With A Cherry On The Top

With A Cherry on the Top

"This is one treat I am not going to share with anyone!"

I looked at Natasha, or Natie for short, and gave her a broad smile.

"Have as much as you want, my dear," I said between guffaws. I laid my notebook aside and got off my seat. Approaching this angelic girl, I placed my hand on her shoulder and pressed it reassuringly.

"Uncle, you are so ... er ... fantastic! I mean, like out of this world." She licked at the ice cream cone and laughed.

"I won't give up eating sweet stuff ever!" she declared aloud. I raised my right hand and gave her a thumbs up.

Natasha was nine. I had brought her to stay with my family after the death of her only surviving parent, Rajiv. He and I had been to the same college before he and I went our own ways. Life had dealt him a poor hand. His wife had died of a virulent pneumonia when Natasha had been barely four. Rajiv had then raised his only child single-handedly. Tragedy struck again when he was hit by a speeding car. He was grievously injured. Before he died, he had asked me to look after Natasha.

"Of course, I will, you goat! But sheesh ... Don't carry on so," I had muttered, "you'll be fine soon."

He did not pull through, and I took up Natasha into my household.

"We must legally adopt her," said Naina, my wife.

"Sure, we'll do that."

And so it was. This day, on 16th June, Natasha legally became my daughter. She still called me "Uncle", and I suppose, for some more time, she would continue to do so. So be it. I turned to Naina and smiled. She smiled back, and taking my hand in hers, she began walking to our car. Natasha followed merrily, her left hand stretched out into the afternoon breeze, while her other held the dripping ice-cream cone. We drove home to a celebratory repast.

:::::::::

It was about three weeks after this that Natasha wet her bed. Naina and I did what we had to, but did not speak about it the next morning. Then, the same thing occurred the next night. And the next one too. I began to worry. I waited till the evening and then gently called Natasha to me by my chair.

"Do you remember wetting yourself last night?" I asked her as gently as I could.

"No, I don't!" she said. Looking at me quizzically, she asked me if she had really "pee-d in the bed".

"Yes, darling, you did. Has it ever happened to you before?" I asked.

"No, never. Not here, and never when I was with Papa ..."

So saying, her eyes misted over and her face became thoughtful and serious.

"Oh!" was all I could say. I put my arms around her and drew her close to me. "It's okay, Natie. I will see what to do about this," I mumbled softly as I continued to cuddle her.

She looked at me then and said, "I meant to tell you this for almost a week."

"Tell me what, Natie?" I asked, alarmed that a week had passed since something had happened to her, and I knew not what.

"I ... I am not feeling too well, uncle," she began hesitantly.

"What seems to be the trouble, my dear girl?"

Natasha took a corner of her dupatta in her left hand and twisted it nervously. I waited patiently while she mustered up the required courage to say her thing.

"I ... it's like this, uncle ... I cannot understand why, but I get thirsty very fast ... I need to have water almost every ten or fifteen minutes. Then I have to run to use the toilet ever so often ... "

I recalled that I had observed this very thing some days ago when she was home on account of a school holiday. I had wondered why she was drinking so much water, only to go to the loo so often.

"And are you feeling a lot more hungry too?" I asked, wanting her to say "No" since I knew what a "Yes" meant.

"Actually, Uncle, yes, I do! Why do you think this is happening to me?"

Natasha was a thin girl with pretty features. No one in his right mind would imagine what I knew had gone wrong with her. Childhood diabetes. That was what I suspected.

"I think I know why, but let's go to my clinic tomorrow and run some tests on you, okay?"

"But what is it?" Natasha looked worried.

I was not going to label her a diabetic without confirmatory tests, so what if I was a kiddies' doctor. No way! I called up my assistant and told him to make arrangements for tests on Natasha. I discussed the whole thing with Naina at bedtime. She, too, wanted me to delay things no further. I would take Natie for her tests the next day.

:::::::::

Predictably, Natie was as shaky as leaves on a tree in autumn the next morning. She looked very frail and nervous in anticipation of the inevitable. Naina had called up her office to report that she wouldn't be in because of her daughter's illness. I left for my morning rounds at about 7:00 a.m. and arranged to receive Natie and Naina at my clinic at about 9 o'clock. Latika, my receptionist, and Salim, my lab attendant, were both ready to do their bit. I finished my rounds at about 8:45 and drove to my clinic just as Natie and Naina arrived.

