Our walk has been on hold since the beginning of February because of an unexpected turn of events. I had a medical setback requiring surgery. Thankfully, it was not life-threatening. I am healing well, and walking a little more each day without weight. Our long-distance walking will resume when my body is strong enough.
Here is a very personal story about the chain of events that led to the Feb. 9 operation. It’s gynecological-related. I tell you ahead of time so you won’t get squeamish. I’ve chosen to share this because it’s a very big marker along our walk, and I think many women will relate to it. There are also deeper stories here about our thought process, and the incredible kindness we were offered these last few months that deserve acknowledgement.
Mostly, this is an intimate view to my inner workings, and my journal about one of the more important choices I have had to make, to date, about my health.
“Please come to Delhi.”
Typing the words in the subject line make my stomach turn. I hate that these words will scare Lluís, and will make his stomach turn, too. But I need him to know without opening the email that our plans have changed, in a bad way.
He is walking solo along our route somewhere near Haridwar in north India. His Internet connectivity is sporadic, and since we only have data plans on our phones, there is no way I can call him and tell him what I have to tell him.
All I want in this moment is to hear his calm voice, a voice that stays steady in anxious moments. And, that won’t be possible until he sees this email and opens his Skype app.
I exhale, and continue typing the note, unsure how long I will have a signal.
Bearer of bad news, and I have to talk to you.
The cyst has gotten worse and is now a solid mass with increased blood flow. I’m running new blood work and getting an MRI.”
After a two-week meditation and yoga retreat at the Art of Living ashram, my south Asian paradise near Bangalore, we were supposed to rendezvous in a couple of days around Rishikesh, an Indian center of spirituality and white-water rafting.
Before that, I had to pit-stop in Delhi and do a follow-up ultrasound, doctor’s orders from Jessore, Bangladesh. The words I hoped to write in this email were, “On my way to you. Clean bill of health.”
But, life doesn’t always work that way.
In early November, after a few months of unusually heavy bleeding and abnormal periods (even more abnormal than what has become the new abnormal of my mid-40s) , I spoke with several women at the Banchte Sheka NGO where we had a few down days waiting for our Bangladesh visa extensions and Indian visas. With some concern in their eyes, they all matter-of-factly recommended two doctors: Dr. David and Dr. Hasina, English-speaking, Western-trained gynecologists affiliated with good hospitals nearby.
Margaret, a law student working at the organization which helps empower Bangladeshi women, became my Jessore guardian angel. She picked up one of her two phones and scheduled an appointment with her ob-gyn doctor for the next afternoon. She held my hand as we sat in the bicycle rickshaw, guided us to different doctors’ office and labs, and explained things in Bengali to the hospital’s administrative staff with confidence I lacked in English. She opened doors (both literally and figuratively) that I may not have found on my own.
I wanted to believe that my recent problems had to do with my IUD, known in this part of the world as an IUCD (intrauterine contraceptive device, as opposed to intrauterine death, something I quickly learned and had to distinguish). I thought it had slipped out of place and was doing strange things to my uterus. It was easier to think about that than the fact that I was almost 45 and possibly being haunted by family history.
Dr. David Biswas, a kindly man with good eyes, listened patiently to Margaret’s Bengali, and then listened again to my version in English. He jotted down my concerns, made notes on a gray piece of letterhead and ordered an ultrasound. He called his colleague at another hospital, Dr. Hasina to see if she could squeeze me into an afternoon slot.
Margaret took me to Queens Hospital, and when she knew I was in good hands with my story well-communicated to the nurses, she returned to work. I watched the parade of woman, draped head to toe in either all-black robes or a rainbow swirl of wrap-arounds and leggings, enter and leave the room. A graceful young woman with perfect posture and modern-looking black-rimmed glasses wearing a beautiful purple and blue shawl minded the door separating the ultrasound patients in the small dimly lit room from the larger, overcrowded waiting room outside. Every time there was a knock, about every two minutes, she unlocked the bolt lock, opened the door just enough to let only the woman pass and directed them to a chair that dictated the order of care; husbands and male relatives stayed behind the door. Each time she opened the door, I glanced out to make sure my hiking boots were still among the sandals and flip-flops piled around the archway. I’m in Muslim country and the chances of shoes being stolen are slim, but still, they are my most precious possessions and I can’t help but fret over them.
My bladder needed to be filled, so I waited for the liter of water I swallowed in fast gulps to make its way through my digestive tract. I stared at the metal frame and cloth screen dividing the seated patients and the ultrasound section. Every few seconds, the doctor would say something from behind the screen to her assistant; her assistant, sitting cross-legged on her wheeled office chair, repeated the numbers as she typed them into the computer.
