Wednesday, 29 June 2016

so how is your father doing?

I just got back from another short Mussoorie stint.  Almost everywhere I go, I get asked the question.  "How is your father doing?"

Sometimes it is followed up with a statement: "He is OK, isn't he?"

A few also tell me that they are praying for him.

How do you respond to the question on hand.  The easy way out is to mumble a "yes", put on a smile, and move on.  Allow the questioner the comfort of knowing that all is well.

Reality is harder.  Even asking Dad the question is hard.  What is he supposed to say?  To give a minute detailed description of the various pains he is going through?  To share what it is like to have difficulty digesting food and have a family looking at you at every meal, hoping that you will eat more?  To tell about his times alone with God - talking to Him and praying in the night hours?

I have at times told people that 'everything is not OK' - but that God is with us despite it all.

That Dad continues to be positive.  And that we are working on helping to alleviate the pain - but that we are walking in new territory here.

Most of us want things tied down in neat bundles.   In crisp categories.  You are either well or you are sick.  But can you be both?

Dad is walking down that path now.  He spends much of his day in naps.  But also is up and about for meals.  He reads God's word and prays.  Most days he takes a small walk if the weather is dry outside.  He takes his medicines regularly.  He tries to eat well.  Mum has been making special meals for him - and the portions are small, but we are happy for every meal Dad has.  He and Mum look out their bedroom window at scenes like this:


photo courtesy Christa Eicher - as are all the photos in this post other than the first - taken by Bhagat Pun


Alternately, Dad gets to see God's glory in small spaces courtesy the flowers that Mum lovingly curates in the garden or up on the small 'green house' on the terrace of Shanti Kunj.

We are currently still working on what levels of pain medication Dad should be on.  We have for the last 2 weeks started him on low-dose morphine, and have increased it a bit this week.  Getting delayed release morphine-sulphate has not been easy, but we are working on it.  In the mean-time, Dad keeps a close account of when he gets up at night, when he takes extra pain-killers, what he has eaten.  All of this helps in making these days as blessed as possible for Mum and Dad.

So how is my father doing?  Well, the outer man is wasting away, but the inner man is being renewed every day.  Each and every sunrise that Dad experiences is a miracle.  We are grateful for every opportunity we have to be with him.  The knowledge that the shadow of death is nearer instead of some far-off-distant-future-never-never-event is blessedly helpful in many ways.  It brings an added joy to every conversation, an added tweak to every good-bye.

But most of all, Dad has been ready to meet his Lord Jesus for years.  If there is someone ready to meet his Maker, it is my dear father.

We know, and absolutely believe, that our Lord Jesus can remove every single cancer cell from Dad's body and give him another 15 years of life.  Why stop there - God has the power to give 100 more years, make that 200 hundred.   And this loving Lord of ours does not in anyway look down on us if we ask Him for more life for Dad.  But, we also know that an awful lot of people have already prayed and continue to be praying for Dad daily - and the cancer continues to work its way through Dad's system.  Will we only receive blessings from the Lord and naught else?  Can there be goodness while walking into shadows too?  We know that God is sovereign - and He is good.  And so we gratefully receive whatever He has for Dad.  Getting another 2 days is a miracle.  So is 2 weeks or 2 months or 2 years... or 20.  We don't have the power to even grow a single extra hair on our heads (I should know!).

So how is Dad doing?  I would say, that given all that Dad is experiencing these days, that he is faithfully walking his path with the joy of the Lord.  With a peace that passes all understanding.  With a faith that continues to glow, especially in the darker valleys that he and Mum are exploring these days.

Tuesday, 28 June 2016

Walking along side

The big volvo bus of the Uttarkhand Transport Corporation eases out of the Interstate Bus Terminus in Delhi.  Asha is sitting next to me as the cool of the AC gradually wicks away the sweat of muggy pre-monsoonal Delhi.  

Over the next 8.5 hours the bus will ease out through the urban sprawl of Delhi and its satellite cities, squeezing past various roads and other public and private construction sites.  We pick up a bit of speed once we get past the urban areas, and finally get out to fields of sugar cane and poplar plantations.  The road is wider than it was 31 years ago when I took a similar bus trip, but not as clustered with eateries and temporary fruit and curio stalls that seem to clot this lifeline like a sclerotic artery.

