CURE, CARE and HAPPINESS

MEDICAL ONCOLOGIST

Dr Kumar just parked his car and inhaled a few breaths of fresh air to calm his nerves. This was like his first day in the city's famous 'St Florence Cancer Hospital'.It had been a long journey from Delhi/India to Manchester /UK. He was appointed Medical Oncologist seven years ago as a Consultant. It was the fruits of his perseverance at the university and his practice gained on patients at Budha Hospital in Delhi. Today he was going to attend the general meeting of his department's year-end budget requirements. It is being November and coming near Christmas he did not like the timing of the meeting. It could have been held in New Year after all the seasonal celebrations finished. Although he is not a Christian over the years he loved the customs and celebrations of the Noel, especially parties held in the hospital.

CEO of the hospital with other Trustees were going to be in a meeting to raise questions for ongoing funds shortages in general at the hospital. He was one of the best at getting extra finance for his department. He was trained and learned how to give the best treatment to his patients without sufficient medicine, equipment and money when he was working with a shoestring budget at the Budha hospital. Mastering the manipulation of the suppliers whether pharmaceutical companies or medical supplies were based on their ambitious sales techniques which he took the advantage of them. The UK pharmaceutical, medical and health insurance companies practices were no different in that respect surely they were more generous with their commissions. He had no problem with the annual review of his departmental budget.

"Hi, Mandy good morning, everything ready at the conference room ?" Dr Kumar asked. " Yes, I prepared everything including drinks, sandwiches and biscuits, also additional stationery on the table in case needed, Jack also tried the projector and the slides are all in working order. If you think of anything else let me know. The meeting will start in an hour will give you a ring," Mandy replied.

TWO PATIENTS

"Hi, Alan, it's nice to see you, time flies !! another monthly IV (intravenous) treatment day, please sign the insurance papers before we can start. I shall also organise new dates for blood tests and CT takings let you know later. Take a seat, will call you soon," Jane said, the nurse at the reception. Last five years, I am having Chemotherapy treatment which is the monthly sequence of IV drips of nine different medications. I don't know what they are for the only difference I can see is the colour and the time takes to complete each bag. It is a kind of patience game. It is not easy to spend nearly fourteen hours sitting on a chair and count the seconds, minutes, hours. The waiting room was packed as usual with similar faces. Always there are few missing replaced with new ones. I took my seat next to my friend.

"Hi Lucy, we meet again. How it's been last month. You look fine to me," I asked my friend of chemo. Once a month same dates we see each other. She has bowel cancer I suppose it is a different treatment than mine which is the oesophagus. "Not bad really, Dr Kumar says I am doing fine but no details really, keep coming back here for more drips, CTs and other tests. Pills given are killing me worst than the IV, I struggle with fatigue" said Lucy. "Same with me, It has been nearly five years we keep coming here every month for the same procedures and medications but no idea how the treatment is working with cancer. Dr Kumar is not informative. It is frustrating," I said. "In a way, you are lucky by lunchtime you will be leaving while I am still here till 9 o'clock in the evening," I sort of complained to her. " Not really, look at me I lost my hair, am much skinny and will feel awful with nausea, vomiting next few days, after every treatment, I am forced to stay in bed," Lucy murmured. I felt sorry for her but agreed with her comment. I only had some heat attacks and numbness in my feet after my IV treatments. Pills prescribed to me (24 of them per day ) did not have many sides affect but nobody knew what would be the long-term effect on me. She had already seen the Dr was waiting for the new arrangements and dates. "See you, Alan, I am finished for the day," Lucy walked away and left me on my own at lunchtime.

I had been seeing her last five years. Since we met the first time I liked her striking green eyes and long blonde hair before she was bold. She was forty-eight years old still attractive. We were both seeing the same consultant on the same date of the month on top of that with both had fifteen hours of operation for our cancerous tumours. It was like a bonding we always had lots of things to discuss which were common to our illness. We got to know each other and opened up about our normal lives. Small talks became more interesting and curiosity between ourselves grow naturally. Having Lucy as a friend was good enough at the time. Over the years of being together with her in the waiting and treatment rooms, my feelings for her were more than friendship but did not know how to express them. We had opened up to each other. I knew she was divorced and was living with her mum in York. I was being sixty-one had retired from my teaching post at Manchester high school due to my health. She was nearly sixty miles away from me around two hours driving distance. It was a matter of finding a way of getting in touch with her out of the hospital.