I found myself mulling over absurdities, distracting myself with mundane things. “Why would they put empty toilet paper rolls around the legs of the metal frame dividing screen? To prevent toes from being stubbed? But toilet paper rolls without paper wouldn’t provide any cushioning. I hope they don’t have to take out my IUD, uh, IUCD…that will hurt like hell. I saw stars when the Barcelona doctor tested it – one time in, one time out. I can’t believe I almost kicked him in the head when he told me to relax as he slid the device through my cervix for the last time. Maybe I should drink more water? How long does it take water to move into the bladder. They should have told me I needed a full bladder before I got here.”
My disconnected thoughts were interrupted by the curious onlookers sitting beside me. We exchanged hellos, which then seemed to be an invitation for deeper conversation.
“Is it good news?” one of the 30-something women asked in broken English, patting her belly to indicate the universal sign for pregnancy.
“I don’t know yet.” I answered her honestly. However, to her disappointment, pregnancy was not going to be good news for me. I have managed to avoid that for decades, and such news would not be welcomed now.
The only news I was hoping for was that my IUCD was in place, my organs looked normal and the strange bleeding was a perimenopausal annoyance that I would have to put up with.
I got part of the good news I was looking for.
Dr. Hasina Akhter, a woman who I could tell had seen a lot of things in her time as a doctor in Bangladesh, asked me why I was in Jessore as she rubbed and pressed the wand over my gel-slathered belly. The two aides standing around the bed and giggled at my lotus flower tattoo around my bikini line, a novelty for them.
Dr. Akther told me that my uterus looked okay, and my IUCD was where it was supposed to. The unsettling thing she saw on the screen was a right adnexal complex cyst measuring 68 x 37 millimeters. It showed up as a black shadow on the ultrasound image printout. “This will need follow-up care. It may be nothing, but it will need follow-up,” she said to me with a neutral professional tone that left me wondering if I should be worried or not. She smiled politely as I buttoned my pants. She told her assistant some numbers which I heard her type into the computer behind the cloth screen.
“Don’t worry,” Dr. Biswas reassured us, flipping through pages of the ultrasound report and images back in his office at Genesis Hospital, “We’ll run some blood tests and then go from there. Cysts and things like this frequently show up in women your age. They usually pass in a couple menstrual cycles. But if it doesn’t pass, it can be removed laparoscopically.”
I knew that to be true from stories I heard in my own family and among friends and acquaintances. Still, I held my breath when I picked up my CA-125 and CEA test results. These are cancer markers, and out-of-range numbers would change the conversation.
“Normal,” I sighed when Lluís and I read the immunology report in the lab lobby, surrounded by locals trying to figure out how two foreigners ended up there.
With the immediate threat of cancer out of the way, Dr. Biswas gave me a three-month prescription for three pills: one to regulate my heavy and irregular bleeding; one to shrink the mass occupying space near my right ovary, and an antacid tablet because the other pills may upset my stomach, he said.
“I think the cyst will shrink and pass, but make sure you get a follow-up ultrasound in India in three months,” he added, jotting down more notes in my medical folder, which I shoved into my backpack later that evening. “It will be okay. It’s a common thing,” he said, speaking more to Lluís than me, a typical interaction in this male-dominated country.
Yes, I know it’s common. I just don’t want this to be common for me.
But I may not be able to sidestep genetics. My aunt, grandmothers and other relatives had “women’s stuff” going on in their 50s and 60s. My mother, who also suffered diabetes and high blood pressure, died when she was 58 because of complications from endometrial cancer.
“We’ll go from here, and see what comes,” I told myself, casting aside worries about the black shadow.
The nurse brought in a tray of sweet ginger tea and cookies. “If you don’t mind and if you have a few minutes, I’d like to ask a few things about your walk,” Dr. Biswas smiled. He, too, was curious how the two of us made it to Jessore and to his office on a random November weekend.
For three months, I swallowed pills with biscuits and morning tea. My periods became somewhat controlled, changing from a six-day long aggravation of heavy bleeding (which started after I had the copper IUCD device lodged into my uterus and never subsided, a possible side-effect my Barcelona doctor warned me about) to my pre-40s normal of three or four-day inconveniences. It remained a mystery, however, when they would show up. I lost the predictability of a 26-28-day cycle a few years ago, and since then, my body was engaged in its own private Roulette game…19 days, 29 days, 21 days, 32 days, 26 days and, once out of the blue without rhyme or reason, 48 days.
