So long dear friends, Al Vida!

Al Vida is a Hindi word meaning Goodbye! This year has been a bit rapid in the wrong sense! I lost three dear friends of mine to the almighty till today, 11th April 2017. I am not writing an obituary but I am writing random thoughts that come to mind when such deaths take place. I am now 67 and it’s not a big deal really to face that your friends or family are dying. I know the realities of life and know very well that one has to go at some stage. My first such experience was when I was in final year of school and I had lost a friend to destiny. I have written a blog on this event

https://panvalkarpramod.wordpress.com/2011/03/23/he-is-gone/. That time it was a big shock!

In my grandparent’s time, he died at the age on 89, reaching that age was a miracle! Medical science and other allied sciences were not yet really developed and reaching the age of 50 was a great feat. Probably this threshold has already gone up to 55, then slowly to 60. My father and father in law both died at the age of 63. Celebrating 60th birthday was a great event then. People were considered to be at their prime around age of 40/45. Things have really changed now; almost 10 % of my batch mates from engineering college continue to work and are in reasonable health. Another maybe 50% are in good health though they have retired. People go for walks, treks, climb hills daily or hit the gym.

Now people are considered to be in prime around the age of 55/60 and I have known a few who have started new ventures after crossing 60. Definitions of old age are changing rapidly in India, the age bar for doing new things, new achievements has gone up! Besides improvement in medical sciences what has helped to raise the bar? New technology has brought people together. The isolation that older people had to suffer is now almost becoming history because we are in touch many people and many of the contemporaries are still around. This has definitely added to improved longevity.

I only feel sad that two of my friends who died, passed away almost instantaneously. Third friend was unwell for a few months. I don’t know the details about their health status for the period before they died. My other friend Suresh who was an Air Force pilot, flying MIG 27, had once told me. “Pramod, planes are as good as the way they are maintained. Except for one system, all hydraulics can be checked on the ground; only one system gets checked during flying. Similarly there is no sudden heart failure; there are signals which are ignored or sometimes due to diabetes the person does not feel the pain.” Had these two friends been a little more proactive in getting themselves checked who knows….

In this world time is the same for everybody. One minute for me is the same one minute to everybody. How we use this one minute is what matters. If we are day dreaming, thinking of future for ten minutes, we lose ten minutes from the current time which we could have spent better. Similarly if we had used those ten minutes to remember what we had done in the past, the net result would have been the same. It is the current time that is THE time!

Out of the three friends that I lost one of them was current time person. He would enjoy life to the fullest, whatever he was doing. He passed early morning. He had just come back from a party a couple of hours before he died. He had the real zest to enjoy the life. His son had shared the following on Facebook, sometime back. It is a perfect fit to my dear friend’s style!

The Dalai Lama, when asked what surprised him most about humanity:

“Man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. Then he is so anxious about the future that he does not enjoy the present. The result being that he neither lives in present nor the future. He lives as if he is never going to die, and then he dies never really lived.”

My friend really lived life and it is not easy to be so zestful all through your life. Thank you dear for showing us the path how to live and in the how to go!  Goodbye, Al Vida, My angels!

Life’s Speedbreakers


Life patterns have changed for many in my generation in a way, at least I had never expected. In our parents’ generation 58/60 was the age for retirement. In those days most people retired and quietly went into the sunset. Deaths within a few years of retirement were very common, one of the reasons could have been there was nothing to look forward to! This was true in case of males, but women somehow remained busy with household chores, helping their daughters/ daughter in laws and grandchildren.

Our generation has seen things from bullock carts to electric/hybrid cars, snail mail (भारतीय डाक सेवा) to WhatsApp and god knows what in future! Going has been generally good. In our generations people try to work as long as possible because of reasonably good health, opportunities and will! When in life things are following a normal course, one tends to forget the human fallibility. Heart attacks, cancers, dementia, and accidents always happen in other homes not in my home! So we tend to breeze through and generally are in cruise control or auto pilot mode. We tend to forget that there can be speed breakers in our lives. I am writing about how I “flew” over a speed breaker, had rough landing and managed to go into “cruise control” mode again.

 Why this blog?

In life we have to face difficulties starting from family difficulties, to financial difficulties, health difficulties and so on. I thought I should share my experience with others to let them know that these are surmountable provided we keep a positive attitude in tough situations. Of course HIS blessings are the first thing you should have!! Which of above mentioned difficulties are tough to handle, everybody will have different opinion but in my opinion the above mentioned sequence is in reducing degree of difficulties. It is always good to have financial soundness plus decent insurance coverage. This puts your mind at rest about the expenses involved.

