Writing is something I enjoy. I take pleasure in writing, especially because of my beautiful handwriting. When I started school, we had to write with a lead pencil until fifth grade. I was so excited to write with a pen when I started sixth grade. After I learned how to write with a pen, I have been writing nonstop. I found my writing mesmerizing. My friends used to cram notes and books while preparing for an exam, but I was more interested in making notes in my beautiful handwriting because it gave me a chance to write more. I still find it very satisfying to write with an ink pen, but I have been typing for a long time now. I feel tired of typing all day and miss the joy of writing with an ink pen, the feeling and the satisfaction of seeing the beautiful cursive writing on paper.
I never knew that someday I would discover this talent of mine differently. There is no concept of personal secretaries, medical assistants, or medical transcriptionists in our hospitals. Eight years ago, when I was a fresh medical graduate doing an internship in a public sector hospital, many patients came to us with a stack of forms that required the treatment details from the physician to get reimbursement for their treatment charges from their employers. Most of the time, I had to do this task of filling out endless forms because my colleagues found it quite boring and did not have the patience to listen to a lot of patient queries. They always handed over those patients and that stack of papers to me because they knew that not only was I patient, but I also wrote more legibly than most of my colleagues.
I kept on writing summaries without knowing that I would be doing that for years. We see many patients from other countries who need details to get a visa. Our Pakistani patients require many summaries as well regarding their treatment, where we must mention the number of cycles of chemotherapy, radiation sessions, estimated costs, expected treatment duration, and when the patient would be fit enough to return to work. My seniors discovered this talent of mine when they saw the first summary I made. Over time, I mastered the art of writing summaries and learned how to write visa applications for patients, using persuasive language to highlight the gravity of their circumstances and successfully advocating for patients’ families to receive visa facilitation. When my seniors got to know that I made exceptional and detailed summaries for visas, patients’ employers, leave certificates, and death summaries of our deceased patients, many patients and their families started coming in to see me.
One of our breast cancer patients has an only son who works in Australia. After completing neoadjuvant chemotherapy, she prepared for surgery and specifically requested her son to be by her side during the procedure. My consultant told me to write an excellent letter to the embassy so that her son could be facilitated regarding his visit to Pakistan. I wrote a heartfelt letter to the embassy as a physician, and he got the visa within a week. The patient was so happy, and the whole family came to thank us. She got her surgery and radiation treatment done, and now she has been cured. Whenever she comes for a follow-up, she always comes to see me. I love seeing her smile.
Since that day, I have been assigned to make more summaries every day. I don’t know whether I should feel happy or miserable about it, but the thought gives me a good feeling that at least I am doing something for my patients to facilitate them. I feel satisfied when they get the kind of response they want from the embassy or their employers just because of my words. Despite that, I hate typing and miss writing with a pen.
Another positive side is that all day I call the pharmacy asking them about the cost of every chemotherapy drug and getting familiar with different brands of chemotherapy, immunotherapy, and targeted drugs available in our country. This has given me a lot of confidence when I am trying to decide the treatment for the patient because I always try to keep their socioeconomic conditions and financial aspects in mind.
One of our patients has metastatic breast cancer. Her disease progressed along many lines of chemotherapy and hormonal treatment. After that, she got her next gene sequencing done. It’s a very costly investigation that detects specific targets/genetic mutations against which we can give a specific treatment. Very few patients in Pakistan are privileged enough to afford this test and the targeted agents needed in their particular case. Most of the time, these medications are not available in Pakistan because of the restrictions of the Drug Regulatory Authority of Pakistan. Mostly, these drugs are imported from other countries illegally through unreliable sources, and we never know the conditions under which they have been brought, so we can never be sure about their efficacy. They are extremely costly; nevertheless, people buy them because there is no other option.
Our patient had a mutation detected in her NGS for which she needed a drug that was not available. Her family tried every possible source, but they couldn’t acquire the drug. Then we got to know about a program of Novartis that would supply us with the drug free of cost only if we enrolled her in a clinical trial. That involved a lot of paperwork and a lot of time and effort, but as always, I was assigned this task. The attendants were after me because they knew that I was the one who was trying to arrange that drug. I spent days completing all of those forms and the correspondence through mail. Three weeks later, we finally got that drug for our patient. Novartis supplied three months of medication, and the family was so grateful. They always remember me and show their gratitude whenever they meet me. The patient knew that I love to read, so she gave me a beautiful book as a token of love. On the title page, she wrote, “For the doctor who forever changes lives. Thank you.”
I know her disease might progress someday, even on the medication, but still, I am hopeful that maybe it works. I will always remember the joy on her son’s face when I handed him the medication. I will remember her smile and the day that she gave me the book in which she wrote such lovely words. I don’t know what I will do in the future and where I will practice, but I am sure this beautiful memory will stay with me for the rest of my life.
Damane Zehra is a radiation oncology resident in Pakistan.
