My father died from Stage IV stomach cancer on March 5, 2016.
What follows was written before I knew exactly how little time remained.
At the time, I was not writing a story about death. I was trying to prevent one.
I was keeping notes because events were happening faster than I could understand them. Symptoms became diagnoses. Diagnoses changed. Hospitals led to larger hospitals. Questions multiplied faster than answers. Our family began reorganizing itself around beds, medicines, meals, reports, money, transportation, blood tests, doctors, lodging, and the fragile appetite of one sick man.
I did not yet understand that this is one of the ways death enters a family.
Rarely as a single moment.
First, it enters as inconvenience.
Then uncertainty.
Then fear.
Then logistics.
Only much later does someone tell you that time itself has changed.
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Part I: Before We Knew
My father first complained of an ordinary pain.
Nothing about it seemed worthy of history.
Families do not know which ordinary afternoon will quietly divide their lives into a before and an after.
He had recently visited Gaya. He was having stomach pain and feeling feverish. Something seemed wrong, though no one yet knew what. A local doctor suspected typhoid.
He was examined and prescribed two weeks of typhoid medication.
So we entered those first fourteen days still belonging to the old world, the world in which illness had a name, medicine had been prescribed, and recovery was expected to follow.
But after two weeks, Dad was not recovering.
His fevers remained high. His platelet count was low. He was extremely weak.
He had lost a great deal of weight, much of it muscle. His ribs had become visible. His thighs had grown thin. His back hurt badly.
The body was telling us something the diagnosis had not explained.
My family decided to seek another opinion.
Dad was taken to Mission Specialty Hospital in Durgapur.
There, doctors found a severe dengue infection and admitted him.
The infection had affected his liver and his small and large intestines. He remained at Mission Hospital for the next eight days and was also treated for stomach ulcers.
His white blood cell count was 21,000.
Then it rose as high as 29,000.
Things were not looking good.
And then, slowly, they did.
He improved enough to be discharged.
During that hospitalization, doctors had looked everywhere they knew to look. X-rays were taken. A CT scan was done. An MRI was done. Tests accumulated around him.
Nothing appeared suspicious.
Nothing suggested the thing that was already growing inside him.
As far as we understood, this had been a severe infection. Something frightening, but treatable. Something from which a person could recover and return to ordinary life.
Dad came home with follow-up appointments scheduled at Mission.
He was still weak, but he could eat. He could talk. He was home.
Yet his back pain remained.
His appetite was poor.
He had severe constipation.
And despite the treatment, something fundamental was not improving.
Then one night the fever returned.
His health and energy collapsed.
We did not know why.
No one knew why.
That may be one of the most frightening sentences in medicine.
We do not know why.
Illness is easier to bear when it has borders. A diagnosis gives fear a shape. Even a terrible answer can sometimes be more merciful than a growing mystery.
But Dad’s illness kept escaping its explanations.
It was time for a larger hospital.
My brother, one of my uncles, Dad’s younger brother, and one of my cousins took him first to Kolkata. From there, my brother, uncle, and father flew to Chennai.
They were trying to reach Christian Medical College in Vellore.
And somewhere during those weeks, before anyone had told me what was really happening, I began to feel afraid of a word no doctor had yet spoken to me.
Cancer.
I told Neha, my fiancée, that something felt wrong.
For reasons I could not explain, I had spent the previous two or three weeks reading about cancer, researching it, watching documentaries about it.
I did not know why.
I only knew that an uneasiness had begun gathering inside me before the diagnosis arrived.
Years later, I still do not know what to call that feeling.
I do not need to name it.
I only know that before medicine gave us the word, some part of me had already begun fearing it.
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Part II: The Long Diagnosis
January 29, 2016
Day 41
I arrived in Bangalore at 3:55 in the morning on Friday.
There is something strange about arriving in a sleeping city while someone you love is seriously ill somewhere beyond it. Airports are still functioning. Buses are still running. Vendors still count change. Roads continue carrying people toward ordinary appointments.
Your world may be breaking.
The rest of the world remains on schedule.
At four in the morning, I took the Vayu Vajra express bus to the Majestic interstate bus terminal. I reached around five.
From there I took another bus to the satellite station.
Then another bus toward Vellore.
The fare was Rs. 152.
From the Vellore bus stand, I took an auto for Rs. 70.
My cousin received me and brought me to the lodge where the family was staying.
The place provided the bare minimum.
Its hygiene was acceptable, though with open questions.
By one in the afternoon, I was at the hospital with Dad.
We were expecting to meet the cancer specialist at two.
A stomach biopsy had been performed.
We were waiting for the results.
Waiting for a biopsy result is a peculiar form of time.
You are still technically living in the world you knew.
But somewhere in a laboratory, a truth already exists that may destroy it.