"Is that going to hurt a lot?" asked Natasha, pointing to the needle and syringe that Salim was holding in his hand. While Natasha tried to smile bravely, Naina was clutching my hand till her knuckles turned almost white. Salim tried to make small talk as he drew a sample of blood from Natie. He then asked her to go to the loo and void a fresh sample of urine into a plastic jar.

After this, Naina and I retired to my rooms, where a breakfast of cheese crackers, Kellogg's cornflakes with strawberries and milk, and a hot cup of tea awaited Natie's attention. She ate little, but kept a cheerful face throughout the duration that we hung around in the clinic. Two hours after the first test, it was time to take Natie's blood again. We went through the rigmarole again. Finally, I told Naina that we were done here. The results would be known within a few hours. I told them to go to a nearby shopping and entertainment complex and have fun.

"I'll call you on your cell as soon as I know something." I told Naina as they were leaving.

I called in my first waiting patient.

:::::::::

Within five minutes of my seeing off the first patient, Salim rushed in with some papers in his hand.

"What is it? Is it ...?" I asked with bated breath.

"Sir, I think you'd better see these glucose levels yourself," said Salim, with not a little trepidation.

I was prepared for the worst, but even so, Natie's blood glucose levels shocked me. Her fasting was over 360 mg/dl, and her post-breakfast was a God-help-me 523 mg/dl! She was in the danger zone where a child diabetic can slip into coma!

I sat down resignedly into my chair. My hand automatically reached for the telephone. I asked Latika to immediately call Naina and ask her to come back to the clinic. To say that I was stupefied is an understatement. Natasha was a walking diabetic time-bomb waiting to blow up in our faces!

My mind blanked out for a short while. The next patient entered and sat across from me. Just as I was beginning to make my enquiries with the parents, Latika buzzed me.

"Sir, I have been repeatedly calling on madam's cell, but all I am getting is a busy tone," she said.

I felt frustrated and annoyed, but I kept my counsel as I did not wish to alarm my clients who had come to see me.

"Keep trying, Latika. I must have them back here as soon as possible," I replied and cut the line.

Back to my routine for now, I thought to myself as I smiled at the child sitting across from me.

Time went agonisingly slow. I worked continuously, asking Latika if she had succeeded in contacting Naina from time to time. No, she kept saying. I did not know what to do. I'll tell them when I reach home. Accordingly, I left for home at about 7:30 p.m., or near about dinner time. Thoughts of Natie going on two to three daily injections of insulin kept whirling in my mind.

:::::::::

Fully expecting Naina and Natie back home with many parcels of merchandise, I was astonished to see that no lights shone in our windows. The house was preternaturally silent. I approached the main door and let myself in. No one was home. I was completely flummoxed. I took out my own cell from my briefcase and called up Naina.

"Hello, Naina?" I began tentatively, not knowing what was happening.

"Hello, is that you?" asked Naina. She sounded panicky.

"What's the matter, Naina? Why are you sounding so troubled?" I asked.

"Er ... listen, Natie and I were having some ice-cream here in the park, when all of a sudden, Natasha whimpered, started sweating all over herself and just collapsed in my arms!"

"What?"

"Yes! This happened over 45 minutes ago. I tried to call your clinic, but I could not get through ... so I brought her here to the Sunville Hospital."

"What are the doctors saying?"

"They are unable to decide the cause of Natie's sudden deterioration, and are just waiting for the results of the preliminary tests," answered Naina.

The most dreaded complication of childhood-onset diabetes is diabetic keto-acidosis. This complication can sometimes be the presenting symptom in a child with diabetes. It occurs due to a sudden lack of insulin (the main deficient hormone) in a diabetic child who might have binged on a sugar-rich food just a few minutes to a few hours earlier. The child's blood sugar starts rising very fast, leading to a cascade of metabolic changes that culminate in loss of consciousness and if undiagnosed, death within hours.

This academic thought fairly raced through my mind as I took a few deep breaths and spoke to Naina.

"Listen carefully, Naina. Natie has diabetes. Did you get that?"

I heard a catching of breath. After what seemed to be an interminable pause (but in reality, nothing more than a few seconds), Naina acknowledged that she had heard me correctly.