On my 45th birthday in January, the one year anniversary of our walk, Lluís and I celebrated with chicken tikka masala, kebabs and chocolate cake in Lucknow, an auspicious-sounding name and the provincial capital of Uttar Pradesh. The next morning, I boarded a train before dawn to Delhi and soon after, a plane to Bangalore to bask in meditative silence, a most-wonderful gift to myself that I began thinking about the moment we knew India would be one of the countries we would walk. Lluís, not one to sit and chant Om Shanti Shanti Shanti, continued walking, making friends with locals and covering more ground alone than we typically do together.
We were both happy in our own spaces, but the two-week separation had us longing to be together again, ready to start climbing through Indian’s breathtaking mountains. The walk from Rishikesh to Leh, we hoped, would remind us of the peace we felt in the Pamirs.
First, though, I had to tie up loose ends. The black shadow loomed and the three-month review was pending.
It showed up on my Delhi to-do list along with other tasks I had no particular attachment to but had to methodically get done: Sew socks (again!), go to embassies of onward countries and find out visa requirements, get bus and train schedule to Haridwar and Rishikesh, find a place to do another ultrasound. I was certain the medicine had done its job, and the follow-up doctor’s visit was a technicality.
I remembered Simon and Nicky, cyclists I met in Bishkek, had mentioned that they got their rabies vaccination booster at Delhi’s Indraprastha Apollo Hospital, a recommendation they got from someone else they believed was credible. I checked out the website in between meditation sessions in Bangalore. It looked like a good hospital. “If it was good enough for the Germans, it will be good enough for me,” I thought as I wrote the email to the International Patient Care representative.
The hospital staff responded quickly, and I made an appointment for an ultrasound and gynecological consultation for early February, when my mind would be quiet and my body stretched with yoga.
I took two metro trains for an hour to the hospital, and walked past the crowds of Indians in the lobby, which felt like an airport terminal, and beelined into Platinum Lounge set aside for international patients. Crammed on the rows of chairs were people from Africa, Central Asia, the Middle East and me.
A tall, handsome man, elegant in his dark navy suit and neatly trimmed beard, escorted me from counter to counter. We started in the ultrasound department. The receptionist said I needed a prescription. I showed her my doctor’s orders from Bangladesh, my email from the International Patients representative confirming my appointment and said I was visiting the gynecologist after the ultrasound. “Go pay at counter 2 and then come back here,” the receptionist said.
The suited gentleman walked me through the lobby and spoke to the man behind the counter in Hindi. The guy behind the counter asked who was my doctor. “I don’t have one yet,” I said, shrugging my shoulders.
The gentleman leaned toward the glass window and said to the man behind the counter, “Dr. Sushma Sinha.” He then smiled at me, “She is a very good doctor.” I nodded, sort of dismissively; I was only going to be here for a few hours for a meet-and-greet, and then I was moving onwards.
“Do you want a pelvic ultrasound or an entire abdominal ultrasound?” the guy behind the counter said. Surprised that I had the option and never having seen any of my important organs, I figured it would be cool to know how all my middle insides were doing after a year on the road, I prescribed myself a full abdominal ultrasound.
“3,900 rupees,” the guy said. I pull out my credit card, buying peace of mind for about $60.
The gentleman escorted me back to the crowded ultrasound waiting room and I waited for Dr. Balraj Gill to call me in another room.
Our conversation started the way most conversations do. “What are you doing in India,” Dr. Gill asked, pressing the wand into my stomach, liver, uterus.
“Walking. My partner and I are on a multi-year walk.” I shiver a bit when the cool device rolls over my skin.
“Really? Walking? That’s an interesting way to go,” he said in perfect English. I’m impressed with the amount of English everyone knows at the hospital. “Your stomach looks okay. Your IUCD is in place. Where have you walked?”
“We started in Bangkok and are making our way to Barcelona. In India, we crossed over from Bangladesh into West Bengal and walked through Jharkhand, Bihar, Uttar Pradesh and we will continue up towards Leh and maybe Jammu Kashmir.”
“Wow. That’s brave. Your left ovary is normal, but this mass in your right adnexal region is now a solid mass with vascularity. It will need follow-up care,” Dr. Gill said, without changing a beat.
I don’t know what vascularity meant, and histopathology and solid mass sounded bad. I’m disappointed the black shadow is still there and required more follow up. But since his voice remained steady, I kept mine even keel too. “What is vascularity?”
“It’s blood flow into the mass. Look here.” He turned the screen and showed me the color Doppler images. There were red and blue dots pulsing inside and near the black mass. “Ok. we’re done. The report will be ready in an hour. Good luck with the rest of your trip. It sounds amazing!”