You simply have not been told yet.
January 30, 2016
Day 42
I woke at five.
Jet lag had ended my sleep early.
After briefly talking with my brother, I left for the hospital.
It was still dark.
I walked along the main road looking for better lodging, particularly somewhere with a kitchen.
Already, care was turning into infrastructure.
Where could we sleep?
Where could we cook?
Where could we buy supplies?
How close could we stay to the hospital?
I searched for shops and medical stores where I might find paper rolls, plates, cups, and other basic items.
Then I entered the CMC campus and walked through it so I could understand the geography of the place: the blood bank, OPD, Radiology, the Scan building, the different wards.
When someone you love becomes seriously ill, you begin learning a second city inside the city.
Not streets and monuments.
Elevators.
Laboratories.
Pharmacies.
Ward numbers.
Billing counters.
Blood banks.
Places where bad news is delivered.
During that early walk, I saw women praying in the chapel and at an outdoor stone vigil lit by candles.
I noticed them because I had entered that condition in which everything begins to look like a possible language of hope.
I returned to Ward W, where Dad was staying.
I paid Rs. 200 to the overnight caregiving woman, the aaya. She asked for some money for morning tea, and I gave her another ten rupees.
The hospital allowed only female companions or caregivers to remain overnight with patients. Male family members were allowed in limited numbers, a maximum of two at a time, between six in the morning and nine at night.
Men could sleep outside the ward near the elevators if they wished.
By then it was becoming obvious that bringing Mom might make sense, or bringing someone who could devote herself to cooking healthy food.
But that solution created another problem.
Mom had serious knee trouble.
Caregiving seemed to reproduce itself.
One sick person did not eliminate everyone else’s frailty.
It revealed it.
And I began noticing something else that disturbed me.
The basic conditions surrounding caregiving felt dangerously inadequate.
Families caring for sick relatives were themselves sleeping poorly, eating poorly, staying in poor lodging, struggling with hygiene, and improvising their way through habits that could expose already vulnerable patients to further infection.
Something as simple as washing one’s hands properly before feeding a patient could no longer be treated as small.
So I made a list.
Paper cups.
Paper plates.
Spoons.
Knives.
Plastic food wrap.
Aluminum foil.
Straws.
An RO water filter.
A juicer.
Napkins.
Kitchen rolls.
Toilet rolls.
Shampoo.
Skin moisturizer.
Antibacterial hand sanitizer.
A writing pad.
Vomit bags, or lunch bags that could serve the purpose.
Plastic bags.
Facial tissues.
Wet wipes.
The list may appear trivial beside cancer.
It did not feel trivial there.
Cancer had entered our family as a biological catastrophe, but caring for cancer was becoming an accumulation of tiny physical acts.
Clean this.
Carry that.
Buy this.
Feed him.
Wash your hands.
Find water.
Find food.
Find somewhere to sleep.
Find the doctor.
Find the report.
Find the answer.
We were still buying food from outside, from street dhabas, both for ourselves and sometimes for Dad.
I found this increasingly difficult to accept.
I wanted to save my father.
I also wanted the people trying to save him not to become sick themselves.
I knew we needed fresh fruit.
We needed to make juices ourselves.
We needed to prepare meals.
We needed basic cooking utensils.
We needed a smartphone with a local SIM card.
We needed an iPad or something similar for Dad’s entertainment.
Every answer created another task.
And every task competed with the same diminishing resource.
Time.
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Later that morning, around eight, the hospital performed a routine blood test.
Only one tube was taken.
I remember watching it and immediately thinking about Dad’s weakness.
If blood was being drawn regularly while he was barely eating, how would his body keep up?
My mind began operating continuously in this way.
What is being lost?
What needs to be replaced?
What is causing this?
What have we overlooked?
How do we improve the system around him?
At the time, I believed he needed a nutritious diet throughout the day to compensate for his poor intake and ongoing testing.
I was still thinking like a son who believed enough vigilance might discover the hidden lever.
At 10:30 that morning, the chief oncologist came to see him.
Afterward, he met with my brother and me.
The doctor began with the sentence that changed the architecture of our lives.
“It’s a Stage IV cancer because it has spread all over the bones and into the lymph nodes.”
There are sentences after which the room remains physically unchanged but nothing inside it occupies the same place.
Stage IV.
Bones.
Lymph nodes.
The doctor continued.
There was no cure, he told us.
Gastrointestinal cancers were difficult. In his explanation, they did not respond to chemotherapy as well as some other cancers such as certain breast or lung cancers.
His plan was to begin chemotherapy on Monday and administer it weekly.
They intended to use smaller doses, which he said would cause fewer side effects while providing similar benefit to larger doses.
My brother and I asked questions.
