“How much time do I have?"

Very few fortunate brain tumor patients (such an oxymoron) have the sad opportunity of asking this themselves. Most of the time the question is asked by someone from the family. But the question always comes up, so it is by no means unexpected. However, this time it was asked much earlier than I had expected or would have liked. Alas, how I dread answering it.

He was 35 years old, tall for his ethnic background but still short for the global average. Brownish, medium weight when I first met him, but much thinner now after all the 'treatments' he had received. He was a part of the country's shrinking educated middle class, an engineer working for a local firm that was apparently doing really well.  He used to be accompanied by his wife, a pretty woman who was a few years younger than him and a mother of a boy and a girl, neither older than three. The wife hardly ever participated in the discussions. I once met his parents too, but they did not talk much either. He did all the talking. When we first met in my tiny neurosurgery clinic a few months ago, he appeared anxious, or rather terrified. 

After his surgery, there was obvious relief, perhaps as a consequence of the mistaken assumption that the worst had passed away. On his next visit, I saw him in a completely different mood altogether. He was neither anxious nor afraid. He was simply tired.

"How much time do I have?"

I knew the answer. I could respond to the question without answering it. Or I could choose not to answer even when replying in detail. That is my privilege as a physician.

So how am I to answer this all-important question? Do I tell him that he has a rapidly enlarging brain tumor which has recurred despite all forms of 'advanced' treatment that decades of research have arr​ived at? Decades of research worth a billion dollars which have benefited a generation of researchers, students, universities, and of course, numerous drug companies. But has the research benefited any patients? Only a very few, giving them a few more weeks to live or a few more weeks to die.

Do I tell him that it should not matter to him anyway because in a few weeks, he will lose all perception of time, person, and even reality?

Or do I tell him to go home? Go home and start preparing for the final journey, to a place which may or may not exist depending on his belief. Go home and tell his wife that he loves her. And then tell her about all the loans he took in order to afford this treatment with the hope that he would one day return it all, only to now pass it on to his wife. She will need to find an extra job. Her children will have to cancel their plans for a vacation or their desire for one. He lost this gamble and his wife will have to pay for it. But then again, he knew the stakes were high. His doctor had told him that there might be a treatment. Might.

Do I tell him to go home to his little boy and girl, to hug and kiss them before he stops recognizing them, to give them his life's worth of experience and advice? He has learnt so much in his life and it is all stored in his memories. Now that he will lose his memory, the information must be transferred elsewhere. And when I do tell him how much time he has left, do I look him in the eye, or at his forehead just below the scar I gave him for a surgery that now seems unnecessary, ridiculous even. Such an expensive procedure rendered futile by my colleague in histopathology, despite the 'scientific evidence' I had to support my decision. Not decision, recommendation; perhaps it is the same, for this too is my privilege as a physician.

One of the greatest scientific minds ever, Einstein, defined stupidity as “repeating the same actions and somehow expecting different results." Einstein should read some of today's 'scientific' papers.

Einstein also advocated that time is relative. I understand this now, for this patient's remaining time just cannot be quantified. Can you compare a few weeks of independent, healthy life to a few months of totally dependent, vegetative state? Which one is longer?

"How much time do I have?"

Death is an event, but dying is a process that starts when I answer this question. If I don't, the process does not start. I cannot delay death, but I can delay dying.

Time is indeed relative. And I certainly do not have time for this.

I smile at him and tell him to see the oncologist who sent him to me.​

I leave the room.

DISCLAIMER: ​Copyright belongs to the author. This blog cannot be held responsible for events bearing overt resemblance to any actual occurrences. The views expressed do not necessarily reflect the views and policies of CCIT or AKU. ​

 About the Author: 

​Shahzad Shamim is an Associate Professor and Consultant Neurosurgeon at Aga Khan University Hospital, and specializes in Spine and Brain Tumor surgeries. He is the Chief of Services for Neurology, Neurosurgery and Psychiatry Services, Director of Internship, Surgical Neuro-oncology Fellowship, and Deans’ Clinical Research Fellowship Programs at AKUH. A father of three, he likes to spend his free time reading, scuba diving, playing tennis and golf. His close friends insist that he should stop trying at these sports and stick to Neurosurgery. He also has more than a hundred research publications and can be reached on Twitter @Shahzad_Shamim​