Once upon a time, there was a patient, who, for the last one month, had been on a breathing machine because no one could figure out what was wrong with her. Or how to fix her. For the last one month, every doctor in the unit, all the top brass had been scratching their head thinking “what the bloody hell is going on?” They tried every trick in the book. Making the patient lie upside down. Inhaled nitric oxide. Fancy modes of ventilation. None of the tricks worked. Some made things worse.

Then came this man who walked into the ICU one day. He was a very simple, unassuming man. He stood and watched the patient for a while. Watched the breathing machine do what it was doing. Looked at all the blood tests. Then, almost as if he was thinking out loud, he started talking. Went to the breathing machine, and played with the settings. Almost immediately, the patient’s breathing improved dramatically. Two hours later, her blood tests looked better than they had ever looked in the last one month.

This man did what everybody in the last one month was trying to do, but nobody actually managed to do it. And the beauty of it was, when he actually explained what he did, it was so bloody simple. Its what should have been done right at the start, but no one thought of it because it was so simple. Nobody tries simple things with a complicated patient. Yet that is exactly what was needed.

Sometimes, it takes a real genius to focus on the problem without getting distracted by all the superfluous details along the way. A la Arjun. I really wish I had this clarity of vision in my repertoire. What this man did today blew everyone away. There is now hope for this patient. Hope that she will survive. Make it out of the ICU someday. See her grandchildren grow up one day.

You know, I never really understood why people liked working in the ICU. Its a hard lifestyle. You get called at 3 AM. You miss your kids’ birthdays and school performances. Your stress levels are perenially high, because all your patients are bloody sick. But today, I had a glimpse of why ICU is such a rewarding career. And it took my breath away…..

…. you meet a truly remarkable human being. Who impresses you from the word go. And whose memory will stay with you long after they are gone. Who has style. Panache. Strength of character. Just an all-around great guy.

I met one such person last week. And ever since I met him, I cant help but admire him. I really like him. Its hard not to. Here he is, a man in his 70s. More than 6 years down the line after being diagnosed with a lethal form of cancer. That in itself is a miracle. But thats only the beginning. In his fight with cancer, he has won some, and lost some. He has won six years. Along the way, he has lost his voice box, and now communicates through text messages, emails and writing. He has a hole in his neck to breathe through. He has another hole in his abdomen to feed through. He has cancer all over his body.

Now the cancer is slowly getting bigger. He can see it swelling under his skin everyday. Sometimes it bleeds out through the skin. Occasionally, the bleeding doesnt stop. He knows the cancer is now starting to win.

But the thing about him that really amazes me is how accepting he is of that fact, without necessarily giving up. He still lives on his own. He doesnt have a car. He cycles everywhere. Cycles to go see his grandchildren. Cycles down to the pub to go see his mates. He does his own vacuuming, and mows his front lawn every few weeks. Orders all his medications by email. If the tumour starts bleeding with no sign of stopping, he sends an urgent text message to one of the nurses here at the hospital, who goes to see him urgently to make it stop bleeding.

It amazes me how well he manages. Every morning, I go to see him. I talk, he writes. When he laughs, the air gushes out the hole in his neck with a soft ‘swoosh’. He always greets me with a smile and a wave. By the time I get to see him on my round, he has already finished the cryptic crossword in the morning paper. He doesnt even bother doing the classic crossword, its too easy for him.

Him and I both know he is dying. But the grace, the absolute style with which he is doing it, I can only look on with admiration. Its almost as if, he is an expert about it. I guess that is not so surprising, after all, he has been practising for six years.

The following is a real conversation between a doctor (Dr A) and a patient (Mr X). The lines in italics are thought bubbles above Dr A’s head

Dr A: Hello Mr X, I hear you are having nose bleeds again. Its almost certainly due to the leukaemia, preventing your body from making any platelets

Mr X: Yes doctor, you are right. It always happens when I have no platelets and then I blow my nose.

Dr A: Do you have a cold? Why are you blowing your nose?

Mr X: No, I dont have a cold. I blow my nose so I get rid of the bacteria, so I dont get a cold.

Dr A: What the hell??!! Ummm….Mr X, please dont blow your nose. Because you cant get rid of bacteria like that, and all you are doing is giving yourself nose-bleeds! You almost died with your last bleed, as it wouldn’t stop bleeding!

Mr X: But you always fix my nose bleeds. So, no problems!

Dr A: Walk away, because I am not going to win this argument!

Dr A returns half an hour later to see if the nose bleeds have settled down.

Mr X: Yes, they have settled doctor, but the bleeding starts if I get up and walk around. Here, I show you…

(Mr X proceeds to get out of bed and walk around before Dr A can tell him not to. The nose starts to spurt again.)

Dr A: Great!

Dr A spends the next hour trying to stop his bleeding

Moral of the story: some people are hell-bent on proving Darwin right. You can only stop them from doing it so many times

Someone has left a large bunch of flowers in the doctor’s room. Expensive flowers. The kind that you can smell from the end of the corridor. Huge pink lillies, some yet to bloom, pink roses, purple sweet pea. All in an expensive pink ceramic vase. There is no name attached to these flowers.

Working on an oncology ward, you can never be sure what these gifts signify. Did someone bring the flowers in because a loved one was cured? Or because we had no cure for that loved one, but thank you for trying anyways?