I would have missed him in the Sunday rush at the vegetable market if he had not almost fallen on me. He was trying to fit in some long and unruly snake gourds in an already-crowded bag that had a few stubborn ridge gourds unwilling to yield room, while simultaneously trying to ensure another bag, packed with fruits, on his other shoulder stayed in place.

Only after I caught him did I realize that he was Mukesh uncle. He thanked me multiple times before he recognized he was talking to a long-time friend of his son.

“Oh, it’s you! Thanks a lot!”

I decided to return to the market later. Right now, he needed help with the bags. I started walking with him to his house which was, fortunately, not too far from the market.

“Do you know Arpit has completed 20 years at work?” As expected, it did not take long for the conversation to turn to Arpit, his son and my friend.

“I hope he will also get a Long Service Award soon. Have I told you about the Long Service Award I got from my company?” He had, many times over the years, but it was only polite to let him tell me yet again.

“I had completed 25 years. The whole company gathered to honor me with a gold medallion, which the big boss gave me personally. Imagine! Next time remind me to show you that when you come home.”

Not again, I sighed. But he was not finished.

“Then one by one they spoke about me. When I had joined. About my work over the years. Then they wanted me to speak. I was about to cry and could hardly speak. I tell you, it was not a company. It was a family.

So many they had honored. When someone could not make it for the function on the day she completed 25 years because she was unwell, some of us, including her boss, went to her house and presented her the award.”

I politely refused his invitation to step in for a cup of tea when we reached his house. After I carefully placed the bags down with all the gourds intact, he asked me to wait. I knew what was coming.

He rushed in and came back with the Long Service Award. “When Arpit gets his award from his company, I will keep it right next to this.”

He moved a little closer and whispered: “I have told my son that when I am gone, he must publish the name of my company in my obituary and say for how long I had the good fortune to work there. I still feel I really belong there.”

As I walked away, I realized what Arpit had not told him, at least not yet.

Soon after Arpit returned to the US after his last visit home, his company had made him an offer. The same offer hundreds of his colleagues had received. “Now that the total of your age plus the years you have put in with us has crossed 50, we are offering you the benefit of opting for voluntary retirement.”

The offer was delivered not in person but as one of the routine emails from HR. Some accepted. Others, like Arpit, who had declined the offer, were prepared to be kicked out sooner than later. He was now busy looking for other options. However, it was not easy. His intelligence and experience stood no chance. Every company he approached was busy shedding.

I could only hope he would succeed. And that he would be able to make his father understand that long service was no longer award-worthy but a liability. Because it was long.
​
The glittering medal in the glass case would never have a companion. Even after it was immortalized in an obituary. 

​A fast-moving broken plastic bottle crossed my path as soon as I stepped into the school compound. Some boys and girls were happily kicking that bottle around in true FIFA spirit. Probably clueless about the world of the cup, they were just having a ball with whatever they could kick around.

I was at the government school with a friend who wanted to ensure his name survived the special intensive revision of the voters’ list. Some hectic web searches and several phone calls had guided him to this location. 

I waved him on while I waited and watched the game. The players were very happy to have a spectator, that too an adult. Some even invited me to join them. Then the bell rang and the ball was abandoned.

As I walked up the stairs, the children ran all around me. Up, down, left and right. It was as energizing as it was deafening.

I located the class where my friend was talking to someone seated at the teacher’s table that was weighed down by several piles of papers. Most students of the class were moving in and out, while some remained seated. For now, she was not a teacher but the person responsible for locating the all-important enumeration form for my friend, that would confirm or erase his electoral existence.
 
As they matched numbers and names, I looked around the class. The posters on the wall (“A for Apple”; “Sad X Happy”) suggested it was a primary class, which the teacher later confirmed. The students were yet to decide whether to settle down or keep running in and out. Except for one boy right in front, his desk closest to the teacher’s.
 
That boy was drawing something. Every now and then he would look up and pay attention to what we were talking about.

After the form was dug out, I had a quick conversation with the teacher. Surely, they could not afford to be distracted by the forms when they had a classful of bouncing boys and girls in front of them?

This is what we have to do. This is the fifth or sixth duty we have been asked to perform this year. Yes, primarily we are supposed to teach them. But what can we do? And what can the children do? Their parents are poor. They feel fortunate that their children have got admission and will grow up to live a better life. We do what we can. 

