“Airports have seen more sincere kisses than wedding halls and the walls of hospitals have heard more prayers than the walls of churches.” – Anonymous

It’s 1 a.m. in the night. I am on call duty, which starts at 8:30 a.m. in the morning and ends at 10 a.m. the next day. I finished entering the labs and doing my final tasks at approximately 12:30 a.m. Then I ordered some food because I felt famished. The call was so hectic that I couldn’t think of eating the whole day. The food would be arriving in approximately one hour. When I walked into the on-call doctor’s room after the whole day, I couldn’t find any bedsheets or pillow covers. At this time of night, we usually go to the linen room to get these things. This is my favorite task at the end of the day; every night on call, I just make a very nice bed, change all the sheets, replace all the pillow covers, and empty all the dustbins. I don’t know whether I would be able to sleep or not, but I just do it out of habit, and seeing that bed gives me a lot of satisfaction, lol.

When I was on my way to the linen room, the corridors were all deserted. There was a lot of silence in the hospital, and I like that time a lot, the nighttime when most of the stable patients and their attendants are sleeping, most of the work has been done, and you are just on your own to think of all sorts of things and just have a few peaceful moments.

While passing through the deserted corridors at night, I always watch the caregivers and the attendants sleeping on the benches; their snores seem peaceful to me, at least. All day they are so worried, anxious, and questioning the doctors and the nurses, but when the night comes, everything comes to peace. I feel as if they are so tired and drained from the misery of the whole day that they just doze off.

Passing through these corridors of oncology floors at night gives me a lot of time and the atmosphere to reflect on the whole day. How many people would have listened to the word cancer for the first time in their life? How many would be worried while undergoing screening tests and praying secretly to God to have their reports with no cancer at all? How many Stage IV cancer patients would be thinking about the future of their children and family members today? How many patients and their attendants would be roaming around from hospital to another hospital just to find morphine or fentanyl for adequate pain relief? We are facing a lot of shortage of these effective pain medications just because of the lame excuses of our Drug Regulation Authority. Sadly, marijuana is available at every nook and corner in Pakistan, but cancer patients are suffering from excruciating pain just because of the unavailability of effective pain meds. I think about the number of patients we had been referred to hospice that day because they could no longer be treated. I think about the hint of denial, shock, and pain in the eyes of their loved ones when we break this news to them. I think about all those ladies who have complained of hair fall, the embarrassment of being bald, the loss of nails, and the ugly skin changes due to chemotherapy. And I also think about the lame excuses and solutions I have suggested to them the whole day just to cope with their problems.

I see a lot of people losing their loved ones, the cries, the pain, the last sighs, the color of death, and the last touches with the people they have loved and adored unconditionally all their lives. I think we are so busy with diagnosis and treatment that we always ignore the part of bereavement and dealing with the grief of the people who are left after the loss of their loved ones. Grief is not just about the loss of life; it is not actually about the physical presence of a person, but also the loss of the relationship, the friendship, the laughter, the intimacy, and the joy shared together. Grief is actually the loss of hopes and endless possibilities that could have been fulfilled once that person has been alive. Some of the grief is about becoming the person they could be if they had not suffered from the disease. Some grief is about the disappointment and darkness that the sole breadwinners face when they cannot find a way to support their own treatment and secure the future of their family when they no longer will be here for them. Some grief is about the loss of pride when a person has to ask for help just to meet the costs of the costly treatments. Some grief comes at the relapse of the disease about not being able to make good choices at the initial treatment due to cost and logistical issues.

Grief is not experienced by the patients or the ones who are suffering only; it is experienced for years by the caregivers and doctors, too. Just assuming that a doctor who has been in oncology for just 4 to 5 years would develop a very strong heart and mind is just a very silly concept. Sometimes, people can take years to master this skill and the ways to cope with their grief. I once read that grief could pass through generations if not tackled wisely and at an appropriate time.

I think there should be affordable and accessible sources to learn skills to cope with grief for everyone. Especially the people working in oncology, the patients and their loved ones, who are suffering on a daily basis and that too for years. We do not have very good accessibility and acceptance to the concept of therapy and mental health in our country, and I have seen people suffering for years. We are just relying on our religious teachings and are denying the importance of good and solid counseling and medication for psychological issues, and this needs to be addressed. In our country, we are relying on the role of oncologists for the extensive counseling of the patients on this matter, and that is not enough. We need more mental health specialists, priests, religious scholars, and psychiatrists to deal with these kinds of issues in an effective way.

From the book Harmony by Whitney Hanson:

I believe that there are two kinds of grief.
First develops immediately after loss.
It’s the type that tears at your soul.
And twists you into knots that you don’t think will ever unravel.
It’s the sinking feeling of loved ones in hospital beds
And people whose hands you will never hold again.

The second is the string of yarn.
Once you have untangled it all.
It follows you.
It snags on the shadows that look like the silhouette of people you once loved.
It catches on the corner of your smile.
And reminds you that love is a temporary gift at the end of the day.
It is the second kind of grief that saves us.
Because it ensures we never forget how precious life is.

Damane Zehra is a radiation oncology resident in Pakistan.