We had arrived with the ordinary human hope that somewhere inside medicine there must still be another door.
The answers kept closing them.
What was the primary cancer?
The stomach.
Squamous cell carcinoma, according to the diagnosis we had been given.
How far had it spread?
Into the bones.
All over.
And into the lymph nodes.
Which stage?
Stage IV.
What was the prognosis?
The doctor referred us to what the available data showed.
Could they operate on the stomach?
No.
Not now.
Not later.
The cancer had already spread to distant parts of the body.
Could chemotherapy be combined with radiation?
Radiation, we were told, would be used to alleviate pain. It was not being offered as a cure.
Could surgery become possible after chemotherapy or radiation?
No.
Again, the metastatic spread ruled that out.
What had caused it?
Bacteria?
Genetic mutation?
Environment?
Food?
The doctor said they could not know.
It might have arisen from any number of causes, perhaps several acting together.
The cancer had probably been growing for years without warning symptoms.
That, he said, was part of the nature of the disease.
He also suggested that it might not represent a particular hereditary mutation because such cancers can sometimes appear earlier, in the forties or fifties. Since Dad was almost sixty, the doctor considered it more consistent with a cancer appearing with age.
If treatment went well, what would change?
As long as chemotherapy controlled tumor growth, we could continue.
But eventually, he said, the cancer would overtake the chemotherapy.
Had it entered the bone marrow?
Yes.
How extensively were the bones involved?
All over.
Every bone contains marrow, he explained, and evidence of cancer was appearing throughout the bones.
The meeting ended.
The questions did not.
I walked away from the hallway in Ward W with more questions than I had carried into it.
How much of the stomach contained tumor?
Did we know the original location?
Was there one source or several?
How extensively were the lymph nodes involved?
Could DNA testing be performed on the cancer cells and compared with Dad’s normal cells so we could identify the mutations?
A doctor had earlier mentioned that the bone marrow looked sickle-shaped. Did Dad also have anemia? Were we dealing with a second problem alongside the cancer? Why did those cells look that way? Could this explain some of his fatigue? Could anything be done?
What about immunotherapy?
Had he been tested for H. pylori?
And more questions were already forming.
I felt an urgent need to research.
I also believed we needed another opinion.
Something inside me resisted the idea that our only task was now palliation.
I understood the need for comfort.
I wanted his pain treated.
I wanted every available measure taken to improve his quality of life.
But he did not want merely to be made comfortable while dying.
He wanted to live.
He wanted to take care of my mother.
He wanted to leave the hospital.
He wanted to become healthy and functional again.
The doctor had told us what medicine believed was possible.
My father was still asking life for more.
And I was not yet ready to tell either one of them that the other had won.
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Part III: Learning to Become Caregivers
January 31, 2016
Mom and my younger uncle were expected on Tuesday.
Mom was also searching for a full-time cook who might come with her.
This felt like very good news.
For another two days we would still have to buy food outside, but we could at least be more careful about what we ate and what we gave Dad.
Two of my brothers went searching for a cleaner, larger lodge with a kitchen and reliable phone connectivity.
We had been living with almost no internet access at either the hospital or the lodge.
Before this experience, internet access might have seemed like convenience.
Inside a hospital, it became part of our survival system.
Questions emerged constantly.
Doctors were caring for enormous numbers of patients and had limited time.
Information arrived in fragments.
A phrase spoken during rounds could occupy your mind for hours afterward.
What does that term mean?
What treatment exists elsewhere?
What are the success rates?
What are the side effects?
What questions should we ask tomorrow?
When your family is drowning in information, the internet becomes one of the few places where you can surface long enough to orient yourself.
Neha, meanwhile, discovered research suggesting an association between blood group A and stomach cancer.
Dad had A-positive blood.
So did my brother.
So did I.
I remember that detail because after a diagnosis like this, every fact begins looking backward at you.
Blood type.
Diet.
Family history.
Years.
Genes.
You begin searching the past for something that will explain the present.
My friend Alam urged me to seek another opinion.
His father had been diagnosed with early-stage colon cancer and had been successfully treated at Tata Memorial Hospital.
Alam told me something practical that became immediately important.
Get the biopsy report.
And get the slides.
He warned me that another hospital might not accept the biopsy report without the actual pathology slides. He told me to insist on obtaining them.
Cancer treatment, I was learning, is rarely one doctor’s solitary decision. Pathology determines the type. Specialists interpret the findings. Teams decide what can be attempted.
Behind one word, cancer, stood an entire machinery of classification.
The ward nurse told us a new bed was ready for Dad.
The attending doctors came by.
I asked whether the new room would have a small refrigerator.
There were several room categories at different prices, they explained, and we should ask the ward nurse.
Dad heard us.