Another teacher walked in and joined the conversation.

Yes, you are right, there is technology. Those in government and their rich friends all have technology. Can you please write to them to make good use of it? So that we can get back to what we should be doing? 

They have no qualms when they question us why the children are doing so poorly. There is no point arguing. We just obey and get around to teaching whenever we can. Yes, we feel bad for these children. But we are helpless.

As the teachers finished speaking, my eyes went back to the boy on the first bench. He was looking at the teacher and then me. There was a certain adult-like angst in his eyes.

Don’t the candidates send multiple people multiple times to every house when the election is round the corner? I whispered that question to my friend as we walked out of the class, yielding to more form-seekers walking in. Why can’t they do the same thing now? They suddenly lose resources and people when we elect them and they become government, is it?
 
My friend growled and hushed me. He admonished me for getting into needless conversations. Just get our job done and get out. These children are not our problem. He walked ahead in anger leaving me behind.

As I was about to cross the compound and reach the gate, a voice stopped me: “Uncle, uncle”. I turned around. It was the front-desk boy. There was no hiding his agitation now.

I held the boy close. He definitely needed some calming. In a mix of the local language and English, he told me what was bothering him.

He did not want to make the teacher angry. He definitely did not want to make the government angry. He just wanted to become a doctor. A heart doctor. He was very sure. For that he knows he has to study. But how can he when his teacher has to do so many things other than teaching? Will he ever be able to become a doctor?
 
The immediate thought in my mind was if I would be allowed the power of my vote to try and remedy the child’s problem. Would it matter at all in the larger scheme of things? I did not speak that doubt. In words that did not convince my own heart, I assured him he would. He just had to keep studying hard. His teachers would help him. His family would help him.

He made an effort to look happy. Then he showed me the paper he was carrying. It was the drawing he was working on. It was more emoji than anatomy. But there was no doubt. It showed what his heart was set on.

It was just a vacation
Across the border
Then the colours took over.

Blues of the skies
Greens of the forests
Browns and greys of the mountains
The distant silver of snow
Gurgling transparent waters
Forever cleaning the white stones.
 
All encouraging
To breathe deep and slow
Abandon the rush, the crush.
 
Drop the worries buried deep
In bodies and minds
Shut the devices
Open the heart, open the eyes
Drink in deep.
 
Satiate body, mind and soul
With calm and peace
As we all could once.
 
Still ours to reclaim
If we truly want to
Just need to pause
Take a step back
Care more
For self, others, all of nature.
 
Was just another tourist
Yet there you stand
A compassionate mother
With open arms
Urging me to come again
And just be me.
 
I miss you
Dear Bhutan.

Imagine you are possessed. By a human from the afterlife who grows close to you but remains invisible to others. Cheerfully goes on to help you cope with the difficult decisions in life. Will you cherish such a partner or rush to exorcise it?

In the movie Sarvam Maya, the main male character is an atheist who turns priest while waiting for an opening in the profession that is his passion, music. He is befriended by a sprightly young girl; the same one he, as the priest, had managed to spirit out of a patient. Only he can see and hear her. She begins by being attached to his mobile. Then they go on to become very attached to each other. In the process they find closure. 

Let's think beyond the movie for a minute. What if gaining such a mystical friend were a natural part of every life? No, not to make one a superhuman with the super strength to do good or wreak havoc. Just a partner you are very comfortable with, you trust fully and with whom you can’t help falling in love, almost.

Will this make us view death differently? Will death stop being the dreaded end, but a natural stage in life?

Will we turn more compassionate towards those who are approaching that stage? Will we stop turning our head away in fear (and some element of disgust) when the body of a fellow patient in the hospital ward is being rolled away?

Once we have such a companion, will we turn more grateful to the life we have been granted? Will it make it easier for us to find true closure? 

Just as the hero in the movie reconnected with his father, found human love, stood up to the goons he used to run away from, and made a mark in music. All thanks to her. And, in turn, she who befriended him finally became aware of who she was and how she had died.

We may not be able to choose such a companion. However, chances are there will be something in common, finished or in progress. 

The movie title Sarvam Maya means "all is an illusion". Indeed, when all is illusory, why lug a grudge, why just plod along and abandon the life you truly want? That could be the path to being the true you, to that coveted closure. 