Back in the waiting room, I read Dr. Gill’s ultrasound report standing up. My liver, gall bladder, pancreas, spleen, kidneys, bladder and uterus were normal. It’s the next page that gave me the chills.
“There is a heterogeneous solid lesion in the right adnexa adjacent to the right ovary measuring 4.2 x 3.8 x 5.8 (50 cc) with vascularity and trace fluid around it.”
The capital letters screamed at me when I skimmed to the summary.
“RIGHT ADNEXAL LESION AS DESCRIBED – FURTHER EVALUATION AND HISTOPATHOLOGICAL CORRELATION IS STRONGLY SUGGESTED TO RULE OUT MITOTIC ETIOLOGY.”
I pulled out my phone and looked up vocabulary words. Study of diseased tissue and the cause of cell division. I sat down to catch my breath, refusing to jump to conclusions. “Let’s see what the doctor says.”
I knew right away that I liked Dr. Sushma Sinha. She has good eyes, which for me means everything. Her warm smile and sincerity made me instinctive trust her.
She listened patiently to my whole story about my recent woes and reviewed the growing pile of papers becoming my new medical history.I saw words underlined in the notes her assistant junior doctor wrote: solid lesion, 4.2 x 3.8 x 5.8, vascularity. These were the red-alarm words.
Dr. Sinha didn’t beat around the bush. I liked that. She told me in a completely calm but gentle way that this solid mass will continue to grow because it now has blood flow feeding it. It has to be removed, and will require an up-and-down cut through my abdominal wall. This will help her see what else may be going on there. They will do the pathology report during the operation to determine if it’s malignant. If it’s malignant, the uterus and ovaries will also have to come out. If it’s benign, the organs will stay. If everything is okay, I’ll be in the hospital for 4-5 days, and then will need six to eight weeks recovery. If there’s cancer, then I’ll be in the hospital a bit longer and we’ll start talking about chemotherapy options or if I want to go home to take care of this. As she speaks, I collected only the keywords I would remember.
Things started clicking together too quickly. My head jumbled thoughts. “She’s thinking I have ovarian cancer. Shit. No way. This is not ovarian cancer. This is just a cyst that will go away on its own.When I said a couple years ago, I voluntarily would do a full hysterectomy to solve the nuisance these no-longer-useful-parts were causing me, I didn’t want the operation to be cancer-related. And chemotherapy options and going home. This is going to be taken care of in India… today. I’m going to Rishikesh in a couple days. What???” I must have looked flustered.
As if reading my mind and the expression on my face, Dr. Sinha jumped ahead. “First, though, why don’t we do an MRI so we can get a clearer image of the mass? Let’s do some blood work, too, and see if the numbers have changed since November.”
“Yes, let’s do that. Can I do it today?” I blurted out. “Let’s get all the information we can and see what it shows. I also want Lluís to be here to hear the results and then we will decide all together what happens next.”
Dr. Sinha wrote down prescriptions. I find my way back to the ultrasound/radiology and blood sample collection departments. “Do you have the receipt?” That’s the first question all the receptionists asked. Pay first, service second. I prefer this system to the run around you get with private insurance companies and public healthcare referrals. I went back to counter 2, to the same man I saw earlier, and bought another 20,000 rupees ($300) worth of peace of mind.
The blood work took 10 minutes. I could pick up the report the next day, I’m told. The receptionist in the MRI area tells me I can do the test today, but she doesn’t know when. If someone cancels, I can go in right away; if not I may have to wait five or six hours. She added my name to the list.
I waited, and waited, and waited until the boredom made me sleepy. I regretted not bringing my paperback book, the newly acquired luxury item I found in a cafe in Varanasi a few weeks earlier. I read the newspaper scattered around the benches, I watched the television screen blabbering things in Hindi. I sized up the other patients…Indians, Central Asians, Africans…all waiting for clarity in the form of magnetic resonance images.
I’m called in about 7 p.m. I put on the checkered aquamarine scrubs, and the lab assistant placed big sound-blocking headphones over my ears. “You’ll hear a lot of loud noises, but remain perfectly still. It will take about 20-minutes,” he said. I closed my eyes before my head entered the tunnel. I slipped quickly into a meditative trance, accepting the small space and beeping noises as part of my space. Keeping my breath steady took all my attention.
I made way back to my dinghy hotel room. It was late and dark. This was not the Thursday I was expecting. I knew Lluís would check his email soon, and see the words I wrote while I had a weak signal in the MRI waiting room.
Unfortunately, “Please come to Delhi” is our new reality.
