After being diagnosed with lung adenocarcinoma, a type of lung cancer at an advanced stage, my father died in December 2019 at 71. The ordeal we all went through over eight months of my father's struggle for survival taught me important lessons. The growing realization of my loss is an experience that I felt compelled to share. It is not easy to write about one's own loss, but since death is a part of life, my thoughts may be of interest to others.
My father's cancer was primarily treated at Mumbai, India. We gained the impression that his condition was improving, and that God willing, he would survive for a few more years. We were complacent and did not realize the urgent need for an open discussion with my father, about his wishes and instructions when he was no longer with us. Sadly, his cancer spread quickly and unexpectedly, and his health deteriorated very rapidly. The first lesson I learned was how crucial it was to spend more time with my dying father. A closely related second lesson is the importance of candid communication between patients and caregivers.
The third realization I had is, often we forget how labour-intensive and demanding medical care is. Medical care for complex diseases like cancer demands a huge amount of personal time by loved ones and requires caregivers to stay in close proximity to the patient. For terminal cancer patients, there comes a time when caregivers must stay with the patient constantly. The task of constant caring ultimately falls on the children, not hired nurses or benevolent relatives. Our parents deserve our time in those crucial final days.
Couples in my generation have two or fewer children on average and there is no guarantee that our children will be physically present at the time when we will need them. That is why I no longer think that having two or more children is a burden. In the final weeks before my father's death, we three brothers were staying almost as a joint family. It became so convenient as our absence did not alter the daily routine of our children's school, meal or sleep routines. But the major benefit was the increased bonding between the members of our three families. As my elder brother lives abroad, our children got closer and spent more time in physical contact than relying on electronic tools. This highlights a crucial fourth lesson: I am now such a strong supporter of the joint family that the so-called privacy of the nuclear family appears a mirage to me.
Cancer treatment is financially taxing. Being a financial planner himself, my younger brother set aside some money for our parents several years ago. When my father was diagnosed with cancer, we could move with lightning speed in getting the best treatment for him because liquidity was not an immediate problem. It was like having access to seed money for a would-be entrepreneur. Many families become financially indebted or experience an erosion of wealth from the cost of cancer treatment. This situation can be partially avoided through precautionary saving like a healthcare fund. My fifth lesson reminds me of an old Bengali adage, "sabdhaner mar nai" (precaution never loses).
Many patients seek cancer treatment in India. I now understand why. Many hospitals in India specialize in cancer so they have specialized nurses and dedicated personnel who can monitor patients during and after treatments such as chemotherapy. Since doctors only come during their visiting hours, it is the tacit knowledge of cancer nurses that becomes so invaluable. Indian doctors also seem to be more friendly in the sense that they are open to modern modes of communication such as email and WhatsApp and on a few occasions, they shared and discussed with me scientific research papers detailing the pros and cons of the cancer treatment that my father was getting.
Travelling to India with a cancer patient and living in a tiny hospital cabin is no adventure for any Bangladeshi. On top of that, there is the language, food and other unforeseen challenges that nobody wants to go through. The caregiver must do all the work alone in India, whereas in Bangladesh non-medical work can be easily delegated. Yet the only reason why the majority of Bangladeshi patients seek medical treatment in India is the supposedly comparative advantage of Indian doctors and nurses in dealing with complex diseases like cancer. India is also lucky to be a partner of several global pharmaceuticals who produce cancer drugs, and those drugs are not only available when one needs them, they are also cheaper than in Singapore or Thailand, two other popular medical destinations for Bangladeshis.
In the final month before my father's passing, he was admitted to a hospital in Dhaka, as my father was not in the physical condition to travel abroad. Both the oncologist and nurses were efficient, though my father was not given any cancer treatment as his body was very fragile. Knowing the daily ordeal of finding a vein, the oncologist advised an implanted port, a flexible tube that was placed on my father's right arm. The port made it easier for nurses to give intravenous medication and fluids, take blood samples, and give food for months. We appreciated this intervention so much and wished this was done earlier, it surprised us that it had not been done in India.
As the time and location of our death are predetermined, had my father quit smoking decades ago he would still be gone but probably died in a different way. Or, had my father refused the cancer treatment, as one of my Egyptian colleagues did in 2010, he would still leave this world but probably after suffering more physical pain. It is very hard to retain and practice an invaluable lesson learned from the passing of one's loved ones, that is "a life of moderation" is a key to a happy and balanced life.
My father got married in his early 20s. The age gap between my father and we three brothers was comparatively less than in other families. I got to see my father's youth when he was in his early 30s. Today, I might be financially better off than my father, but he was much richer in parenting more children than me. The long spell of time he got to spend with his children due to his early marriage is a blessing that I can only wish for. May his soul rest in eternal peace.
The author is Professor of Economics, East West University.
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