The customer was puzzled. This was the same cheese that she had been buying from her favourite farm produce company for years. But now it tasted different, bland.

“It used to taste so good before. Just the right saltiness. Now it has no taste,” she told the manager of the outlet. The manager apologised, promised to speak to the owner and resolve her complaint. After all, she was an old, regular customer. They were friends.

During the next visit, polite conversation apart, the manager was not forthcoming with the resolution. “Now the son is running the show,” he said almost regretfully.

“That is fine, but what did he say about the cheese?” she persisted. “He said,”  the manager paused. “He said the cheese is fine. If you want you can sprinkle some salt before eating.”

She walked out more incredulous than angry. She could not resist a look at the signboard of her favourite cheese supplier. Would she have to find another source now. After all these years?

She never bought cheese from them again. Yet, she would drop in occasionally to buy other small stuff and to say good morning to the manager.

On one such visit, she found the manager missing. And again during her next visit. “He is on leave,” said the person, who now manned the counter, impatiently waiting for her to finish paying so that he could go back to his mobile.

A couple of weeks later, the manager was back. His smile was strained. No, the morning was not good, he said. His wife had to be hospitalised on account of multiple health issues. Now she was back home. “It is very expensive to keep her in the hospital,” he said and turned to attend to another customer.

Over the next few days, whenever she passed by, she noticed that he was frequently absent.

One leisurely Sunday, noticing him alone at the shop, she walked in. Not that she had to buy anything.

“Yes, she is okay. At home. Still in pain. What to do now, we have to manage. It is just the two of us.” He was clearly distracted.

They used to have casual conversations about something or the other. Just to divert his mind, she decided to try that. She picked on a headline in the newspaper lying nearby. “Look at this. Such a big company and they have laid off so many people. These days you have to be fortunate first to get a job and then not to get kicked out for no fault of yours.”

That did not trigger a diversionary response she was hoping for. Instead, his expression turned dark. He leaned closer to her, pausing for a moment to look at the camera overhead. Then he shrugged as if he did not care.

“Every day do you know how much I am spending on my wife? On food and medicines? And you know how much every visit to the hospital costs? We don’t have that kind of money. We were just managing until…”
He paused to catch his breath. His eyes welled up.

“My employer, this company, they know they cannot easily find someone to replace me. Someone who has the experience, who knows the customers well. You are talking of layoff. My boss is telling me to go to hell without really saying that. You know how many years I have been working here? And how many hours each day?”

She did not know how to react. But he wasn’t finished.

“Forget helping me or granting me leave, would you believe they deducted 10,000 rupees for the days I could not come? Knowing my wife’s condition and the state I am in? I wish I could return the compliment and tell them to go to hell. I just can’t. And they know that. So, I have to pull on till they kick me out.” This time he did not bother to hide his tears. He moved away wiping his eyes, gesturing to a junior to handle the customer who had just walked in.

She stepped out, very disturbed. She was sure the camera would have captured his words. But would they also see his tears?
​
She wished she didn’t care. Just like the new young boss at the company. Who had betrayed her expectations from her beloved cheese. And rubbed salt into the oozing wound of a loyal employee.

Two recent conversations with well-placed founder-friends left me with one question. Is two-way boss-subordinate emotional dependency healthy in today’s professional world?

She had just sold the three-decade-old company that she had built from scratch. It was a good sale. Yet her tears conveyed regret. She was sad how the new bosses were treating her erstwhile loyal colleagues.

As she put it, some of “my people” had moved out when the sale process was on and didn’t have to “suffer”. Apparently, the new owners did not find the loyal ones up to scratch and were trying to beat them into the shape they wanted.

Should she have simply disconnected after the sale?

The other founder had recently celebrated his birthday at an informal gathering that included most of his employees. They jostled to get hold of the microphone to sing his praise. The words differed but the tune was the same: “we are here just because you are”.

He was obviously thrilled but modest in his response. Was all the adulation just an attempt to sweeten his mood before the next appraisal?  Other leaders of the organization were present, but he alone mattered.

The day he decides to put his feet up (not too far given his age and health) would the decades-old organisation simply crumble?

Was it positive two-way loyalty on display in both cases? Or self-destructive emotional dependency?
​
What happens when bonding becomes an inseparable emotional crutch the boss or the subordinate can’t do without?

