future course of a disease in an individual patient – they all make educated guesses based on their own evaluation and understanding of the case and the statistics!

Your wife’s words touched a lot of individuals here and made a positive difference in many lives. For that, those individuals shall forever remain grateful – and no cancer can take away that accomplishment!

Dear Mr. Gopalakrishnan,

My condolences on the death of your wife.

I do wish to point out that medical practices vary from country to country.

In the US, doctors specializing in Obstetrics and Gynecology (OBGYN) have the option of doing a sub-specialty (after their OBGYN training) in Gynecological Oncology. These doctors then have the required background to identify, diagnose and treat various neoplasms involving the female reproductive system.

The error you might have unknowingly committed is using a ``breast surgeon`` - I would presume he is a general surgeon with training and experience in surgery of the thoracic region - because the underlying disease was identified as carcinoma of the breast. It is well-known that breast cancer is responsive in its growth to female hormones. A trained GYN-Oncologist would probably have recommended hysterectomy and oophorectomy (surgical removal of the uterus and ovaries) particularly since the patient was past child-bearing age. After surgery, it is imperative to continue consultations with the OBGYN rather than the surgeon.

As to the difference in medical tests such as whole body scanning that might have been initiated in the US (and was not done in your wife`s case), the additional possibility exists that in the US such scans are as much motivated by the doctor` desire to protect himself against malpractice as by concerns about the patient. A recent article in the New York Times (or, was it the Washington Post?) detailed the troubles a woman (I believe she is a reporter for the newspaper) had in trying to get a second reading of her breast MRI scan by a specialist after the MRI scan showed microscopic lesions and her primary doctor dismissed her fears. In addition, the takeover of health insurance plans by MBA-types who want to minimize costs has resulted in doctors being ordered not to discuss treatment options other than those preferred (meaning, the lowest cost option) by the insurance with the patient and/or family. This enables the insurance company to save hundreds of millions of dollars which is paid out in bonuses to the executives while the doctors fume and patients suffer. Believe me when I say that medical practice in the US is not what it used to be 20 years ago.

Again, my condolences. I do agree that with access to better-trained doctors, your wife could have survived longer. But then in India, we equate longevity in one`s chosen profession with competence. Once that mentality goes away -- as evidenced by time-bound promotions as opposed to merit-based promotions -- there is hope for improvement.

Regards.

Dear Sir,
Thank you for sharing this article which not only spreads awareness but reflects that despite many advances in health care and the ongoing battle against life threatening diseases there will be those unfortunate cases of lives lost due to mismanagement of their conditions. As a health professional I know that there is immense responsibility upon us to deliever nothing but excellent diagnosis, treatment plans, and follow up. The hurdles of resources, clinical tests, drug risk-benefit and time continue to challenge even the best of healthcare teams around the world. The price of error is life.
In response to the issues raised indeed survival rate improves with the use of monoclonal antibodies in combination with chemo in early stages, but that would be specific to the type of cancer as not all types can be treated this way. The debate of drug companies putting extortionate price tags on life saving drugs is on going and more so in the West where governments refuse to take it upon themselves to pay for treatments. Unfortunately in developing nations health care is still very much a privelege of the rich but no Doctor should withold treatment on just assumption. Options must always be presented to patients.
On the issue of why drugs like combiflam are still prescirbed-Ibroprufen like many drugs can cause extremely nasty side effects and its suitability for the form of pain being treated must always be considered alongside the tolerability of the patient.

You are a good example of how patients, and families can increase awareness and improve disease management alongside healthcare professionalsin a no-blame manner. We are all accountable for our patients yet we know life is in the hands of a Greater being. I am saddened by the your hard struggle and the loss of your dear wife. My sincere condolances and prayers for you.

Mr Gopalakrishnan,

My condolences on Revathy`s passing. Your experience is very upsetting and heart-wrenching.

Thanks very much for sharing this with us.

Best,
Rakesh

Dear Gopal:

Thank you for sharing this despite the deep loss that you and those who knew Revathy, in whatever manner, have felt.

This is an eye-opener and I can say from my own experiences that wrong or delayed diagnosis can be dangerous if not fatal.

The problem is we trust the doctors, and we don`t have a choice. I have gone through several days of agony only because no one could and can tell me why my blood count is so low...

You know the whole racket is to get you into hospital, admitted there. There is money to be made. Most diagnostic tests can be done at labs, and in Mumbai we have really good ones.

Personally, your article is a wake-up call.

Regards...