Lluís sees the words and his heart drops. We connect on Skype. I rehash what the doctor said. He remains calm and helps me resist the urge to think the worst.
“One step at a time,” he says. That is always our truth, and the walk has made that an even more powerful mantra. He will get to Delhi one way or another. We will handle whatever comes next together. I trust his confidence.
I take a shower, gobble up the egg sandwich I bought from a street vendor and fall asleep reading my book, “We the Living” by Ayn Rand.
The next morning, I email Dr. Sinha’s assistant and make an appointment for Saturday afternoon. I google ovarian cancer, research treatments, the hospital and Dr. Sinha and write down every question that pops to mind.
I message Namrita, a woman I met in Bangalore, one of the few people I know in Delhi. We met after our silent meditation course while booking taxis to the airport. She was going to hook me up with info about an ashram not far from Rishikesh.
Now, crouched down under the hotel lobby using the landline phone, I ask what she knows about Apollo hospital and if she has heard of Dr. Sinha, a doctor with more than 31 years of experience, U.K. credentials on her resume and an impressive list of surgical techniques under her belt. She says will ask around and send me names of other gyns, hers and others her sister and mom have had over the years, if I want a second opinion.
Hours pass. Finally, I hear Lluís’ special knock at the door. It’s very late, and there were several train debacles along the way. He looks exhausted, but he’s here. Things immediately feel less heavy.
On Saturday, we take my shopping bag filled with reports and collect the blood reports and MRI finding before seeing Dr. Sinha. We eagerly scan the results. All of the blood work is normal, there are no elevated numbers suggesting cancer. We read the next set of medical jargon, this time written normally in a mix of capital and small letters: “There is evidence of focal mass lesion measuring 4.8 x 3.6 x 4.2 cm abutting the uterine fundus with bridging vessel sign. The lesion is indenting the urinary bladder. The findings are consistent with fundal fibroid.”
I pull out my phone and look up words. I draw comfort from fibroids and not cancerous. Abutting the uterus fundus means not in or near my ovary.
Dr. Sinha also finds relief in these same words. “These results are almost too good.”
The three of us go through everything. No sign of cancer. The fibroid is stemming from the uterus, not from the ovary which was the initial concern. These kinds of fibroids rarely turn malignant, but it is pressing against my bladder and now that it has blood flow it will still grow, we don’t know how big it will get, but it will keep growing. I can take care of it here, or I can wait and do follow-up care home or somewhere else, but it is not as urgent as the ultrasound suggested. Yes, there is a possibility with fibroids that once you get them, more could come and become a reoccurring thing. And, my family history of fibroids, polyps and hysterectomies increases the recurrence risk, and my mother’s endometrial cancer is a weight I can’t ignore. In families with gyn-related cancers, one woman may have endometrial cancer, another one may have ovarian cancer and someone else may end up with breast cancer. “They are all connected,” she says.
So what are the next steps? That’s the logical next question on all our minds. In my head, this needs to be resolved in India, where I trust the doctors, the hospital and appreciate their level of English. Images of onward countries flash before me. I am definitive in thinking that follow-up care is not happening in West Asia.
“How can we take care of it here?” I ask.
It would be a bikini line cut, not an up-and-down cut, which will be easier but will still need a few days in the hospital and at least six weeks of recovery, Dr. Sinha says.
Our heads spin towards a serious conversation we had pre-trip: If you have to cut me open, why don’t you just take everything out — uterus, fallopian tubes, ovaries, cervix… and while you’re at it, my appendix? Concern about our appendices bursting in the middle of nowhere creeped inside our worst fears, and I have carried worry about my lot in life since my mother’s death in 2008. We did some research about voluntary surgery in Barcelona, and economically, it was out of our reach.
Dr. Sinha looks a bit surprised, but takes it in stride.
I’m not too sentimental about “saving my organs,” and waiting around for more things to show up that need more follow-up in who knows which part of the world. I’m 45 and am already having increasingly frequent night sweats that soak my sleeping bag and hot flashes that forced me to sit down for a few minute. Why do I have to deal with all this for another five to seven years? How much more “women’s stuff” will I have to go through before some medical expert decides it’s time for me to say goodbye to my parts, that nothing more can be done for them? I think of a Catalan phrase, “Mort el gos, morta la ràbia. Dead dog, dead rabies.” Cut me open once and be done with it. I’m not getting a similar surgery for similar stuff a few more years from now.
“We can do that. If you’re already have night flashes and hot flashes, your ovaries have already begun their decline,” Dr. Sinha says. “If you want to keep them, you’ll still be producing hormones for a while, probably until you’re about 52. The hormones will help keep your skin and hair nice and manage your weight. If you have any problems after surgery, we can look into hormone replacement treatment.”