I continued. "Look here, Naina. She will pull through. I'll be there as soon as I can. You must go to her doctors and tell them that she is a newly diagnosed childhood diabetic. Give them my name and number and ask them to give me a call on my cell-phone. They will know what to do once you tell them that she has diabetes. Did you get all that?"

"Yes, I did. Okay then - bye for now. Do come soon, all-right?"

I disconnected the line and paced about my room. Within a few minutes, the call from Sunville came through. Dr. Panicker introduced himself as a Pediatric Endocrinologist. He sounded unduly effusive.

"Hey, Joker, remember me?"

I was taken aback at this address and composed myself a bit. "Do you know me?" I asked. He had called me by my college-days nick-name.

"Of course, yaar. You were one year junior to me, got that?"

I racked my brains. An image of a cheerful, broad-shouldered, intelligent medical student with the largest beard this side of the Suez Canal came up before my mind's eye.

"Oh, Pots, is that you, my God!" I exclaimed, finding mirth even in my blackest moment.

"Yup, that's me. Your kid is admitted here with sudden unconsciousness and your wife says she is a newly diagnosed diabetic ... is that right?"

I told him the whole story and said that I was on my way soon. He signed off with a pleasantry or two, but I can't say I registered any of that as I was becoming too anxious to appreciate humour.

It was about ten minutes later that I parked my car inside the parking lot of the Sunville.

:::::::::

Natasha regained consciousness within one and a half hours after the insulin therapy was begun. Panicker was the doctor who came out of the PICU (the Pediatric Intensive Care Unit) and informed us of the favourable change in Natie.

I recognised him immediately, despite the fact that he had a much smaller goatee and he had slimmed considerably.

We hugged each other, while Naina and the others looked on with curiousity. I made the introductions.

"Hello, Mrs. Shenoy, " said Panicker as he shook hands with Naina. He added, "I remember your hubby was the brightest student of his class."

"How is Natie?" cut in Naina, almost embarrassing Panicker.

"Oh ... I am sorry to be flippant, but Mrs. Shenoy, fortunately, I bear good news. Natasha has come out of coma and is sleeping for now. We should have her out of the PICU within the next 36 hours."

Naina and I exchanged looks of relief. I requested to be allowed to enter the PICU and take a look at Natie.

"Of course, Dr. Shenoy, it'll be my privilege to share notes with you," said Panicker officiously. We both went in.

Natasha looked even more frail in bed than outside it. I went up to her and eagerly squeezed her hand. She opened her eyes and closed them back again.

"We have not sedated her at all. I think she's plain tired because of the onslaught of diabetes." revealed Panicker.

"Thanks, Hari. I'll be indebted to you forever," I said feeling very good now that Natie was out of imminent danger.

Naina and I retired to the waiting room to rest and discuss Natie's illness. Later that night, I was allowed to see Natie again.

She smiled at me when she saw me. I was moved to tears. I fought them off almost successfully, but Natie saw through the charade and lifted her IV-line inserted hand up to pull me towards her.

"Hello, Unc ... er ... Dad. You must be really mad at me for all this, right?"

"Of course not, my precious! We are so happy you are well for now." I said as I wiped my inexplicably watering nose on my sleeve.

"What is wrong with me, Daddy?"

I tried to brush away the question, but she persisted in knowing what had happened. I told her only that she had passed out while shopping with Mummy Naina, probably out of weakness.

She accepted the simple lie and held my hand while I leaned closer to her and brushed her hair away from her face. She kept smiling for a while. Then she asked how Mummy was. I replied that she was all right. She snuggled close to me while I let her remain where she wanted to. She went back to sleep after a while, her hand clutching mine with the same force that she had used while drawing me to her over an hour and a half ago. I left the PICU and Naina and I went home to wait out the night.

Neither of us slept much.

:::::::::

As Panicker had predicted, Natie came "out" of the PICU the next day, and was shifted to a special room in the Pediatric Wing. By now, Natie had recovered sufficiently enough to interact with Naina and me. She even joined us in a game of Scrabble® that we were playing late in the evening.

In the next few days, we took a discharge from the hospital. Natie would have to follow a strict regimen of twice-daily insulin injections and a rigorous diet that would restrict her intake of desserts, sweets and foods that tended to raise her blood sugar rapidly after being ingested.