Me and MR KUMAR

"Hi Alan, How is my best patient today? Any complaints for last month," Mr Kumar asked. " I am doing fine nothing to mention really except a few morning sicknesses. On only two occasions I am getting side effects which are: first it is CT or MRI. I am getting hot flushes in my body might be the allergy to the Iodine given me by intravenously second is the monthly IV drips lasting nearly fourteen hours, in the end, I start feeling my feet are getting hot and swollen which is a very disturbing situation, they are lasting few days, had occasional numbness at my toes as well which is on and off" I answered. He stares at the pages of my file with a little smile on his face and starts scribbling some notes. That file looked like having very few pages in it whether it's good or bad I don't know. " See you next month, you doing very well, What you are mentioning are the general well-known side effects of your treatment. Don't worry just a piece of advice, put some skin cream on your feet when you are feeling like that." Mr Kumar ends the meeting. It is a similar routine each month very short and brief. I do not really know how my medications work in my body. No explanations were given by him. In that respect, I am in real darkness. " One more thing, I needed to inform you today that I shall cancel my private insurance effective from next month. Premiums are gone so high I can't afford them anymore. I shall inform the administrator," I told him. His face suddenly changed and became very serious after a few minutes of silence " Sorry to hear that, it has been nearly five years since you have been treated in my surgery. I can not let you down by letting you join the NHS group and will keep seeing you in my room till further notice. By the way, the good news is you are in remission will not need further chemotherapy. I just want to see the progress you will make after the next monthly meeting will see you initially every three months and so on. In the meantime, any problem just let me know," Dr Kumar finished his surgery.

MEETING

" Hello,' George (CEO) and the Trust members, (ladies and gentlemen) I shall open today's meeting with brief summary of the financial situation in my department, proposed for future projects and investments required for the patients' health. at the Medical Ontology Dept. I shall answer your questions at the end be patient with me, please.

I increased the Department's capacity of the (private patient) section twofold to make room for an additional 25 patients per month. This process will increase the present income (commissions)received from medication, pharmacy, equipment and private insurance companies by around 32%. I am also recommending cost-cutting proposals to the department managers to control the waste. As far as NHS patients are concerned government guidelines are observed and issued to the staff. We can only get supplies for certain medications and equipment to treat the patients. The Government's annual contribution to our budget is fixed and medical science directives are limited to utilise such as certain medicine and equipment. This means patients treatment periods are shortened, the amount of medication used is reduced to reach our department's targets till the next budget. It means hospital waiting periods for cancer patients has been increased and patient screenings are reduced. All the figures related to this department contribution to the St.Florence general budget is presented in our financial paper. I can take questions now:

George(CEO): On the paper, it all looks good and beneficial to our hospital expansion programme which is already under development of four floor separate building to accommodate and provide services to proton therapy, surgical operation rooms and additional long term wards for the patients. This will definitely be planned to increase the number of private and NHS patients registered with our hospital. But your proposals are contradicted our purposes, especially for NHS patients Am I right?

Dr Kumar: Not really, unless your instructions to me had been changed to accommodate your wishes. What I mean is multi-million hospital extension project has been subsided by all departments of St Florence. I only used parameters applied to my department. Proposed targets and numbers only show my interpretation of your project. I can not be responsible for other departments. Briefly, my department will accommodate more private patients and reduce to NHS patients not only to increase income but also cut the cost. In the end, numbers will be equated as you expected between system users. I am happy with my proposal.

Trustee: It looks like it is a little bit capitalistic approach to the health system. As far as I am concerned Your departmental work sacrificing patient health.

Kumar: I am sorry but I do not get engaged with the overall development of the health facilities in St Florence. When your general budget requires raising a certain amount of money whether it is government, charities or private health care schemes that can't fill the cash gap, departments are asked to do additional contributions to complete the project. I am one of them and my proposed income raise should satisfy your point. At the same time, the health of the patients which are taken care of, our statistics will show, we are doing a good job on that.

George: I think we are satisfied with your suggested methods. Any further inquires from the trust members can be done privately with the general budget requirements and other departments proposals. Thank you, Dr Kumar.

LAST APPOINTMENT

" Hi Alan, I am sorry you are leaving us. You do not need to sign anything today, you will see Dr Kumar soon. Thanks for the Christmas card and the box of chocolate. Take a sit Please," Jane made her remark.

" I believe this is your last visit I am told it's a shame, I shall miss you," Lucy sadly whispered. Just sit down next to her just staring at her beautiful eyes somehow I felt like a teenager not knowing what to say but had to pull myself together " I had private health insurance. In the last five years premiums are increased to a level I could not afford with my pension. It had to stop. The most amazing thing is apparently cancer was already in remission !!! Dr Kumar has already stopped the treatment it will be just regular visits to report in case of any future side effects. I shall miss meeting regularly with you. Can I have your mobile and email address to be in touch with you?" I had surprised myself with my last comment but could see a little smile on her face " No problem, I shall text you the details now give me your mobile number, will be nice to hear from you," Lucy said. It made my day. Next, I was called to Dr Kumar's surgery and she was gone.