“How soon can we do the surgery?” Lluís asks.
Dr. Sinha makes a quick phone call. “I can get you scheduled for next week, Feb. 9.”
Our eyes widen. Somehow the entire conversation has shifted from mandatory, possibly cancer-related surgery to the empowered option of making an educated, informed choice someplace where we could afford an operation without going bankrupt. We had joked while planning the trip that if anything medically happened to us in Asia, we hoped it happened in Bangkok or Delhi where we knew there was a good reputation for medical care and medical tourism. Suddenly now that wishful thinking turned into a real decision we could own.
We ask her if we could talk privately outside her office, and get a cost estimate from the admissions. The estimate for the surgery, removal of all the organs, hospitalization, surgeons’ fees, anesthesia and everything else needed for the procedure is roughly the average price of removing only our appendix in Catalunya, about $5,000 – $6,000.
With all the information on the table, we methodically analyze what is in front of us. We look at the facts, evaluate the pros and cons and move through a long list of questions.
Our thought process looks like this:
- There is a strange mass in my body, and it is not malignant.
- It likely will not evolve into cancer, but it is of a considerable size and will keep growing.
- I am already going through “women’s stuff” and showing signs of “the change.”
- These menopausal symptoms have made me crazy for a few years now, and they are becoming intolerable during our walk.
- We have no intention of having children.
- I have a family history of gynecological issues, and as I get older, this becomes more worrisome to me. I have a fear of being victimized by cancer.
- What happens if we do nothing about this mass now, and continue with our walk?
- What happens if we take out the mass now?
- With my family history and the likelihood of recurring masses, what happens if we remove the mass now, but others show up later?
- What if take advantage of the surgery to remove my uterus?
- And, if we are removing my uterus, why don’t we remove my ovaries, and eliminate most of the worries I have about all these things I fear.
- And, if we are opening Pandora’s box, let’s take out the appendix, too. We wanted to each do that back in Catalunya.
- If we do nothing, what kind of follow-up care will this require?
- Our walk is going to continue, and this mass will not stop that. So , where are we going to be able to get the required follow-up care? How likely is it that we will be able to do this in the next countries we plan to be in, which in many ways will be less developed than or equal to India? And what are the chances of finding English-speaking doctors?
- In our heads, we knew if we needed medical attention for any significant reason, we would try to get ourselves to Bangkok or Delhi, capital cities we are familiar with and where we know they have qualified doctors and international hospitals that would offer us a good level of care.
- The cost of care for an elective, non-emergency operation in Bangkok and Delhi would also be much more affordable than returning to Europe. We would also save us time and avoid going through the public health system, which would require several rounds of doctors’ appointments, referrals and likely other alternative treatments prior to the last-resort option of surgery.
- And what about this hospital? What is Apollo’s reputation?
- And, what about the medical team and Dr. Sinha, both as a doctor and a surgeon? What is her education and experience in doing hysterectomies? Who would remove the appendix?
- How do I feel about her? What does my gut instinct tell me about this surgery and her capabilities? Am I willing to put my confidence in her expert hands?
- Do I want a second or third opinion?
- What is the recovery period?
- Can we manage the recovery time within the visa time we have?
- How will this impact our trip? How can we manage a six to eight week delay and still cover the 1,500 kilometers we have left in India, which will be through some of its more beautiful parts?
- What if I need more time to recover? What if I don’t heal well?
- I won’t be able to carry weight for six to eight weeks after surgery. What are we going to do about my 20-kilo backpack and daypack filled with water? Lluís is strong, but he can’t carry 45+ kilos by himself.
- How will weather impact our forward trip? We had hoped to finish India by the end of April before the very hot season and before the summer monsoons. What will a two-month delay mean as we get into the higher mountains and what will Delhi be like when we come back to get onward visas? How does this impact our trip in West Asia, where want to finish before very cold winter sets in?
- Lluís has a one-year visa for India, I was granted only six months. The visas are clearly marked that they are not extendable. What will we do about visas extensions and police registration after 180-days in-country? Will immigration people grant us an exception? Can I do that here or will I have to fly to some place like Nepal or Sri Lanka to get a new tourist visa?
- Where will we park ourselves during the recovery time for a month or two?
- What is the cost of operation? Just to remove the mass? To remove all the organs?
- Is it worth making the investment now and hopefully avoiding problems later? What investment — a partial surgery dealing with the immediate issue of the mass that will keep growing or the whole kit and kaboodle?