In August of 85 I took a bus the same distance and for a similar purpose.  It was a monsoonal August day and my father was sitting next to me as our bus left the Centaur Hotel outside New Delhi airport.  An hour earlier I had my first contact with my future Woodstock fellow students.  I was starting boarding school for the first time in 11th grade, and we were the ‘new students’ – and most of us had parents with us.  The school had chartered a bus for all the newbies and we were told to report 3 days before the main school started.  And so with my Dad next to me I was looking at fellow newcomers to boarding and wondering who of them I would be friends with as the greenness of the unfamiliar countryside passed outside our grinding non-AC bus.

Yesterday it was I who was the father.  And next to me is this amazing 15 year old who got a miraculous admission into Wynberg almost in the middle of their school-year.  As she dozes a bit on the long bus journey I have to wonder at who she is becoming.  Where has time gone?  Can it really be that Asha will be away from us for the next 5 months as she burns through her 10th grade?

The bus to Woodstock ended up with us tumbling out to the greyness and dampness of monsoonal Mussoorie.  Yesterday’s trip had us in the back seat of a taxi up from Dehra Dun, driving through the misty darkness with the headlights swiping by the blessed dark green trees and past more garish advertisements for hotels than you can shake a stick at.  Asha is dozing, curled up to my lap, and then the sudden sweetness of the Raat-ki-rani flower pierces the darkness.

A mobile call when we pass the Landour bazar means that we are met at the top of the hill by Vickey who helps carry bags down to Shanti Kunj.   I came up with my Dad as a stranger in a strange land.  Asha’s situation is of a different shade, she has come to Shanti Kunj every year since she was 2.  And it is from Shanti Kunj that she leaves this afternoon to go into boarding for this 5 month spell till the end of November.

Before she goes down today, I have another task to do.  This time it is me who is accompanying Dad and not the other way round.  We are being driven down to his palliative care doctor at the pain clinic of SMI hospital in Dehra Dun.   Dad had gone with me into a new territory as I stepped into Woodstock School – while today I have the joy of taking Dad’s special prescription paper and being driven around Dehra Dun trying to find sustained-release morphine-sulphate tablets.  It takes quite some time and we ultimately do not find exactly what we want, but I leave the main medical distributer with 30 tablets of morphine in my pocket.  That is the easy part, the harder one is accompanying Dad on his path of pain.  After supper tonight he has a sharp pain in his chest and so we give him another 5 mg between his regular doses.  It’s all very very new territory for us.

As I write this Asha is in her dorm.  One big room.  40 odd girls from the 9th and 10th standards.   We left just after 3 for the quick drive down to WAS.  Except that is wasn’t quick.  One index of our nation’s wealth is the width of the SUVs that her prosperous citizens drive.  Mussoorie is a wonderful place to be, but Landour’s road (notice the singular) is narrow with a steep drop off.  This means that many places are too narrow for 2 large vehicles to pass.  Most of the time you or the other vehicle back up a bit and then the two cars squeeze by.  Not so this afternoon.  There was a traffic clog of epic proportions.  We waited for 20 mins basically stationary.  Then a few vehicles slipped by us.  A gain of 30 odd meters saw us stuck again – along with at least 30 other vehicles both ways.  

Asha had to report to her dorm by 4 PM.  We made a snap decision.  Walk it out.  Oma stayed with the small suitcase and violin in the vehicle along with Bhagat who was driving us.  Asha and I clutched umbrellas and set off at a brisk walk to do the 2+ kms to WAS.  We huffed and puffed and made it to the dorm and signed Asha in on time with seconds to spare.  Oma and the luggage followed later.

And so another two days in the beautiful and selectively messy parts of our lives conclude.  Our roles change and shift with us taking on responsibilities and experiences previously limited to our parents.  Likewise, we see our kids living out some of the steps we have taken earlier - as well as moving into some paths we have not trodden. And we see our parents walking into areas of their lives, and experiences that we have no living memory of.  

It is such a true comfort to know that we do have a Father who loves us very much, and allows us to mirror and reflect His love to each other.  Whatever part of our journey, He has gone before and is walking alongside us, like Aslan walking beside Sashta all through dark night journey along a mountain path.

Time, like an ever rolling stream,
Bears all its sons away;
They fly, forgotten, as a dream
Dies at the opening day.

Our God, our help in ages past,
Our hope for years to come,
Be Thou our guard while troubles last,
And our eternal home.