It was so sad to take her blood for glucose estimations two to three times a day, but there was no help for it. My heart wept every time she winced as the lancet poked her finger for me to collect a drop of blood for blood glucose testing. However, she faced me bravely and even cracked jokes about this after a week had passed by.

Over the next fortnight, everything went well, and we began sending her to school. She, too, began to adjust to her condition and stopped complaining about the injections and the dietary restrictions.

We heaved sighs of relief as her urinary problem also began to come under control.

It looked as if the sun was again shining benevolently on us and the troubles that had dogged us for the last few months were now resolutely behind us.

:::::::::

Two months after this, Natie had an acute febrile illness that we initially diagnosed as a viral fever. During the illness, as was the rule, she received slightly higher doses of insulin. It was not necessary to hospitalise her right then, but to my dismay, her condition did not improve in the six to eight days that it normally takes for viral fevers to get controlled. In fact, not only did her fever persist, she also worsened vis-a-vis her diabetic control.

On the tenth day of fever, her blood glucose was over 320 mg/100 ml of blood, a rather poor level since she was taking insulin so often. On top of that I had to deal with the universal comment of being unable to handle the problem despite being a pediatrician...

I took her back to the hospital, but my stars were crossed, because all the beds in the PICU at Sunville were occupied by paying patients.

I discussed the issue with Panicker, who held that while he could not immediately arrange for a bed for Natie, he would certainly call me up as soon as it became available.

I decided to take her to a smaller private hospital owned by a doctor friend of mine. Naina was not agreeable to this since Dr. Oza's setup was a small one with no facilities for intensive care. I reassured her that there was nothing to worry about since we would be called to Sunville within hours.

"I still don't think we're doing this right, but you're the doctor, so I'll go along with you," said Naina.

"Oh come now, Naina, you are being unreasonable here!" I protested.

"Fine, let's not argue. Let's go, shall we?"

It was Naina who always had the last word. I kept my mouth shut and swallowed my pride. We reached "Oza Medicare Clinic" in about fifteen minutes. Rakesh Oza was only too helpful and we had set up an insulin drip within seconds. I drew blood for a fever screen and asked for an abdominal ultrasound as an additional precaution since Natie had been complaining of stomach pain since the morning.

In routine cases, sonologists simply "do" their work and we learn the reports afterwards. Imagine my surprise, therefore, when Prakash Jhaveri called me up at my clinic (where I had proceeded to see my patients after seeing to it that Natie was getting all the needed medicines).

"Sorry to bother you, Dr. Shenoy," he began deferentially.

"Yes, Dr. Prakash?" I responded, knowing that this was a courtesy call and nothing more since his patient (namely Natie) was a doctor's child.

"I am afraid I don't have good news," he said. A pit opened up in my stomach as I held the telephone receiver tightly. My hands became sweaty, and my heart started palpitating.

"Go on, doctor," I said nervously.

"Natasha is an otherwise healthy girl, and I was confident that I would find nothing on the sono," he said, and then continued as I listened silently, "but the moment I began the deep examination, I started getting abnormal echoes from the glands at the back of the abdomen."

Glands? Was he talking about tuberculosis?

"Carry on, sir," I nudged him when he stopped talking.

"These glands are pretty large and quite different from the many tubercular glands that we keep seeing day in and day out, and my feeling is that they are non-tuberculous," he said.

His silence allowed me to let the facts sink in. A non-tubercular gland in our country meant trouble of the worst kind, because tuberculosis is the unofficial national disease in India. I was devastated.

"Are you certain?" I asked, hoping against hope that he would laugh and say it was all a joke between friends.

He did not laugh. "I suggest that you see an oncologist right away, Dr. Shenoy," he said with finality and disconnected the line.

I cancelled all my appointments and called up Dr. Panicker.

"Hello, is that you, Shenoy?" he asked, having already recognised my voice and salutation.

"Yes, I am. Tell me, Doc, is that bed available now?"

"No, my friend, it isn't yet. Why don't you call me tomorrow? I think I should have a place available by then."