These tough times could be overcome mainly due family support and positive attitude. (By family I mean the family, extended family and friends) Probably the saying, “Tough get going when times are tough” is very apt here. During my treatment phase I have seen a patient go down as he did not have good family support. He required hospitalization and his wife never came to meet him! She was afraid of hospitals; he never recovered. So when there is a critical event in your home, it is not only you but your whole close family goes through tough times. Even if one cog in the system is weak, handling the same can be very very difficult. I was lucky we had no weak links!!

I have chosen to give this date wise activity to explain how my family and I took quick decisions to move fast with treatment. As they say Time (and Cancer) wait for nobody!!

The Story

I was continuing with my profession and was 64 years of age, in November 2013. Though my life was not very high speed life, it was reasonably busy. I was cruising in my life with manageable health issues and my mind set was as per previously mentioned thoughts, in short I thought I was infallible.

One fine day, I woke up with a squeaky voice (in retrospect, voice quality had changed a couple of weeks before) and thought maybe some oily foods or cooler weather is causing issues. I went to my ENT friend Vijay for the check-up; he suggested usual gargling and minor medication and said “call me when you get well!” After a couple of more check-ups and medications, including steroids Vijay said some more check-ups are needed. I was guided to Dr. Sant;

1st Dec 2013

On that day there was some health issue for our new born grand-daughter Rhea; I told Jaya and Priya that I will go alone for the check-up. I almost decided to go alone but Deepti insisted that Raju will go with me! Check-up was done using Stroboscope and Dr.  Sant said, Pramod I wish my diagnosis is wrong, but I am yet to make incorrect diagnosis. “You have cancerous growth on your left vocal cord and that is the reason for change in voice”! What a speed breaker! I bumped my head on the roof, was almost thrown on the wind screen! From Dr. Sant’s office, called Jaya and discussed. Called Dr. Atul (my nephew and physician) and immediately at 8 pm we went for CAT scan to check the spread, if any. Luckily no spread! On the way, ate something; diagnosis did not prevent me from getting hungry!

3rd Dec 2013

Second meeting with Dr. Sant and he had con call with Dr. Vijay and Dr. Bokil, Onco surgeon. Plan decided. 7th Dec Excisional Biopsy by Dr. Sant at Sahyadri Hospital.

7th Dec 2013

On 6th evening got myself admitted in the hospital, again Raju was great help! He stayed with me for the night. At admission counter, clerk said please get the patient; I said I am the patient! She was surprised, maybe I looked impatient!! At night, doctors wanted to take X-Ray. I walked out of the room towards X Ray area but the helper came rushing and said I must use wheelchair! I said why; he said that was the protocol and besides that doctors will blow him out if I don’t use wheelchair! Biopsy done on 7th, looks like everything went as expected. Was back in the room with major pain in the throat. Was back home in the evening, again Raju and Deepti took us home.

10th Dec 2013

The results declared, Dr. Sant passed with flying colours, cancer was confirmed.

14th Dec 2013

After discussions with Dr. Bokil, went to Ruby Hall to finalize radiation stuff with Dr. Maiya, Radiation Oncologist. Plan fixed. Dr. Maiya had told us at the beginning of the treatment, that in cancer treatment, upto 60% cure is due to family and positivity; balance 40% consists of medicines, doctors and equipment. If one remains positive, medicines and treatment are more effective.

  • Immunotherapy intravenous weekly- total 8 doses
  • 34 radiations

20th Dec 2013

First dose of immunotherapy given in ICU (just in case) and the radiations to be started within 2/3 days. Feeding tube inserted by Dr. Bokil through the nose for later use.

23rd Dec 2013

First radiation given; same day moved to new home next to Priya for easy management of the baby and grandpa!

Fell into a routine of leaving for Ruby hall 6.20 am daily.

24th January 2014

Radiation put on hold due to cough and minor fever. General weakness felt as Steroids, Antibiotics and drugs to check blood/sugar taking its toll! Sugar level checked thrice a day. Difficulty in swallowing solid food starts. A couple of feeds of liquid diet started. Body rash in head, neck and on back but manageable. Throat pain begins and so do pain killers; followed by cough bouts especially at night. I was not hospitalised but was at home right through.