(Isaac Watts)

Saturday, 25 June 2016

Thinking, praying, planning together

The last 36 hours have been a blur.

The Harriet Benson Memorial Hospital family has been blessed to be visited by Dr. Sunil Abraham who is a Professor of Family Medicine at CMC Vellore (the first in the country!) - and a dear friend of ours too.

We are going through a strategic review and are looking to develop a 5 year programme to take HBM through 2016-2021.   So we wanted to tap into some of Dr. Sunil Abraham's experience at the Low Cost Effective Care Unit and Shalom Family Medicine Centre of CMC Vellore.

Sunil very graciously squeezed in a visit to us as we at the HBM hospital have three Family Medicine Specialists on staff currently (Tony, Asangla and Sheba) and are working to understand which way the hospital needs to move in the next 5 years .... and beyond!


What a privilege to have Sunil with us.  Here he is sharing with the HBM staff family at the morning devotions.

We kicked off the process late last month with a 'dreaming session' where our staff wrote down what they would like to see happen at HBM.  Over the past few weeks we have been running focus groups with different groups of staff, have done a man-(or-woman)-on-the-street survey about hospital use in Lalitpur, have done an HBM patient satisfaction survey and are trying to understand the patterns of geographical access to our hospital.

The reality of the matter is that HBM Hospital has been struggling financially for some years now, with some big liabilities over our heads and a changed environment where we are not able to function in the way we used to because of new regulations and restrictions on our medical practice.

But as we spent this past day and a half in conversation, sharing, discussion and prayer together with Dr. Sunil, we come away deeply encouraged by the amazing dedication of our senior leaders and so many of the staff.  A joy of seeing a whole raft of new faces who have the potential to be do great things for God (and the energy to match!).  And the knowledge that in all our weaknesses and short-comings, our heavenly Father is so gracious and wants to work in and through us.  And the amazing potential we have to impact not only the town of Lalitpur, but all 6 blocks of Lalitpur district as well as the neighbouring districts in Madhya Pradesh too!

It was particularly appropriate to be meeting as a core 'Transformation Team' along with Dr. Sunil in the historic 'Bacon Bungalow' - the very building that Mrs. Elizabeth Mercy Bacon had purchased in 1890 when she established the Reformed Episcopal mission in Lalitpur.

Here we are, 125 years later, discussing and listening to each other to see where the next steps should be for HBM hospital.

A few years ago, generous funding for the HBM Palliative Care programme helped us to rennovate this beautiful historic building.  And so it continues to be used for building others up!

One thing that came out very clearly from our discussions was just how important each one of us are to take things forward and see transformation happen - but that we have to go forward as a team.  In EHA we aspire to be a Fellowship for Transformation through Caring.

As a unit, the HBM Hospital and all the ministries linked with HBM want to live this out in practice.

And in some ways, we are doing so.  But, of course, we have much more work to be done - and many ways that we can improve.

Sunil tasted a bit of our fellowship in our Thursday night cottage meeting.  We of course pressed him into service - maximum squeezing for the 36 hours he was with us - and so had the blessing of having the HBM family meet at our place and continue learning about the fruit of the Spirit in our lives.


And so we step into the next level of moving forward.

We have expressed some of our dreams.  We have discussed some of the opportunities we have.  We have come up with some possible solutions to the challenges we face.  We have been meeting for specific prayer for the past 3 weeks on Monday nights.

Now we need to synthesize what we have been talking about and develop concrete, visionary-but-doable-with-God's-help steps to put what we are hearing from God into action.

Here is the 'word cloud' from the short exercise we did where we asked our staff to write down how they would like to see HBM Hospital in 5 years from now.  Amazingly to me, the Epi Info 7  programme which we use to analyze our surveys has this function.  I was thrilled to see what came up.  Obviously the whole exercise is to capture some of what we as a staff team would like to see happen at HBM Hospital:
It is striking that the word 'should' is word No. 1 - the biggest word since it was used most often.  "Should" talks about change - and the desire to move into more than just the status quo survival mode. We must change... and with God's help we will!

Thanks for being along with us on this journey.  Please write to us at lalitpur@eha-health.org if you would like to be part of the exciting new opportunities that we are hoping and praying will be implemented in and through us very, very soon!