“How much is the room?” he asked.
I told him.
Rs. 3,050 per day for double occupancy.
Rs. 5,500 per day for a single room.
Rs. 10,000 per day for a corner single room with a refrigerator, telephone, and other amenities.
His face changed.
“It’s very expensive. How will we afford?”
“It’s not much,” I told him. “We can afford.”
“But if you add up for a month, it’s a big amount.”
Then he began to cry.
My Phupha and I immediately tried to reassure him.
The treatment was within our financial capacity.
All of us were contributing.
He did not need to think about money.
His job was to eat.
To take treatment.
To become stronger.
To leave the hospital.
By then my brothers had returned and saw him crying.
“What happened?”
“Papa is taking stress about money,” I told them.
They joined us.
We repeated the same thing.
Do not worry.
We are all in this.
Focus on treatment.
But the tears continued.
And beneath the words, I understood something he never fully said.
All my life I worked to provide for my family.
I saved what I could for them.
Now I may spend what I saved on myself.
Illness had attacked not only his body.
It had entered his identity as a father.
A man who had spent a lifetime understanding love partly through provision now feared becoming the reason those provisions disappeared.
What does a man do with that?
What does a father owe his family when remaining alive itself becomes expensive?
What does a family owe the father who once carried them?
These questions do not belong to economics.
They belong to love.
There was nothing I could do in that moment except keep telling him that money was not the problem.
Yet I understood his tears.
I knew what they meant.
And somewhere inside myself, I made a private decision about what I would do when the opportunity came.
The head nurse arrived.
The new bed was ready.
Pisa fed Dad a banana.
A wheelchair was brought.
We helped him into it and began moving toward Room 713A.
The seventh floor of Ward A housed cancer patients.
Dad received Bed A in Room 713.
The room had a television and air conditioning.
The bathroom was larger and much cleaner than the previous ward.
The other patient in the room was a ten-year-old boy with leukemia.
His grandmother was staying with him.
The boy had suddenly become sick. Doctors discovered that his body was not making blood properly. The physicians in Patna had told the family to take him immediately to Delhi or Mumbai.
They chose CMC.
He was ten years old.
And he spoke about chemotherapy with the strange authority children sometimes acquire when life has forced them to learn things no child should need to know.
He explained his experience.
My brother pointed him out to Dad.
Look at him, he said.
Look how much energy he has.
Listen to him talking.
My father looked at that child and found strength.
This is one of the mysteries of hospitals.
The sick sometimes become medicine for one another.
Not by curing anything.
Simply by continuing to be alive in the next bed.
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Later that afternoon, the three brothers went out looking for an apartment we could rent for a couple of months.
Eventually we found a place with a reasonably sized room, an attached kitchen, and a bathroom.
While waiting for an elevator, my brother looked several times into an open room.
The people inside seemed to come from our hometown.
They were curious about us too and invited us inside.
We accepted.
They let us look around, answered our questions, and offered us thekwa.
Their father was there because he had paralysis in the lower half of his body.
By then I had been in Vellore only a few days.
Yet I had already encountered so many sick people that something inside me had begun changing.
Every room contained another family.
Every family had arrived with its own catastrophe.
Cancer.
Leukemia.
Paralysis.
A child whose body could not make blood.
A father unable to move.
A mother sleeping beside a bed.
Someone waiting for results.
Someone searching for money.
Someone praying outside before sunrise.
The hospital had compressed human suffering into floors and corridors.
I felt as though my heart lived permanently in my mouth.
And somewhere inside my mind, it wept.
⸻
That night, at around 9:30, we returned to the lodge.
The 2016 Star Movies Awards were playing on television.
I lay on the bed with Pisa and my cousin while my brother arranged a place for himself on the floor.
Then my cousin asked whether he could ask me something.
“Yeah, sure.”
“Why did you do love marriage?”
I corrected him.
“Not marriage. We are engaged.”
He continued.
Why had I chosen that path?
The family had not expected it from me.
He spoke about how much hurt it had caused.
He said he was not arguing whether love marriage was right or wrong, but in his view people who chose it were selfish.
I was stunned by the timing.
My father had just been diagnosed with metastatic cancer.
Every hour felt unstable.
We were trying to understand chemotherapy, prognosis, lodging, food, medical reports, and whether another hospital might offer something CMC could not.
And here, in this small room, another old family conflict had somehow survived intact.
I argued with him.
I pointed to contradictions in his own behavior and marriage.
Internally, my response was harsher.
I felt judged by someone I believed did not understand the love he was speaking about.
But underneath my anger was something more vulnerable.
My father might be dying.
He was depressed.
He cried.
Our entire family was under pressure.
And I was being asked to defend whom I loved.
I lay awake for hours afterward.