:::::::::

By the next morning, we had shifted Natie to Sunville Hospital. An oncologist, Dr. Shafiq Arab, was called to examine Natie, and he soon got involved in Natie's care. He immediately advised us to go in for a Magnetic Resolution Imaging - or MRI for short - a sort of non-invasive scan - to further study the lymph glands behind the stomach.

The MRI was unequivocal: Natie had malignant lymph glands, most probably a lymphoma.

Naina and I were at our wit's end. We cried a lot that night but decided that we would fight this menace with all our strengths. We would not give up. Not now, not ever.

Natie then underwent a series of tests and also an abdominal operation to take out an enlarged gland and to confirm the diagnosis, as well as to explore the cavity to see how far the disease had spread (a staging laparotomy).

After Natie had become lucid, both of us held her tiny hands in ours and laughed to hide our sorrow.

"Dad, Mom, I know diabetics do not get operated on. So - tell me, what is happening to me?"

Natie's question was salient, but it threw us off since we did not expect her to know about such things.

"Where did you read up on diabetes?" I asked her endearingly, my left hand's fingers gently combing her luxuriant black hair.

"Natie, you should be sleeping tonight without worrying," said Naina.

"I will, but will any of you please tell me what is ..."

"No darling, not tonight. Not till we have a confirmation of the suspected diagnosis, okay?" I countered.

Presently, Naina went out to refresh herself and to bring back a cup of coffee for me.

"I am dying, aren't I?"

I looked at Natie, not believing I had heard those words. I hugged her close to me. Her prescience was causing me to break down right there and then. I fought back my tears as I said, "Of course you are not ..."

"Dad ..."

I was still hugging Natie and did not acknowledge the whispered word.

She nudged me gently with her hand and said again, "Dad!"

"Yes, my dear," I said, wiping my eyes on my coat sleeve.

"Daddy ... why are you crying?" she asked.

"I ... oh no, why should I cry?" I replied with as much bluster as I could.

"You have been crying, and don't you try to lie to me, Dad."

There was an unnatural pause in the conversation.

I got up and began to pace the room. It was a bit odd for a diabetic to land up with a lymphatic malignancy. I have been a bright medical student and have a lot of qualifications, awards and recognitions, so don't think my grey cells were sleeping. I did not remember reading anything like this, ever.

I decided to consult the city's top endocrinologist and try and arrange a joint meeting with him and the onco-hematologist today. While I was thinking, Natie again called out to me.

"Yes, what is it?"

"May I have a fresh strawberry ice cream? Please?"

"No, dear, you know you have dia ..." I stopped myself midway. It seemed pointless ... or not, depending on what the results were going to be. I decided anyway to be cautious.

"No, no, no."

Natie grumbled a bit and turned her head to the other side and ignored me.

The results came in the same afternoon. Natie had non-Hodgkin's lymphoma, a particularly aggressive lymphoid cancer. The malignancy had spread far and wide within the abdomen, and had also spread to the chest. She would have to go on chemotherapy.

Naina and I had resigned ourselves into the hands of Fate. We had to keep smiling whenever we met Natie, however, and try and cheer her up. Thus, it was a great surprise to us when she asked me point blank this on the second day of her chemotherapy.

"Dad, these medicines that the doctors are giving me ... are you sure they are for diabetes and weakness?"

"Why ... yes, of course!" I lied blatantly. The lies were coming easily to me since Natie's diagnosis of a killer lymphoma.

"And," she continued, "is that also the reason the doctors poked me on the butt-bone and in my back?"

Non-Hodgkin lymphoma cases need a bone-marrow examination to rule out spread to the marrow - in which case the child is treated as a case of a particularly vicious form of leukemia (or blood cancer) - and they also need to have a spinal tap to rule out spread to the nervous system - in which case they also need repeated spinal taps to inject drugs almost weekly for one to two years.

In Natie's case, while the two sites had come negative, I knew that she would still need nervous system injections of slightly smaller doses of drugs to prevent neuro-disease.

I did not know how to reply. I fielded this question with a "I am not so sure, I will have to ask Dr. Arab," line, but then Natie countered with:

"I know what I have, Daddy, Mummy," she said.

"What? What are you talking about?" Naina asked, frightened so much she was clutching my hand as if in a vice.

"Go to sleep, Natie, precious, don't exert yourself like this," I said benignly, not wanting the next statement of hers to crush us.