Tuesday, 21 June 2016

Rain rain rain rain, beautiful rain


We arrived in Lalitpur after our latest Mussoorie trip on Friday last week.  We stepped out of the train just before noon into a sauna.  You have to feel the heat here to believe it.  It feels like… well, you get the sense that if I marianated myself with some curd and ginger-garlic paste and Amma’s secret curry powder – I would be a tasty tandoori treat.  As it is the sun (ok the UV rays from our nearest star) already turn my melanin-deprived skin into various shades of red from rose to salmon to stop-light hues.  So I look the part a tandoori-chicken on the outside too.

The saving grace was noticing that the ground outside our house was soft.  It had rained in Lalitpur the previous night.  We could feel the humidity of the previous rainfall and see the splash marks in the dust.

We continued to bake for the next 3 days, and then what we hoped for took place.  It rained.  And it rained again.  And it rained a third day in a row.  Not just a few splashes of water, but steady, goodly stuff.  Not quite buckets being emptied out from the sky, but certainly enough to gush all over and bring a delicious coolness to everything.

Our friends tell us that we have already had more rain in these few days than Lalitpur had all year in the scanty monsoon of 2015 – and that too being a second year of drought in a row!

Most of our work in the community for the past year has been in the shadow – or should we say the unsparingly harsh sun-shine - of drought.  We have structured a lot of our work to respond to this through facilitating ‘cash-for-work’ activities.  These allow people in the villages to earn through manual labour on land-treatment activities linked with water conservation.  With cash in hand, we were hoping to help some of our families stay in the village instead of migrating for work.

What a beautiful relief to have these delicious drops pouring down.  We got so much rain that our dear “Papaya” (nano car) has been stuck in the mud in its parking place.  

The rain has not come back accident.  God says in His word that He sends the rain on the just and the unjust.  We have been praying, as have folks all over our nation and in other parts of this dear planet… for rain.  And we need to keep praying, as the full onslaught of the monsoon has not hit us yet.  The steady constant sheets of water that we are looking for have not yet been tasted, but we hope – and pray – that they will.

Mr. Baswaraj, who has come for a month to help us out with the watershed management work, has said that the small ‘bunds’ (earthen ridges) which some of our villagers have built on the edge of the beneficiaries’ fields are doing their work:  water has been gathering which previously had just flowed away, not recharging the water table and carrying away precious top soil.  But now it has the opportunity to percolate down – and farmer’s fields are staying with them too.

Having felt answered prayers as wet splashes on our faces – we don’t want to stop.  We want a full monsoonal deluge – with the right amount of rain over the next few months for farmers to get a bumper crop and for the ground water to be fully recharged.

Getting enough water this year will help us avoid this:

 (note the Eicher tractor!)
  
This is a  water tanker that one of the villages had brought from another place so that their households would have drinking water early last month.

We know that the impact of our watershed management activities in the 15 villages we are working in will be very modest.  They will have some impact, we believe, but are far away from covering all the landscape.  However, we do hope that their impact will be felt locally.  We hope that wells near the farm-bunds and gully plugs will fill up faster.  And our desire is that through the hard work of working together, our local village watershed management committees and self-help groups will grow in confidence and be able to access bigger tasks and opportunities in the coming days.

The rain has come.  We hope, and pray, for more.   


What a joy to already see a thin shade of light green as new grass is already sprouting from the soft earth.  What a pleasure to have house where everything is not glowing with heat.  Beautiful rain.  Welcome monsoon – you wet blessing from our dear Lord Jesus who loves our India so very much.

Sunday, 19 June 2016

Wild life

The HBM Hospital Community Health and Development Project works in the Jhakora and Bar blocks of Lalitpur.  I have been doing most of my field visits to the watershed management work in the Bar block.

Most of the land is spare and dry - though we have just had our first rains (and we hope for much more).

On the way to the large village of Bar - which is the block headquarters too - we pass a small barbed wire area which is under the care of the forest department.

One day, my colleagues told me that there were quite a few deer in that forest.  I pooh-poohed the thought after a quick look at the small area (perhaps 20-30 acres at most) and the spread out decidous trees.  And anyway - it was noon.  Which animals would we see at this time in the heat of a late summer day?

Well, I had to eat my thoughts pretty quickly.  We soon saw chital deer.  And not only one - but more and more.


I clambered out of the jeep and came close to the barbed wire.  Sure enough - two young males were doing their thing - butting against each other with their antlers to an enthralled audience.