Illness does not suspend the old dramas of a family.
Sometimes it exposes how stubbornly they continue.
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February 1, 2016
I woke around six, an hour later than usual.
Even in sleep, the words from the previous night had followed me.
They mixed with my fear for Dad until I could no longer separate one distress from another.
But morning had arrived.
And the work remained.
I got ready and went out to buy coconut water.
I asked for two.
The vendor misunderstood and gave me four.
I handed him Rs. 150. At Rs. 30 each, he owed me Rs. 30 back.
Another man standing nearby told him to return the thirty rupees.
Instead, the vendor began cutting a fifth coconut, intending to make the total Rs. 150.
I refused.
He resisted.
I had ordered two.
He had given me four.
Now he was insisting I take five.
It became a brief argument before another vendor helped and I finally received my Rs. 30 back.
It was an insignificant encounter.
I remember it precisely.
That is another feature of crisis.
The mind preserves strange things.
A biopsy result may blur.
But you remember the price of a coconut.
I reached Dad’s room around 6:30.
He was asleep.
I asked the aaya whether he had eaten anything and whether he had used the bathroom.
She told me she had given him water and taken him to the bathroom once during the night.
Another woman had been washing clothes in the bathroom for approximately forty-five minutes, preventing the caregiver from using it.
The aaya was frustrated.
I understood why.
She was trying to do her job.
I paid her and released her.
When Dad woke, I asked if he wanted to eat.
I gave him one organic banana and ate another beside him.
Then I gave him the fresh coconut water.
“This coconut water tastes fresh,” he said.
“Yes. I just got them.”
I told him that next time we should try to buy it immediately before he drank it because storing coconut water diminished that fresh taste.
It was such a small exchange.
At the time I thought I was discussing food.
Today I hear something else in it.
A son had gone out before sunrise to bring his father something fresh.
And the father noticed.
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Part IV: The War Against Time
After Dad settled, I texted Neha.
I told her how inadequate I felt.
Too many events were developing at once.
Medicine had transformed into a race against uncertainty, and I could not tell whether we were running fast enough.
A physician came into the room and began asking questions about Dad’s medicines and condition.
I found her impatient, loud, and deeply unprofessional in the way she spoke in front of him.
She asked whether we wanted to remain there or take him home.
Then, while Dad could hear, she said that his stage was incurable and that after a few rounds of chemotherapy we should continue treatment somewhere closer to home.
What disturbed me was not simply the information.
We already understood the diagnosis.
It was the manner in which it entered the room.
There is a difference between telling the truth and placing the full weight of truth onto a frightened human being without tenderness.
By approximately two in the afternoon, the attending physician returned.
A nurse brought the new medications and the chemotherapy drug Taxol.
Dad was asked to sign a waiver.
They explained that chemotherapy was about to begin.
My brother bathed him and changed him into clean clothes.
All of us encouraged him to eat.
The doctor had emphasized the same thing.
Eat.
Eat even if you feel nauseated.
Eat even if you think you may vomit.
If you vomit, we will manage it.
But you must keep trying to eat.
At 3:30, the nurses began administering anti-allergy medication and other preparatory drugs intravenously through a line in his right hand.
At 4:10, my father received his first chemotherapy.
Because his previous pain medication had worn off, the nurse also administered tramadol.
Between the drugs and the exhaustion, Dad slept through essentially the entire infusion.
We watched him closely.
The first session passed without an obvious serious reaction.
There may have been some itching when we briefly woke him, but nothing more dramatic appeared.
We let him sleep until almost eight.
Then the hospital dinner arrived.
We had ordered hospital food for the next several days until we could move somewhere with a kitchen.
We woke him.
That night, he ate better than he had on previous nights.
Rice.
Beans.
Curd.
Some vegetables.
Afterward he took his medicines and drank a cup of milk.
We were very happy.
This is how the scale of joy changes around serious illness.
A man eats a little rice.
His sons rejoice.
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At 8:30, my brother and I noticed another problem.
Our overnight aaya had not arrived.
The caregivers were normally assigned between seven and eight.
It was now late.
There was no one.
I went to the nursing desk and asked what had happened.
At first, the nurse thought perhaps we had never submitted a request.
I told her we had.
My father had just undergone his first chemotherapy.
He could not walk independently.
There was no possibility that he would be left alone overnight.
I returned to the room and asked my brother again whether he had filled out the request form.
He had.
We both went back to the desk.
By then the staff nurse had investigated.
We were right.
A request had been submitted.
Somewhere in the process, the nurse responsible for depositing the form had forgotten or failed to do it.
The mistake was CMC’s.
The staff nurse called her supervisor and asked whether, given the circumstances, one of Dad’s male relatives could remain overnight.
The answer was a firm no.
