A brillant mind, gone too soon...

 Community Medicine Laboratory left side corner desk. I was seated in front of my laptop and was writing something. A young demure girl, all of 19 years walks in and stands near where I am seated. “Sir, I am interested in doing a research study. I approached my professor in General Medicine department, and they asked me to consult you regarding the study design”, she said and stood there. We started discussing her project on neutrophil-lymphocyte ratio as a predictor of early diabetic nephropathy. I told her to read up more and gave suggestions to refine her design and research tools. The very next day, the senior professor from General Medicine department meets me in the corridor and says, “Vijay, what did you say to that second-year student, she came running to me straight from you crying and said she never wants to go back to you again”. I was shocked that I had evoked that kind of a response. Sometimes unintentionally we intimidate people. I felt very bad that I had made that student cry. But after that she would also turn and walk away whenever we bumped into each other, and I also had a sense of awkwardness to initiate any conversation. This was how it all started. 

 

This morning, we lost, Neha, one of the brightest young minds I have worked with to complications of a bad tumour of the brain. As I returned from her home, after meeting her devastated parents, not able to speak any meaningful words of consolation to them, Neha’s calm, stoic and detached voice kept reverberating in my mind. All the memories came flooding in my head during that long and tedious car ride and periodically I had to brush off the tears that would just involuntarily flow down my cheeks. 

 

When she was diagnosed with this bad tumour during her final year of MBBS, it was a serious shock for us. Neha persevered on, attended final year postings amidst tedious surgery, radiation therapy and chemotherapy. She wrote the final year exams and passed all the subjects. The day that their results came, she had come to college to meet the professors to discuss her internship plans. Internship would be heavily demanding with long working hours and tedious physical labour. We were wondering how Neha would manage despite undergoing surgery, chemo and radiation therapy. Even for a normal person internship can be tiring and exhausting. How was this young girl going to manage it, with the tumour and all the toxic chemicals and radiations ravaging her body and draining all her energy? That day, Neha met me just outside the OPD building and respectfully walked towards me. She asked me just one sentence, “Sir, should I do internship?” The question was laden with doubt, an acute awareness of the bad prognosis of her tumour condition and the typical uncertainty of a young person who is eager to go all the way, but is not really sure. The question struck me like a thunderbolt. For a second I didn’t know what to say. I showed her a wordless thumbs-up and a broad smile and told her “Looking forward to working with you. Don’t doubt anything. Come join us”. I don’t know if that helped Neha handle her self-doubt. She joined internship and worked very well for about half of her postings. But then the tumour recurred and things got difficult.

 

After our first encounter, Neha and I remained just the distant teacher-student dyad within the classroom with no personal interactions whatsoever. This continued for a long time. During her third year, when she came to Community Medicine postings for clinico-social case studies and presentations, we started interacting again. Neha was that sincere, super-enthusiastic student who would always come first to the ward and eagerly lap up everything that I taught at the bedside. She was super attentive in classes and made sure she didn’t miss anything that was uttered by the teacher. She had the constant fear of missing out on learning opportunities and would always rush ahead towards any place anything clinical was being discussed. We became close during her clinical posting in community medicine. Her curiosity about clinical facts was insatiable and she would constantly ask questions. It was difficult to convince her with any argument when we had disagreements about clinical facts and reasons. It was at that time that Neha said she wanted to come with me to the Sunday clinics that I volunteer time at in Chengalpet. 

 

She was the first student of mine who came to Sunday clinic with a notebook and pen. All others before and with her would casually come with me and talk and chat and play games and learn on the side. But for Neha learning was the core. I remember, we once saw a patient with a prominent Jugular Venous Pulsation. Neha had never seen such a raised JVP before. She was so excited to see the JVP and was thrilled to see it, captured it on her mobile and wrote about it in her notebook. I remember that patient had chronic kidney disease and his lungs were filled with water as the kidneys were not draining water outside. I quizzed her casually, knowing very well that a third year student is not expected to know the classification of kidney failure. But Neha immediately looked it up in detail and came back to me with the five stages of kidney failure, the respective glomerular filtration rate levels at each of the stages and that completely baffled me. That evening she had gone home and read up kidney failure in more detail and she told me more information the next morning when she met me. I cannot remember being so impressed by the enthusiasm and interest of any other student like that before. 

 

During the internship postings in community medicine, Neha refused to avail of any leniencies that we showed her during her postings due to her tumour and toxic treatments. “I want the full experience of internship” she said. It was peak COVID 19 time when she joined internship, but that wouldn’t deter her from going to the urban and rural primary health centres where we posted her. It was visibly obvious that she was tired and exhausted. But she would never miss out on even one review meeting and actively participated in all journal club discussions. In fact, during one of the review meetings, I even had a heated exchange with her for arguing that it is difficult to work in resource limited settings of the primary health centres. I had completely forgotton that Neha was unwell, because she never gave us the feeling. She was so brave and confident that if not for her hair-loss one couldn’t have told that she was fighting a lethal brain tumour. 

 

What started as an awkward friendship loaded with miscommunication transformed into a close friendship and an immense admiration for her brilliance, tenacity, courage and confidence. Today it feels so difficult to come to terms with the fact that someone so young has passed on, while I stay on to witness it and write essays about it. It feels unfair that this young life with so much potential had to go even before she could get her degree. It feels like nothing in this world has meaning. I wish and pray that Neha’s parents have the strength to go through this phase.