This was the last thing I expected in a landscape that is heavily farmed or basically rock.   Hardly any forest cover to speak of.  And yet here are chital deer at noon.  Such beautiful creatures.


So when we passed the same area yesterday afternoon, I had my eyes peeled again.

Sure enough, there were chital to be seen, but they were very far away, and we wanted to get to Bar for our meeting.  But then I saw an awe-inspiring sight.

A nilgai.  The famous 'blue bull'.  The largest antelope in the Indian subcontinent.  As I came close to the fence, he saw me and started trotting off.  Was he alone?  No, there was a Nil-gal for the Nil-guy!


She was a bit shy and far off, but looked back at us with her lovely tan face, as Mr. N. trotted over to her and then they both went further back into the trees.

Visions of beauty.  Wild life.  Oh that we could see more.  This world has a lot of space for such creatures.  In the middle of a highly humanised land-scape (both lovely and ugly versions) it is a joy to see the grace of our cervine cousins.

Friday, 17 June 2016

Opa Elmore Eicher

Yesterday at the breakfast table at Shanti Kunj in Mussoorie, Dad thanked God for his father who had been born 112 years ago on the 16th of June.

My grandfather was christened Henry Elmore Franklin Eicher - but dropped the Henry and was known through out his life as Elmore.  His father Christian Leichty Eicher had arrived in Bombay in January 1904, and so my grand-dad was the first Eicher to be born on Indian soil.

Elmore Eicher was also the first of our clan to take Indian citizenship - for which I am so grateful!

Here is a picture of my 'Opa' (German for Grand-dad - which is what we called both sets of our grand-parents growing up) holding a 5 month version of me in September 1969 at the Alliance mission station in Nargaon.

Yesterday, as we were packing up to come back here to Lalitpur, I actually held a biography of Sadhu Sundar Singh written in 1920 by a Mrs. Parker.  On its cover was written "C. Eicher."  The handwriting looked like my grandmother's but then I did a double-take, since her name is Alice Eicher.  It probably was on of my great-grandfather's books.

As we go through a season of looking after Dad, I am again aware of the brevity of time and the value of every moment we are given to live.  

What a blessing to be able to look back on my parents, their parents and their grandparents and see God's mercies and goodness over the years.

Back in the heat of pre-monsoonal Lalitpur.  Thankful for those who have gone before us.  Grateful for small opportunities to carry on in the here and now.

Looking forward to meeting my 'Opa' Elmore Eicher again - and my great-grandfather Christian for the first time.   Good thing that I believe in the resurrection!

Tuesday, 14 June 2016

Cancer Chronicles: the latest installment


My Lord knows a way through the wilderness
All I have to do is to follow   x 2
Strength for today, is mine all the way
And all that I need for to-mo-rrow
My Lord knows a way through the wilderness
All I have to do is to follow   

Dad has lived and is living a full life.  He is now 74 years old (he counts his age as 75 as he starts counting from conception).

The last 4 months, however, have seen Dad and Mum walking further down paths which are new to all of us.

It started in mid February in Thane.  Dad and Mum came down to be with us in Thane for a month. They wanted to be with us for Enoch's birthday in February, have Dad's follow-up visit with his oncologist at Bethany Hospital in March, and also help us pack up our house before our planned shift to Lalitpur in April.

Since January this year, I had started doing 2 weeks at a time in Lalitpur to try and start up our work with the community health and development programme of the Harriet Benson Memorial Hospital - and prepare the ground for our family to move.  We were also trying to get legal guardianship for Yohan (another story - to be told soon) and I was also hoping to write Dad and Mum's story as well.

When Dad came to Thane, he said that he was having trouble eating - and that he has experienced a certain amount of discomfort in his stomach.  Having undergone a Whipple's procedure as a life-saving surgery a year before, we know that Dad's digestion is just never going to be the same again.

I was in Lalitpur when Dad when for his initial blood tests in the run-up to meet his oncologist. Sheba called me up and said that Dad's CA tumour markers were high, and that the oncologist wanted to have a abdominal and thoracic CT scan done.

A few days later, another night conversation on the phone.  I was pacing outside on a Lalitpur night while Sheba told me the result of the CT scan.  The results were not good. After Dad had taken his chemotherapy last year, the CT scan had shown no visible nodes.  Now nodes were seen.  Some in the lungs.  A possible node in the bone.  Not happy news at all.  Dad's elevated cancer markers had given the clue - the CT scan confirmed it. The cancer was back and had spread.