But we were equally firm about the opposite fact.
Dad would not spend the night alone.
The nurse paced, thought, and eventually came to us.
“Okay. One of you can stay. But please don’t tell anyone or I will be in trouble.”
We agreed immediately.
We had no desire to punish her or the nurse who had forgotten the form.
We wanted one thing.
To remain with our father.
⸻
That evening I returned to the lodge around 9:30 and went out to eat with my cousin and Pisa.
I was beginning to feel sick myself.
Cold symptoms.
A mild feverishness.
Body pain.
Pain behind my right knee.
My breath felt hot.
After four days of eating outside and living among hospitals, lodges, crowds, and exhausted families, I wondered whether I had caught something.
I reluctantly ordered two chapatis and egg curry.
I hated eating outside by then.
Every street around us seemed filled with sick people and the relatives caring for them.
I had become hyperaware of contamination.
Every meal from a roadside dhaba felt like another risk introduced into a system already carrying too much.
In my head, I kept counting the time until we would have a kitchen of our own.
⸻
Back at the lodge, I washed my hands, feet, and face and arranged my thin mattress on the floor.
My cousin and Phupha took the bed and watched television.
I tried to sleep.
The lights remained on.
The television remained loud.
For four nights I had found their television habits difficult to tolerate.
But that night another conversation began.
They asked about my wedding.
I answered that there was no wedding planned.
My father was fighting gastric cancer.
Everything had been postponed indefinitely.
I did not know when anything would happen.
My Phupha said he would find a girl for me.
An engineer.
A doctor.
Someone beautiful.
Whatever my criteria might be.
He said he wanted to be invited to my wedding, but not to travel to the United States for it.
My cousin suggested perhaps I could have the wedding and reception in India.
Then my Phupha said something much harsher.
From his heart, he said, he did not want to attend if I married Neha.
He asked again whether I would allow him to find someone else.
I said no.
By then I was angry.
I turned onto my side and pretended to sleep, hoping the conversation would end.
It did not.
They continued.
My Phupha told me that Dad had once cried while speaking to him about his disappointment over my relationship and my choice of the woman I loved.
I believed what he was saying about my father’s feelings was untrue or, at minimum, being used in a way I could not accept.
And I could not understand why any of this was happening now.
My father had metastatic cancer.
We were racing through treatment decisions.
Reports needed to be obtained.
Second opinions needed to be arranged.
We needed to understand his pain.
We needed to understand chemotherapy.
We needed to understand how long treatment could continue.
We needed to understand side effects and how to reduce them.
Hundreds of questions were waiting.
Time felt physical.
And beside me people were discussing social approval and marriage.
They continued for approximately thirty minutes.
I lay sideways facing an empty wall.
They said that my actions had hurt my father.
That social pressure had broken him.
That I should end my engagement and allow the family to choose someone for me.
That my marriage would last only four or five years.
That after Neha had “sucked” what she could from me, she would leave.
That if I broke the engagement and married according to the family’s wishes, everyone could once again walk with their chests out and heads high.
That I had hurt the family.
That Dad would “jump up and sit up immediately” if I told him I would marry according to their choice.
That I had brought the family down.
That they were saying these things because they loved me and wanted to help me.
That no one was happy with my engagement, even if people were not saying so openly.
I said little.
The fan ran at high speed.
The television remained on.
I stared at the wall.
Neither of them noticed that I was becoming sick.
Eventually I fell asleep while the tube light was still burning.
At four in the morning, I woke suddenly.
I checked my phone.
Then I went into the bathroom, sat down, and began writing.
By the time I had finished recording the previous day’s events, it was nearly five.
I planned to get ready and return directly to the hospital, where my brother had spent the night.
I considered telling him what had happened.
Then I thought about the pressure he was already carrying.
Maybe I would not tell him.
Not yet.
I wanted to talk to Neha.
I needed her.
⸻
February 2, 2016
I reached Room 713 at six in the morning.
My brother was helping Dad.
“Any complications?”
No.
No visible side effects.
So far, so good.
We decided that day we had to find a place with a kitchen so we could eventually discharge Dad and prepare food ourselves.
I also resumed searching for hospitals experienced in advanced gastric cancer.
I asked Neha to investigate how we could obtain second opinions from some of the leading cancer hospitals in India, particularly Adyar Cancer Institute in Chennai, Apollo in Chennai, and Tata Memorial Hospital in Mumbai.
I still had not obtained a local phone and internet connection.
I had not done anything regarding my U.S. visa.
I had not filled out my forms.
My own administrative life had almost ceased.
I was feeling sick.
Dad needed care.
Mom had serious knee problems and also needed evaluation. There was a possibility she might eventually require knee surgery. If that became necessary, we might need to wait a few weeks.
