If you start picking signaling pathways involved in cancer and draw them on a piece of paper, soon you will end up with a jumble of network. It will put to shame, the intricate and illegal network of phone, electric, TV cables, all messed together on the busy junction of Chandani Chowk. To that complex network, throw in generous dose of gargantuan treatment guidelines. These are handbooks that Oncologist should follow while treating cancer patients. Some of them, such as NCCN guidelines look like randomly copy pasted paras from yellow pages, GOVT tender advertisement and “You are here” kind of park maps. Merging treatment guidelines and signaling pathways is like creating the “perfect storm” that you saw in the movie with the same name. If you have it under your belt, that is quite a feat. With some such thoughts brewing in my mind I was sitting in the lobby of one of the hospitals. I was waiting outside the consulting room of an oncologist, that I saw some posters made by kids. At the adjacent seat was a guy in his 35, with a file precariously hanging to his both palms. Some papers were jetting out of the file and somewhere I saw CRC scribbled. A case of colorectal cancer? Hmmm!! If he doesn’t have any family history, doctor may want to find his KRAS and NRAS mutation status to figure if the patient is eligible for a targeted drug Cetuximab. But in case his family history reveals that cancer might have been gifted to him by his family even before his first birthday, he should be screened for Lynch Syndrome. While I was thinking of all this, I noticed his wife was sitting right beside her and me sitting next to them automatically made me privy to their conversations. The guy was in somber mood, peered at the huge walls of the lobby. Doors to oncologist’s consulting room were very tall, thick, made of heavy wood. Those doors did not shed any warmth. Lobby was cold with spotless clean floor. A clean but sterile lobby. I would never want to die there. In the absence of warmth and without the blanket of emotions. His wife was happier than what I would have expected. She blurted out laughter while the guy still peered at the wall. He wore a simple plastic slipper that were slightly smaller for his feet and looked like he simply borrowed it from his wife. May be he was drained of thinking what is in store for him and he never cared about wearing right footwear. But why is his wife cracking jokes? Slowly I started slipping in their world, without knowing. May be they detected the case years ago, maybe he relapsed after first round of treatment. May be they are hard-pressed for the need of funds to meet the expenses of hospital and chemo. It must be quite an effort put up by his wife to make it lighter on her husband. Making him feel that things are not as bad as he thinks. Making him feel that she would be okay even if it comes to….that. While the man might have given up after multiple rounds of injecting toxic chemicals in his body.
I gasped for air and took in a lung full. In that period, I realized, it’s not just about correlating mutated genes to broken signaling pathways to tumor growth to possible treatments. Its more about correlating them to this family sitting in such sterile corridor, trying to fight the enormous sorrow that has fallen upon them.