- How much I have already spent on this mass, and besides the operation and hospitalization, what is the estimated cost of other tests and treatments post-surgery?
- What will this delay cost us in terms of post-surgery recovery? Will we rent a flat, a hotel? Can we take Namrita up on her offer to stay with her and her family? Should we stay in chaotic Delhi, should we move closer to our route and be in a place like Rishikesh which will be close to nature and have fresh air?
- What’s the impact on our overall budget? Good health is our top priority, and there is no price for that. But, we won’t be able to use our travel insurance for this because it is not a life-threatening emergency or accident, and the out-of-pocket cost has to come from somewhere.
- Could I book some freelance work during the recovery time to recoup costs and keeps our bank accounts cushioned? Can we pay for this without dipping into our savings accounts?
We go through each item, and come up with our most honest and practical answers. We don’t make decisions like this lightly. I remember what our friend Alba in Catalunya wished us before we left home: “Good luck with all the decisions you will have to make along the way.” Looking back on all the decisions we have made so far, this is our biggest and most serious one.
Even so, we knew what direction we were heading in.
“What do you want to do?” Lluís says. “I support whatever choice you make.”
“We talked about scenarios like this before. Let’s just take everything out, “ I reply. “I’ve been convinced for a long while that if I had the chance to do this, I would. We are lucky enough to be in India to do it now. We have time here, and we can get more time to be here. I don’t think it’s worth going home for, but the mass has to be taken out sooner or later. If I have to be cut, cut me once.”
We go back to Dr. Sinha’s office, and give her our consent. She books the surgery room for 5 days later.
“I have to take the IUCD out before surgery, and while I’m doing that, I think we should take an endometrial biopsy… to be completely sure there is nothing there and that I can do the bikini line cut,” she says.
I wince at the idea of having this damn IUCD pulled out again. I have come to hate everything this pregnancy-prevention device represents in my life since November 2015. I wonder why it has to taken out now since I’m taking out my uterus soon enough, but I don’t ask. I’m sure it has to do with the histopathology that will post-surgery, but mostly I just want to get rid of this stupid copper thing.
The extraction makes me see stars and I can’t breathe enough to relax. “Look. Look. It’s out,” Dr. Sinha says showing me the IUCD so I know that phase is over.
A few seconds later, I’m totally blindsided by the excruciating, sharp pain of something scraping and cutting my insides. I feel like I’m hyperventilating. I can’t keep my body on the table, and I’m instinctively crawling away from this torture. I again have an instant urge to kick a doctor in the head. The nurse has to pin my legs down.
Dr. Sinha says my lining is thin, which could be a good sign of a healthy endometrial wall, but she adds holding up the vial containing tissue pieces, “I hope this will be enough for the lab to do the biopsy.”
“It better be enough. You’re not putting me through that hell again,” I think to myself as I button my pants and wipe the sweat off my forehead.
The few days leading up to surgery are filled with administrative tasks.
I transfer important documents to Lluís, papers that give him authority to act on my behalf if something goes wrong, and send him a list of contact names and numbers and other data he may need should that happen. They are precautionary things I don’t want him to search for in a crisis moment.
We meet Namrita for dinner. I savor chicken drenched in a thick sauce with Indonesian spices and enjoy my first cold beer since last September. I’m not expecting much from hospital food, so I chew and sip slowly.
Namrita shocks us with her generosity. We will be able to stay somewhere with her — either at her apartment, at her mom’s place or in any empty flat her London-based brother-in-law and sister own in a new housing development that only a few years ago was farmland. She doesn’t even know us, but like other Indians we have met, her gracious hospitality humbles us and leaves us spouting with gratitude. She is our Delhi/Gurgaon angel, and her arrival in my life when I will need help will never be forgotten.
I choose to tell only a couple people ahead of time. I realize this is a big deal, but I don’t want everyone (particularly our families) to worry, and I certainly don’t want them to think that they should be getting on planes to India. I know they won’t like be excluded from the conversation about this milestone, but I have to protect myself from extra anxiety. And, what’s even more true, I don’t want to be talked out of this.
I’m so convinced that I am making a good choice for me, I don’t even get a second opinion. I don’t want to be involved in a “save the organs” discussion, and hear how surgery is the last resort when every other alternative is exhausted a few years from now. I don’t want to hear how I can take another pill, or how I can monitor this every few months with ultrasounds and blood tests. I don’t care about my skin being soft and my hair being shiny. I doubt I will miss for one moment the emotional roller coaster of my monthly friend, and there definitely won’t be any love lost for the night sweats that wake me in the middle of the night soaking wet and miserable. I can find other ways to celebrate my femininity.