A desperate need for a crutch at the workplace is probably a sign of emotional disturbance, opines Lovaii Navlakhi (MD and CEO, International Money Matters). Lovaii describes both sides of workplace love. “A manager may want to be liked or even loved. But a true leader would want to become redundant. On the other side, if you have been a loyal employee for long, the question you ought to ask yourself is do you want to be a boss one day or be a perpetual follower?”

The equation is very situational. Is emotional dependency a tradition? Does the environment allow dependency? Regardless of what the emotional ecosystem is like, it boils down to the maturity of the individual employee. Are you aware of and alert to a world outside your workplace? Are you confident enough to accept a new challenge and move with the times?
​
As for the entrepreneur who let go of the company but not her emotional attachment, Lovaii feels she ought to focus on why she made the sale in the first place. What is it that you would like to do with your experience, skillset and life now? 

​It continues to be in vogue to describe the workplace as “family”. Possibly an expression HR would like to use with a view to retain and attract the talent they need.

But some owners are wary of the terminology. As long it suggests common values and goals, and, more importantly, civil relations, it is fine. The problem starts when some employees begin to take the organization for granted because the “family” will take care of them regardless of what they do or don’t.

It is up to the owners to discourage toxic emotional dependency. More often than not, HR steps after the toxicity has done serious damage.

Sunil Wariar (independent HR consultant; was head of HR at Future Generali India Insurance) believes that the “family” is the right description, provided the organization is “a collection of people with common shared goals where every member is respected for their contribution with pride and conviction to support and succeed the leader.”

It is not uncommon for a leader (or owner) to slave-drive the team, drawing comfort from obeisance, without bothering to share where the team is, where they are headed, and what is expected of them to reach where they ought to be. “When this doesn’t work,” Sunil says, “the leader brings in the concepts of emotional connect and loyalty as remedial measures, without bothering about the root of the problem.”
​
He is all for emotions in the organization, which is after all made of people. However, “it has to be such that it brings in passion, innovation, discussions and disagreements out in the open to get the best from the team. Blind loyalty and subservience with no regard for truth or original thinking cannot sustain an organization.”

Mehernosh Mehta (VP, HR, CG Power and Industrial Solutions) thinks emotional dependency at the workplace is very normal and common. While the entrepreneur who is unable to detach herself from the members of her old team even after she sold the company might be a rarity in current times, Mehernosh thinks it boils down to trust.

“For the juniors, the connection offers a sense of dependency and security,” Mehernosh observes. “Things can get very difficult at work, and one is always on the lookout for a benefactor or guide. It brings comfort and encourages loyalty. For the leaders, who are often lonely at the top, it helps to stay connected.”

It is a “healthy psychological transaction”, a give and take. But closeness can cut both ways. One can get way with the corporate version of blue murder, simply by being “close” to the boss.

Mehernosh points out, “HR cannot stop people from forming relationships. But those relationships should not turn into power centres that adversely affect the organisation. There is a difference between being aligned to the powerful and being loyal to the organisation at large. When the need arises, HR should stand up for the organisation and those who are for it, without being drawn into power tussles. We cannot have one coterie dispensing justice, taking decisions and bypassing other functions. Such unhealthy relationships must be discouraged.”

Once upon a time, it was common for a person to spend their entire working life with the same organization. Even their obituary would name the organization they used to work with. Today, things have changed drastically.
​
“While there are always exceptions,” Mehernosh says, “loyalty has become a misnomer.” In today’s startup culture, the owners are focused on recovering their investment. On the other hand, the employees are game to quickly jump to wherever the grass looks greener. 

Mohan Joshi (Strategic Advisor and Master Coach; ex-President, SCHOTT Glass India) believes “emotions do play a role but within limits.” Regardless of how long one has worked for an organisation, that work was rewarded.

“Today you are required to solve tomorrow’s problems. Owners are looking for those competent to navigate this period,” Mohan adds.
​
He believes, “Emotional bonds may have limited value; competencies matter more. And if you have moved on, prioritize your action plan, not past loyalties. Only competencies can guarantee survival.”

Human beings are emotional by default, though we may rationalize otherwise. Emotion is a good foundation to build trust on and that can become a solid structure of commitment.
​   
There will be departures of employees and changes in ownership. Both can bruise less if the transitions are planned well. As long as it does not lead to conflicts and confusion, the entrepreneur who sold her company is perhaps justified in guiding her old colleagues for their betterment.