She did not expect much from Alan's friendship at the hospital. It had been a very long time she was feeling, unattractive since she lost her hair, colouring on her face being so pale could not hide it even with her makeup and feeling lousy was not helping to be confident either. She was glad Alan had been a good friend since her divorce and start living with her mum, her life has been very lonely. Especially worrying about her cancer had not had time to enjoy and feel good. Initially, she did not find him attractive. He wasn't tall but stocky his dark blue eyes against his dark hair was like the colour of deep-sea one wanted to find out out the secrets of his life. When he asked her details suddenly she felt inside of her was like a volcano, could not help her trembling, heart beatings, first time for a long while she felt alive again. Having dates with Alan was going to be an adventure especially Christmas coming could not wish better present from father Noel. She had bad news before Christmas five years ago being told she had cancer. It ruined not only Christmas but her life. She felt this one was going to be special. It had been a good day.

FRIENDSHIP

In the beginning, we started texting each other every day but soon it turned to a few times a day. Today I needed to pass him the good news " I am in remission too, just got the message from Dr Kumar,", in return I had a smiling emoji message from Alan, just said "Perfect, see u soon," Later, I was on the phone talking to him. I filled him with the story of my being a private patient at the hospital " You know I was an NHS patient because my late father knew one of the trustees I could use the facilities there. It was a privilege do not know made any difference to my treatment but I am very glad I met with you, now I can start living my life again I am over the moon," She was happy, to be honest about it. " I can't wait to take you out for a good meal and celebrate the good news, we also need to make arrangements for Christmas, you need to see the decorations and the tree, " Alan said. It was clear to her they cared for each other. The romance was in the air, she decided to meet with him a week before Christmas. " If it's okay with you we can spend Christmas in Manchester, and welcome the new year at York. You can meet my mum and some other relatives as well," I asked Alan, " No problem I shall meet you next week," he said, everything was sorted.

We spent a week together. On our first day when I arrived at his house, he kissed me under the mistletoe which was unexpected but delightful. After that things start moving very quickly, visiting Christmas Market which was really magical, drinking hot mulled German vine, eating giant Franfruters, seeing the festive lights with the huge father Christmas and snowman blown up figures over the library was really exciting. By now we were an item holding hands, and kissing each other had become very normal. We were like teenagers in love.

After Christmas, we travelled to York for New Year. Alan met with my mum and relatives and friends. I had spent the last few weeks in a very special way by sharing all the beautiful memories and time with him. It had been a voyage of friendship during the last five years the way we helped each other through those difficult days. Now we could face the future together. Although as a word ' remission' is nice to hear there is no guarantee that cancer will not return for any of us we can't help but both worry. The only comfort we have is knowing that whatever happens, we will be there for each other. The future looked bright.

One thing is sure our fate brought us together how dreadful it was at the beginning at the end it had fetched so much happiness and love.

CONSULTANT

" Goodmorning, Mandy anything special today," DrKumar asked the secretary. "Nothing important George will be seeing you this morning will let u know, will bring your coffee soon," Jane said.

It was one of the days, Dr Kumar felt really stressed. He had lost two patients last month maybe the word 'lost' wasn't the right term to use after all they were cured and discharged from the hospital. Now they were outpatients. He treated them longer than other patients. He did not mind doing that if the patient was strong enough to cope with the side effects of medication. Of course, one of them being a private patient income has been beneficial to the hospital. Another had a new drug tested on her and seemed she had done very well with it. He just wondered how the future will shape for them they had become a statistic now.

He took a little whisky and poured it in his coffee although it was mid-morning he needed to calm his nerves. He did not know whether he should worry about it, anxiety and panic attacks were quite frequent recently, being a doctor did not fancy anti-depressant tablets. He could easily become addicted to them. Whisky seemed the best medication at the moment. Since his wife mentioned the growing mould on his right shoulder he became restless and tests showed positive growth of the tumour. It needed to be sorted but on this occasion, he was a coward and post phone the seeing his consultant friend in the hospital. He was not going to rush he needed time to sort departments problems.

"Hi George, take a seat," Dr Kumar shows him the sofa. " It is a little bit early for the strong drink in the morning. Are you okay?" George asked. "No problem it's just a celebration, I wanted to share with you! I had a call from Orbit Pharmaceuticals our New Year bonuses are confirmed and paid to our private accounts. They are happy with our sales figures and promised to reduce the price of their drug further. It is just for our hospital. It is a win, win situation for both parties. I treated one of my private and NHS patients with their medication, in the last five years she and him did very well hardly any side effects and now they are both in remission, discharged them recently," Dr Kumar said. " Goodnews, but keep quiet although remission is good and better statistics for our hospital we have to be patient to see what the future will bring to those patients. We have a few bad experiences with the after-effects of their drugs. I hope history does not repeat itself for your own sake, a few complaints are still registered with the Complain Dept. I saved your skin several times recently you owe me," George walked out of the office.

The truth was ugly for Dr Kumar.