I trust me. I believe I am listening to my body and doing right by it. I am OK with undergoing a common procedure that millions of women worldwide have gone through before me. It’s a setback. It’s an unexpected delay. It’s a choice. It’s my choice…and that makes all the difference.
On Feb. 8, we check out of our Delhi hotel in a touristic neighborhood and haul ourselves and backpacks two metro lines away to the hospital on the far south side of the city. Lluís hangs out in the Platinum Lounge sipping tea from an automatic dispenser and watches our bags while I collect a series of pre-surgery test results.
Before leaving the other day, I had to get a chest x-ray, an ECG, an HIV/AIDS screening, a white and red cell count, glucose and creatinine levels checked and a battery of other microbiology and haematology pricks. I add these to the growing stack of papers I carry around with me, a few more pieces that give me peace of mind.
“Everything looks good,” Dr. Sinha confirms flipping through the stack, pausing now and again to read key pages. I’m normal and healthy for surgery is the story the biopsy, chest, heart and blood numbers tell. “I’ll come back tonight, after you’re admitted. Surgery is set for tomorrow.”
We go down to admissions. We have this feeling of being at a check-in counter at an airport. The formality of the staff and our backpacks make us feel that way. Most other people have small day bags or carry-on size suitcases. We have our entire home on our back. We look like we’re moving in.
My bed is disappointingly near the door, the first spot of attention for anyone entering the room. I will be moved to the window side tomorrow after my roommate is discharged.
The room is standard, clean, good, as far as hospital rooms go. It’s not much different than the various hospital rooms I have been in in the US and Europe. The idea that I am a patient in a hospital creeps me out for a few minutes. I hate hospitals. All but one time, I was always on the visitor or caretaker side of the bed. The last time I was a patient was about 43 years ago, when I was a toddler. The smell of clean sheets and checkered blue scrubs and a soft white towel soothes me.
We remove the few personal items we’ll need the next few days. My eyeglass case, my MP3 player, my book and our toothbrushes take up a corner of a drawer. Lluís piles our bags behind the chair, which will pull out into his bed. I’m relieved that he will be able to stay with me 24 hours for the four nights I will be here.
We say hello to our “neighbor” and her husband, but no one really is in the mood for chatting.
Nurses come in and out to check my vitals, prick my finger, put in the valve for my IV feed. The nutritionist comes in, housekeepers mop the floor, the anesthesia doctor has me a sign paper asking me about dental implants and crowns, the nursing supervisor visits, and someone from food services brings in a thermos filled with tea.
In between, I find a few minutes to sit still. Lluís draws the curtain and guards my quiet space for 10 or 15 minutes, asking people to come back for the next dose of poking, prodding and paper signing. I do a few rounds of nadi sodhana, alternate nostril breathing, and fall into a short grounding meditation, just enough to ease me into what lies ahead and to wrap myself in protective light.
I stare at the clock on the wall, despising its annoying tick-tick-ticking. I should already be in surgery. But, I’m not. India is on IST, which we later come to learn means Indian Stretchable Time not Indian Standard Time. People rarely show up when they say they will, and things don’t seem to start at slated times.
I wish I could have a few bites of the chicken and pasta Lluís got as his attendant meal. But, I can’t. My last bit of food was more than a dozen hours ago. I keep watching the clock.
Finally, I’m rolled down the hall and into the elevator. I wave to Lluís and give him a thumbs up before passing through the swinging doors. We hold each other’s gaze and smile.
There’s a sea of color around me, bursting through different doors and down the hallways. Green scrubs, maroon scrubs, blue scrubs. Doctors, nurses, anesthesiologists.
The doctor who will remove my appendix comes over to say hello. I didn’t hear her name, and kick myself for missing it. I sigh and twiddle my thumbs.
Dr. Sinha flashes me her friendly smile. “Sorry we’re late. There were complications with the previous surgery. Ready?”
“Yes. I hope everything went ok with your other patient,” I smile back at her. I try to be sincere, but at this particular moment, I’m impatient, and I’m hungry. I just want this part to be over.
I’m rolled into the operating room. I see two orbs in my line of vision. They will be the surgical team’s guiding light.
“We’re going to put you to sleep now. Ok?” The anesthesiologist slips the mask over my face.
I close my eyes and take a couple deeps breaths. “Mom, Aunt Carol, Grandma, Grandpa, Baba, Dide…” I call on my ancestors to stand guard.
I slip away with a heart full of gratitude, imagining angels watching over me.
Surgery went well, and everything between then and now is going smoothly. I’ll write about my recovery phase in the next post.
Thanks for sticking with us during this delay.