She laughed and stood up off the bed. She hugged both of us and said, "No games with me, Dad ... Mom ... I have cancer and I know it!"

Both of us felt deflated and defeated.

"Who ... who told you this lie?" I demanded with a false bravado.

"No one. I simply put two and two together. See her?" She was pointing to a wasted old lady in the bed across the room from her.

We were so dazed by her revelation that none of us even looked where she was pointing for a full five seconds.

"Come on, Dad. Look at her." Natie was holding my chin and making me look at the lady in question.

She looked ancient, but I was sure she was barely in her forties. It was obvious that a malignancy was eating her up as well and she was not responding. Her head was practically hairless. Her cheeks were hollow and her eyes, sunken. The disease had ravaged her completely. She was staring vacantly around her. Her arms (such as they were visible) had large patches of bruises. I looked away from her. She was Death incarnate.

"What about her, eh?" I asked Natie, afraid of what she would say next.

"Well, she is getting two of the same injections that are in my medicine box here ... and she told me she has blood cancer."

The finality of her revelation left me with no option but to hug her tightly and cry openly. I drew her back to her bed, cursing myself for not insisting on a private room.

Naina and I sat down on the chairs next to the bed. I apologised to Natie for not having told her much about the illness that was causing her so much misery.

"I ... I have been wondering how to tell you ... but let me tell you the doctors are promising me that they will have the cancer out within a few months ... two or three cycles is what they said, darling ..."

Natie began to cry then. A loud wail that went on for a mere ten seconds followed by a whimpering that went on and on, cutting slices out of our hearts and causing us both to die little by little with her.

We all slept in each others' arms in the hospital room that night.

:::::::::

Two weeks into chemotherapy and we were having a tough time of it all. Natie was vomiting almost all the time, and bunches of her hair were falling out. We had taken a discharge from the hospital and took her to the hospital for her injections. After two weeks, we were all feeling exhausted. She was doing well as far as her diabetes went. Her blood glucose was varying between 90 and 134 fasting, a near normal value. This was heartening, but the leukemia: that was quite another thing.

Her white cell counts went down so rapidly after her fourth cycle that she had to be hospitalised to treat a fever. She responded within a short while, 3 days actually, and we counted our blessings. Then, a few days later, the fever came back with a vengeance and would not go despite the best oral antibiotic use.

Dr. Arab sounded me out that afternoon.

"Look here, Dr. Shenoy, I know it is a bit traumatic for the whole family, but I suggest that you keep her in the hospital this time. She has lost quite a lot of weight, and the fever is a worry too."

I was reluctant to do this because the hospital reminded us all of the deadly illness Natie was having, but I knew he was right. I had a long discussion with Naina, after which we both agreed that we would need to keep Natie in the hospital. I requested (and got) a private room this time.

On the first evening of this hospitalisation, Natie asked me to grant her "one last wish".

"Last wish? Why are you talking like this, my darling?" I asked her.

"Dad, stop pretending, okay? I know I am dying. So, don't go on living in a make-believe world, please."

I looked at my nine-year-old wise and intelligent daughter and tears of pride and sorrow flowed out.

"What do you want?" I asked her.

She became animated. She sprang off the bed and sat close to me.

"Promise me that you won't refuse me," she said, holding out her palm for me to take an oath on.

I held back, not knowing what she might ask. Naina nodded to me and holding my loose hand, she laid it on top of Natie's.

"Do it," Naina said.

"Okay, I promise."

"Good. This is what I want," said Natie, and continued with a smile, "a large strawberry Sundae everyday of my remaining life on Earth!" She was laughing now, seeing the horrified look on both our faces.

She added with a flourish, "With a fresh, ripe cherry on the top!"

I was totally flummoxed. I did not know how I would go about fulfilling her desire. Naina was less worried and squeezed my hand reassuringly.

"Right, we'll do it," I said.

From that day till the end came after two more agonising weeks, I faithfully brought her the promised ice cream at six p.m. everyday. It was a pleasure for her to lick off the cherry first and then the rest of the treat, with some ice cream melting and flowing down her wrist and forearm on to the dress and even on the bed at times. We laughed with her, and we cried with her.

And when the end came, we let her go - with a smile on her lips and tears in our eyes.

End

Please note that this is a work of fiction.