When I got back to Thane, we went to meet with the oncologist.  He said that the cancer was back, but that Dad was 'asymptomatic.'  Further IV chemotherapy or radio-therapy would not be much use now - and there was no focal mass to cut out with surgery.  Wait and see was what the oncologist said.   He gave an new daily pill oral chemotherapy with few side effects which has worked for some people.  And told Dad to contact him if symptoms appeared.  We sent Mum and Dad off to meet their dear colleagues from OM years in Bangalore, and then they went back to Mussoorie with the future very open.

The first few weeks of Mum and Dad in Mussoorie were quiet.  And then we started hearing that Dad was not sleeping well.  Not eating well.  Us Thane Eichers were going through an egg-beater of a time as we tried to work with the system to get Yohan's papers so that he could come with us to Lalitpur - plus were packing away and trying to tie up 13 years of living in Thane as a family.   And so all we could do was pray.

Fast forward to early May.  We have moved to Lalitpur - minus Yohan who the authorities in their 'wisdom' have not given permission to go with us.  I am moving up and down between Lalitpur and Thane to try and move things forward (more on this nightmare later).  And then we find that due to some technicalities Asha was not getting admission at the local school for her 10th standard.  Ay-yay-yo!  Rumba kashtam!

A ray of light emerges when the amazing Principal of the Wynberg Allen School goes out of his way and allows Asha to be admitted mid-term into WAS!  On Thursday we get an SMS from him telling us to come on up to Mussoorie.  Friday evening we are on the train to Delhi.  Night taxi to Mussoorie and we are at his office on Saturday morning.  Forms are filled up and a delightful interview in his office later, we are granted admission.  We get the long-list of items for Asha's boarding and so scurried around on Saturday evening and Sunday afternoon.  And then on Monday morning, we took our first-born and said good-bye as she stepped into a new school and a new world ... and found ourselves as abruptly as the parents of a boarder!

During our time in Mussoorie, we had the sadness of seeing that Dad was just not doing well.  He was in pain at nights and was eating a tiny amount at each meal.  Dad had regularly measured his weight - and had lost 10 kgs in the past 2 months.  It was painful to see.  With Asha in boarding, we decided that we had to take Dad to see an oncologist - and so got an appointment at a large private hospital in Dehra Dun for the next day.

Sheba, Mum and myself took Dad down the hill the next day, with Manoj driving us in a jeep.  The hospital was plush, and Dad perked up a bit, as it reminded us a bit of the spick and span of Bethany Hospital in Thane.  Dad was all smiles and friendships with the folks around him - but at lunch in the cafeteria, we could see him tiring as he bent over a table and slept a bit.   The oncologist asked for the normally battery of tests to be done - which we did - including another CT of the abdomen and chest. He said that this was most likely a relapse and suggested starting a 2nd line chemo-therapy the next day.  He said that we should try for 3 months and see if it works.

Sheba and I had our tickets booked to go back to Lalitpur and so we as a small family decided to go forward with starting the first dose the next morning.  We left Mum and Dad with dear friends of theirs in Dehra Dun and drove back with Manoj to Enoch who was alone in Shanti Kunj for the day.

The next morning we met Mum and Dad at the plush hospital.  We had our cash in hand and Dad was hooked up for his day treatment on the new course of chemo.  By 3 PM he was back out of his chemo and we packed them off back to Mussoorie while Sheba and I headed for the railway station.  Just before we left, we pocketed the final report of the CT scan.

It did not make easy reading.  The report said that the cancer had spread to the lungs and there was a small amount of fluid gathering outside Dad's right lung (pleural effusion).  There was evidence of spread into the liver.  And there is a mass in the place at the pancreas where the operation was done last year.

Back in Lalitpur we emailed this report to some of our friends - including our dear Tan Tzu Jen. Jen was with me at Taylor and we spent a memorable summer living together while he did research on rat hearts and I counted species progression in fields for a weed-seed ecology study.  Jen came and visited me when I was at Nav Jeevan Hospital in Bihar before marriage (both of ours) while he was a med student.  Today Jen is a surgeon and missionary doctor who divides his time between the River Kwai Hospital in Thailand and his native Singapore.