Everything was layered on everything else.
And outside the hospital, Vellore still felt to me more like a village than a city.
I was spending close to fifteen hours every day inside the hospital.
When I left, it was usually to buy juice, eat something, or search for somewhere we could live.
Dad’s legs and thighs hurt because the cancer had spread into his bones.
We pressed and massaged his legs to relieve the pain.
I pressed until my hands became exhausted.
Then I rested.
Then I began again.
Sometimes care is no more sophisticated than this.
Your father’s legs hurt.
You place your hands on them.
You press.
You cannot remove the cancer.
So you press.
You help him sit.
You help him lie down.
You massage his back.
You feed him.
You talk about small things.
You try to make him smile.
You keep his spirits up.
You do whatever remains available to your hands.
Feeding became one of the largest parts of care.
Dad rarely felt hungry.
He could still taste food.
The problem was not that taste had disappeared.
The problem was that appetite had.
After only a few spoonfuls, he felt full.
We therefore tried liquids, small portions, and frequent feeding.
His tendency to sleep for long periods made feeding more difficult.
Everything became a negotiation with the body.
Wake.
Drink this.
One more spoon.
Rest.
Sit up.
Try again.
⸻
By February 2, my own flu-like symptoms seemed somewhat better.
With a little strength returned, I began thinking again about what needed to happen next.
I asked Neha for help with several things.
First, I asked whether her father might be able to visit Dad in India, if appropriate, and simply have some ordinary conversation about our eventual wedding.
Second, I asked whether she herself could come for five to seven days.
She could help us understand meal planning.
What should we cook?
How?
What could Dad tolerate?
It would also allow my parents finally to meet her.
After five or six days she could perhaps continue to Nepal or return to the United States.
She could also bring practical supplies we lacked: a Magic Bullet, a small electric juicer, and other items.
Finally, I asked her to prepare a PDF with specific guidance for feeding a cancer patient undergoing chemotherapy.
Dad had gas problems, so we wanted to avoid foods that worsened them.
He also had high blood pressure, so we wanted to be careful with anything that might be harmful from that perspective.
Because he struggled to eat, I wanted liquid meal options.
Perhaps smoothies.
Protein powder.
Antioxidant-rich berries.
The hospital dietitian had recommended approximately 1,700 calories per day.
I asked Neha to create a plan of six to eight small meals a day that would add up to roughly that amount.
We could repeat the same meals.
The important thing was to build the system once.
I did not know whether any of these ideas would matter against Stage IV cancer.
But that was not how my mind worked then.
If one problem could be solved, solve it.
If one calorie could be added, add it.
If one infection could be prevented, prevent it.
If one opinion remained unheard, find it.
If one door remained unopened, open it.
We had entered a war against time.
And I still believed that enough questions, enough effort, enough medicine, enough attention might reveal a route the first doctor had not seen.
⸻
My Father’s Condition
From the outside, Dad often did not look like a man with terminal cancer.
His face looked good.
His skin looked good.
After shaving his head and beard, he actually looked younger than his age.
Only when he had to stand, sit, or walk did the weakness become obvious.
With adequate pain control, I hoped he could begin moving around and slowly regain strength.
I was thinking about food constantly.
One pomegranate a day.
A shot of wheatgrass.
Kiwi.
Other foods I had read might support the well-being of people with stomach cancer.
The immediate obstacle remained painfully mundane.
We were away from home.
We had no kitchen.
No proper cooking utensils.
Even knowing what to prepare was difficult when we could not prepare it.
This is what serious illness does to grand intentions.
You may be thinking about genomics, immunotherapy, distant hospitals, survival curves, and experimental treatments.
And then someone needs a spoon.
⸻
That day, when only Dad and I were in the room, he asked me about Neha.
How was she?
What was her nature like?
How did she behave?
Then he asked a more specific question.
“What does she feel about my current situation?”
I answered plainly.
“Papa, she is helping you as much as she can despite never having met you. She is helping you from there.”
He seemed comforted by that.
I did not tell him that I was already thinking about how to bring her to India, or how our families might meet once he became better.
Perhaps he understood more than I said.
Perhaps fathers often do.
Meanwhile, Neha wrote back.
She would begin working on the things I had asked for immediately.
⸻
Part V: The House Around the Patient
Cancer had been diagnosed in my father’s body.
But it was now living in all of our lives.
It reorganized where we slept.
What we ate.
What we talked about.
How we spent money.
What we searched for.
Who traveled.
Who cooked.
Who stayed overnight.
Who pressed his legs.
Who spoke to doctors.
Who collected reports.
Who was permitted inside the ward.
Who waited outside.
Who needed to remain calm.
Who was allowed to break down.
The patient lies in the bed.
Around the bed, an entire house begins moving.