2nd February 2014

Switched over 100% to liquid formula for adults; there are two of us on liquid formula in the house, grandfather competing with grand-daughter! For me it was delta change of switching from solid diet to liquid diet but for Jaya it was a logistics nightmare. Giving me first feed at 5 am so that we could leave home for Radiation at 6.20 am. Needed eight feeds to keep me going and in the whole process I lost only about 3 kgs. (Atul said weight goes down upto 10/15 kgs sometimes) My last daily feed was at 11 pm. Logistics for this feed was 15 minutes preparation, 15 minutes for feed and 15 minutes cleaning the stuff. Eight such feeds in a day plus tablets three times a day was also a feed because I could not swallow!! Plus managing day to day chores at home!! Phew! Plus managing phone calls, visitors (we had requested all to differ visits) How Jaya managed!!

16th February

Jaya had a very strong migraine attack and had to be hospitalised. On her way to hospital she called Ashwini, who rushed. She and Priya managed last couple of days of my feeds and otherwise!

20th February

Final radiation treatment!

Family Support

During all this process Dr. Gauri our niece came and stayed with us for 5/6 days. Priya was trying her best to support even while nursing the baby. Our son Sachin came from USA and stayed for two weeks. Last three days of the treatment was logistics nightmare. Jaya collapsed due to all the stress. She had an attack of relief migraine. Jaya went to hospital and checked in like hotel check in, got herself treated for 3 days, paid her bill and came back! Who managed me during this period? Our other niece Ashwini rushed at 1 hr notice and managed with some help from Priya. Who managed Jaya, God and family!! Of course Raju and Deepti were there to support all the time. Dada and Pushpatai was there for moral support. Situ, Ashwini and Anish came so did Mai & Nilkanthrao. Jaya’s brother Nanda a great support for logistics. Nikhil & Sushil were also a great help.

Friends Support

Jayprakash took Jaya to hospital when she had migraine attack, Sanjay came and met. Sharya, Ram Prabhu, Prakash Raykar came from Mumbai to meet. Chandru, Bhave, Bhide, Dada Parulekar, Santosh, Ajit, Pakya Nirgudakar (in spite of his own issues) barged in. Vijay & Madhuri came down from Mumbai. Jaya requested, Sudip, Rufus and many others to differ visit as she was getting overwhelmed! But Ranjith had come from Australia so came in with Rufus. Saurabh dropped in from Mumbai. There were so many emails, WhatsApp messages and so forth which was a reassurance that help was just one phone call away. I may have missed some names for which I may be pardoned!!

Unknown parameters

Initially I did not even know that there will be 34 radiations, I thought just one or two radiations and it’s done. I also did not know that immunotherapy was a full day affair of intravenous drug, and potassium support. Weekly blood/urine tests were also not known to me!!I also did not know that I had to wear Spiderman type of mask during Radiations!! Prognosis was the unknown factor but Doctors started indicating that cancer of vocal cords is a non-spreadable variety and there were chances that recurrence may not happen as the spread was also minimum. Fear of the unknown, honestly it was never there!

Medical fraternity professionalism

Atul, as the physician, was as usual there to indicate what can and cannot happen. Dr Maiya, Radiation Oncologist, was very clear in his thoughts and explained to us the complete roadmap during the treatment; it was like when the real issues will start, when they will taper off, what are the precautions to be taken; he was available 24/7 which luckily was not needed.

Emergencies

Once I was required to rush for chest x ray due to persistent cough, but things turned out to be normal. Once there was an indication of kidney function issue but Atul reassured that things were under control. No other emergencies cropped up.

Recovery

Dr. Maiya had explained how recovery will happen by talking my language, in graphical form. It took exactly same path indicated by Dr. Maiya. Within ¾ days of last radiation, I could switch back to bland but solid food. My throat condition would not allow me cold, sour, hot stuff. But it felt good to eat normal food. During first week of recovery, while surfing on the net, bought two tickets for Cricket World Cup final at MCG, (in March 2015!) maybe my way of declaring to myself that I am on recovery path. Started some normal activities, small walk, office for a couple of hours a day on alternate days, and then daily office for four hours. In June I started full fledge office and in July I started with out of Pune travel for work. During this phase some weakness was felt. Later on I started to drive  myself to travel outside Pune. On the whole recovery path was normal with no hick ups. Mental challenge was more than the physical challenge.

October 2015

Except the throat infections, I now do not have any issues. Throat area was directly bombarded with Radiations, so I am sure throat infections will keep on coming at more than normal frequency for some time. Life is back to normal; once in a while I have started thinking that I am infallible!! I travelled to Australia, will be travelling end of October to meet my sons’ family in Seattle. Travel for work is normal plus the greatest benefit is we had 2/3 get together meetings with friends!! What more can one want from life! I can confidently say that I am back to cruising mode thanks to Him, thanks to family and friends!