Jen's response was quick and very sobering.  Dad's cancer has metastasized. The chemotherapy that the oncologist had prescribed was cutting edge and for cancer treatments has a pretty good outcome (about 48% of patients experience tumour shrinking). But, even if it 'works' we are expecting something like 2 months on a 6 month survival after metastasis from pancreatic cancers.  Jen suggested looking into palliation instead. Over the week we got similar responses from Dr. Kenny David at Vellore and Dr. Stephen Alfred from Bethany and Dr. Ann Thyle.

And so less than 10 days later, Sheba and I were up in Mussoorie to talk to Dad and Mum.  We prayed and laid it out to them.  Dad took the news as positively as he always has done.  The first dose of chemo had not been kind to him.  His blood counts were down and he was just not feeling well.  We explained that palliative care is the care we give when its unlikely that further curative care will really work.  We talked about 'adding LIFE to days' (palliative care) instead of 'adding days to life' (the goal of curative care).   We talked about upping Dad's pain medications so that he gets sleep and night and hopefully gets back his appetite.  We talked about the end of life and discussed about where we wanted to be.  Big, big topics to discuss.  Our point was to begin the conversation.  We came away with the peace that passes understanding.  Mum and Dad agreed that we would not pursue further chemo-therapy, but would continue working to make things as comfortable as possible for Dad and work on symptomatic treatment as challenges come.  It was back to Lalitpur for Sheba and myself at the end of the weekend - with Enoch staying on as our representative.

Last week Sheba had the privilege of taking a foundational course in Palliative Care which was hosted at our HBM Hospital in Lalitpur.  And who should be there but Dr. Ann Thyle herself - who helped set up the palliative care programme at HBM Hospital and who has been spearheading the palliative care work across EHA and beyond!   Sheba and I were blessed to have a wonderful evening visit by her which helped us gear up for the next step in Dad's journey.

I was due to come up this weekend to pick up Asha as she has a 2 week summer hols break - and bring back our Mussoorie-holidaying Enoch back to Lalitpur.   Sheba decided that we should both come and help Mum and Dad take the next step with Dad's pain medication.  Thanks to Dr. Ann, we are now in touch with a palliation doctor at a hospital in Dehra Dun.  Dad has been waking up every night and medicating to control the pain.  A certain amount of relief is there - but the pain continues in the back ground.  We are hoping to achieve nil pain.   Sheba and I talked to Dad and Mum on Saturday and then again on Sunday.  We agreed that the current drugs which are low-level opoid-derivatives are not doing the job, and so we are stepping into the next step, which is a morphine-based therapy.

Yesterday we went down to meet Dr. Mayank Gupta.  His office is in the bowels of a large charitable hospital in Dehra Dun.  We meet him at the Pain clinic.  He is friendly and clearly passionate about helping folks with cancer.  A huge difference from the previous experience in the plush hospital.  Dad is very much at ease with Dr. Mayank.  He agrees to start on morphine.  We had come prepared for 2 days of admission while the dose is titrated, but Dr. Mayank is happy to send Dad home and have Sheba monitor his doses.  The drug itself is recorded in the morphine register.  Knowing the street value for stuff that is abused, it is almost comical to see that a strip of 10 costs Rs. 55 only.

And so last night we found ourselves back in Mussoorie.  Dad slept most of yesterday night and we have cut down on the numbers of pills he has to pop each day.  He is in good spirits and we take every day as a blessing from the Lord.

Though not on our agenda - we do have a mini holiday on our hands as we are not down in Dehra Dun at a hospital with Dad.  The cool mist shrouds the oaks.  Shanti Kunj continues to be as beautiful as ever.  There are warbling birds outside in the moss-covered trees.  A cup of coffee is about to be rustled up and Enoch has gone to Prakash's store in search of cinnamon buns.  Scratch that - Asha and I are about to go and buy besan - which Sheba will use to make pakoras (and we will get buns too!).

What will tomorrow hold?  We just don't know.  But we do know who holds tomorrow.  Sheba, Asha, Enoch and I are set to head back to Lalitpur day after tomorrow.  One of us will be bringing Asha back in 10 days.  Stefan is flying in to spend some time with Dad in early July.  We are looking to our Lord to take us through.  Cancer is something that we have not experienced as a family first hand till now.  We are all learning and deeply appreciate the love and concern of so many for us.

Onwards.