This is the part of illness I had never understood.
We speak of a person “having cancer,” as though the disease occupies one body.
Biologically, it does.
Humanly, it does not.
A diagnosis enters marriages.
It enters siblings.
It enters old resentments.
It enters bank accounts.
It enters appetites.
It enters sleep.
It enters prayer.
It enters every conversation that suddenly feels too ordinary or too cruel for the hour.
It enters the future.
And each person standing around the bed becomes, in some incomplete way, part of the treatment.
⸻
February 3, 2016
Mom arrived.
Her name is Sheela.
When Dad saw her, he cried.
She did what only someone who has shared a life with another person can sometimes do.
She spoke hope into him. She encouraged him. She filled the room with positive words.
That morning, Mom, Dad, and I spent hours talking.
The conversation moved through illness and beyond it.
We spoke about Neha.
Mom had developed her own affectionate name for her.
Salil and Neha became Sneha because Salil and Neha sounds Sneha when both sounds are equally important to you.
I showed Dad a piece of 24-karat pure gold bullion.
I gave him my Boston cap.
He smiled.
I took photographs of him wearing it and showed them to him.
He was happy when he saw himself in the pictures.
Mom kept speaking encouragingly to him.
I showed them lava rock.
I showed them our family picture.
Another small happiness entered the room.
These things sound almost absurdly minor beside metastatic cancer.
A cap.
A photograph.
A piece of gold.
A stone.
A family picture.
But the closer death approaches, the less convincing our hierarchy of importance becomes.
A small object can reopen an entire world.
A photograph can temporarily return someone to himself.
A hat can make a sick man smile.
We also spoke about the future.
We discussed moving to Noida, where better hospitals might be available.
Another possibility was returning to Mihijam and continuing Dad’s treatment at Mission Hospital in Durgapur.
My brother and I compared the advantages and disadvantages.
Mihijam began to make more sense.
Even then, even after Stage IV, we were still constructing futures.
Where should we live?
Where should he receive treatment?
How should we organize the family?
What will happen next?
That is one of the ways hope survives.
It begins making plans.
And then I asked my father a question whose meaning I did not yet understand.
I asked him what he wanted to do after retirement.
⸻
Part VI: To Be Continued
February 3, 2016.
My mother had arrived.
My father had received his first chemotherapy.
We were still researching hospitals.
Still planning meals.
Still discussing where he might live.
Still asking what he would do after retirement.
Still speaking about a future in which he recovered enough to leave the hospital and return to ordinary life.
We did not yet know how little time remained.
He died on March 5, 2016.
Thirty-one days after that conversation.
There are parts of those final weeks I have not yet written.
They deserve more than reconstruction from a distance. They deserve memory examined carefully, facts recovered where they can be recovered, and the man at the center of this story restored from behind the machinery of his illness.
Because this cannot finally be only the story of how my father died.
It must also become the story of who he was before cancer reduced his life, in our frightened attention, to scans, counts, medicines, meals, pain, and remaining time.
There was a whole man before the patient.
A husband.
A father.
A brother.
A person who had worked, saved, worried, hoped, planned for retirement, carried obligations, formed opinions, loved imperfectly, and imagined that there would be more ordinary years ahead.
Cancer did not make his life meaningful.
It interrupted a life that was already meaningful.
I understand that distinction now.
I did not understand it then.
Back then I believed we were fighting primarily against a disease.
Looking at these pages ten years later, I see another struggle running beneath everything.
We were trying to keep a person from disappearing inside his diagnosis.
That is why the coconut water mattered.
Why Mom’s arrival mattered.
Why the Boston cap mattered.
Why the little boy with leukemia mattered.
Why pressing Dad’s legs until my hands were exhausted mattered.
Why his worry about money mattered.
Why his question about Neha mattered.
Why asking him what he wanted to do after retirement mattered, even though retirement would never come.
We were still speaking to the living man.
And perhaps that is one of the deepest duties of caregiving.
Medicine must see the disease.
Someone must continue seeing the person.
⸻
Before cancer, time had been invisible.
We assumed there would be another month, another visit, another conversation, another meal, another argument, another chance to say what had not yet been said.
Then a doctor stood with my brother and me in a hallway in Vellore and gave time a number.
Stage IV.
After that, the calendar changed.
Day 41.
Day 42.
January 31.
First chemotherapy.
February 1.
February 2.
Mom arriving February 3.
One event after another.
One small victory.
One new question.
One more morning.
We had begun counting without yet admitting what we were counting toward.
That is what I remember now.
Not only that my father was dying.
That for a brief and terrible season, while none of us was ready to say goodbye, we became intensely aware that he was still here.
And time, which had once seemed endless enough to ignore, suddenly became the most precious thing in the room.
