Glioblastoma

“Splenial lesion with hemorrhage and increased perfusion with choline and lipid peaks; features suggestive of high-grade glial neoplasm. However, Glioblastoma cannot be excluded.”  She stood for a long while at Ajith’s bedside, staring at his MRI report.

“Is everything okay Nena?” The voice of Ajith’s mother disturbed the stillness.

She managed in a firm voice, “All well, Amma!”

She neatly folded the Report along the existing crease lines and slid it back into its cover, carefully, as if any additional bend or fold could hurt Ajith’s brain further. She wiped her eyes with the back of her palm that held the envelope and adjusted the rate of the intra-venous drip, fidgeting with her free hand. She didn’t know what to tell the elderly woman.

Ajith was asleep on the hospital bed. He looked strange, with his skull shaven and bandaged above the nape.

“I’ll be back in a second, Amma. The Neurologist must have come back from his rounds.” Nena side-stepped the mother’s anxiety and gently touched her arm, without looking at her face.

She walked to the door, clutching the Report close to her chest, and entered the corridor beyond in an act of escape. The sterile hospital smells hugged her in the seemingly endless passage, along with the thoughts of Nandini.

“Will she manage to eat something after she is back from class? Did the girl take the spare door key?” The tears rushed back. “Have to relieve Amma fast.” She quickened her pace.

The young nurse at the Neurology nodded her head, indicating that the Doctor was in. Nena nervously adjusted her sari and waited, as the nurse knocked softly on the light green door and held it open for her to enter.

#

Dr. George Thomas looked up and watched the pale face of the attractive woman, apparently in her forties, entering his room. He got up quickly with a smile and motioned her to a chair in front of him.

“Tessa! Please set up our slides,” he called out to the nurse in his cheerful booming voice

The Doctor’s eyes noticed the shiver of Mrs. Ajith’s hand as she extended the Report to him. Her hopeful gaze was on him, even as the nurse inserted the slide and the black and grey image appeared on screen.

He didn’t have to go through the Report. He clearly remembered this craniotomy; they had wound up after the removal of the blocks for biopsy. The tumor was firm, extending intra-ventricular, along the corpus callosum, could not be sucked out. It was unyielding. The verdict was grave; six months? He dreaded these moments of prognosis. He had asked Tessa to share the Report with Mrs. Ajith, to prepare her for this meeting.

The red laser beam from the pointer made a circle around the dark and intense smudge that stood out from the surrounding grey inside the cranial image. Nena remembered the sleeping face of Ajith she left behind in the room and tried to concentrate on this black and grey oval outline on the display. The image looked ominous like a crude symbol, foretelling terrifying consequences.

“Can you see this iso-intense mass, Mrs. Ajith?” the Doctor asked, his tone a shade guarded from his usual cheerful note. Her untrained eyes could clearly differentiate the mass, which appeared poised to heap upon their life as a cloud, dense and menacing.

“On giving contrast, we can see this central non-enhancing area, suggestive of necrosis,” his voice faded away on a plaintive monotone, with its ending notes trailing off banally around that dreaded word, “glioblastoma’.

“We were prepared to go in for the complete removal but found it to be a bit firm and…I’m sure it’s only lymphoma, which is very treatable.” The Doctor was trying more and more to be convincing. “We have removed some blocks for biopsy. Let’s take a pathology opinion, parallel from NIMHANS too. In a week’s time, we can decide on the course of therapy, based on these inferences. Till then, you can take him home. He’ll be fine.”

She had spent the whole morning looking for details and the search results had showed up how unforgivingly aggressive glioblastoma was; the very glue cells that once held the grey matter together, now running rogue. ‘High grade glial neoplasm,’ the words from the Report floated around the room like an unseen presence of Ajith; as usual, in his playful and casual self. When their eyes met again, the Doctor realised that she knew!

These moments of epiphany were always spiritual for Dr. George Thomas. It dislodges a terrible secret from the innards of the mind and cleaves apart a sacred bondage that was, until then, painfully subjective. It creates a new objectivity that is almost… liberating.

He sighed softly and said to the nurse. “Please attach the post-operative inference and ask for a forwarding note to NIMHANS. Tell them it’s urgent please!”

Turning to Nena, he said gently, “He will be okay, maybe a little low on recent memory due to the medication, but fine. Please call me if there’s anything.”

He got up as the lady rose to follow the nurse to the anteroom. There, on the side table, she noticed a glass container with some tooth like white blocks lying within some clear liquid.

“Sister?” She pointed questioningly to the extracted tooth like blocks lying in the jar. The young one nodded in affirmation.

These blocks might have stored some of the thoughts and memories of Ajith, she wondered. Did they guide him to stretch his welcoming hands to hold her in his warm and secure embrace? These crude jagged edges must have throbbed with love for Nandini and dreamt about her future. Did these rogue cells, in anyway, help Ajith to be the wildly imaginative and the artistically sensitive person he was? 

Do they also hold his recent memory, his recent forgetfulness? She remembered with guilt how she fought with Ajith, when he forgot their Anniversary last month; how she suspected there was someone else, when he struggled with her name at their special moments. It was as if he was lost in the thoughts of another.

She broke down, inconsolably. The young nurse put her hand on her shoulder, patiently waiting for her to recover.

“Will you wash your face, Mrs. Ajith?” Nena shook her head to the nurse’s query.

“Thank you,” she mumbled as she wiped her face with her sari and hurried out of the room.

The corridor felt suddenly lonely for Nena as she walked back slowly through that distance, thinking once more of Nandini.

She was exhausted and out of breath as she came to pause outside their door. Her arms felt weak as she turned the handle and entered the room. The sight inside surprised her.

Nandini was on the bystander’s couch with her grandma; both sat together in a close hug, the elder lady patting and kissing the brow of the teenager.

“I called her over,” the old lady explained, extending her free arm towards Nena. Nena ran into that embrace and the three of them stayed in that comfort; three women in their togetherness.

Ajith slept peacefully, totally unaware of their presence.