No one can truly judge a new employer until you have been in there long enough. In the long run (which tends to be rather short these days), what truly matters is the kind of work you do and how your boss values your contribution.

Whether you are looking for a new job or a new enterprise what is important is to learn from the experience. You may remain true to your emotional nature but you must be dispassionate about assessing your own strength and goals.

Today when shallow engagement and quick likes matter more than deep connection and identification with an organization’s professed values, it does not matter whether the organization is called a family or not—as long as both employee and owners feel at home.

​Emotion has nothing to do with it. Or has it? 

This story will shake you up. Even if you are already numbed by what you get to read in the media these days. After all, even the seasoned psychotherapist who shared Sahira’s story had goosebumps while narrating it.

The story is about her, Sahira and him, Nasir. You will not be able to forget her at the end of it. And not want to remember him.
​
We do not know what happened to him. But if he were to tell, this is probably how the story would begin in his entitled voice.

​Let us now shift to Sahira’s perspective, as described by the psychotherapist.

“With no footwear and no money, she ran for her life and that of her unborn child. Her parents took her to a hospital, lodged a police complaint and also filed for a divorce.

“Her own family advised Sahira to choose abortion because she was very young and had a whole life ahead of her. She could get married to someone in a few years and settle down. Her family didn’t have enough money to support one more member.

“However, at the age of 19, Sahira decided that she would not remarry but raise the child on her own.

“Her divorce case lasted for over six years. She felt she was being raped again and again in the court room as the lawyers pestered her with questions and made her go through the whole case in agonizing detail.

“During the sixth year of the case, Nasir was caught by the police in another rape case. He was apprehended in his car while he and his friends were returning to Pune with the victim, from the same farmhouse where Sahira was once raped.

“The judge issued a warrant for Nasir’s arrest. Left with no other option, Nasir’s lawyer reached out to Sahira’s lawyer for an out-of-court settlement. Nasir was ready to give complete custody of the child to Sahira and also give her a divorce, if she would let go of all charges and cases against Nasir and also let go of the huge amount owed to her in alimony arrears. Sahira agreed because this would free her daughter for life from having to maintain any contact with Nasir. For Sahira, that mattered the most.

“Sahira had to give up on her dream of becoming a doctor. But she didn’t give up on her dream to be a successful woman, a responsible daughter and a loving mother.

“She has worked mainly with international banks and is currently in a leadership position in a European bank. An alumna of one of India’s leading institutes of management, Sahira continues to pursue her doctorate in organisation management.

“Sahira remains unmarried and stays with her daughter in a beautiful house she owns. Her daughter, an academic topper, has grown up to be a mature and responsible young graduate.”

Do read the complete post by the psychotherapist, Prerna Shah, here.

At the end of it you may want to curse the villain. Or, more positively, follow the victim’s example and celebrate her victory over “fate”. You can, if you badly want to. She is a living example.

The main challenge when you take a flight that lands at 2 a.m. is not the sleep you lose. But to ensure that the driver of the cab who picks you up will stay awake and alert through the journey.

My strategy remained the same this time too. Greet the driver heartily and after establishing our respective identities, start a conversation about the latest in local politics. Never fails to keep the conversation flowing and eyes open, especially when you are in Kerala.

Of course, as always, I had taken care to quickly scan the interior of the cab for words, images or colours that would have indicated if the driver was already aligned to a political thought or a party. Again, as always, I started out with some innocent questions, expected of an ignoramus not tuned into the here and now of the political landscape.
​
This time my plan failed. Or, maybe, he sensed pretty early that I was a mere pup when it came to politics. So, after a short pause that threatened to induce sleep, I latched on to a topic that was making headlines all over.

“Isn’t it frightening,” I began. “Small school children getting addicted to drugs. They become rude, violent and don’t hesitate to kill. What is happening to God’s Own Country? The most literate state?” I patted myself for that closing. It was sure to kick off a long conversation.

Instead, sitting as I was right next to him, I could discern a change in his expression. Suddenly, he slowed the car down. I looked around to spot a reason. No teashop or public toilet around. All I could see was a signboard that identified the building across the road to be a government school.

He was pointing to that school. Then he turned to face me.

“My daughter studies there. She is in the eighth standard. My son is also there, three years younger,” he paused. His turned his face away and wiped his face on his sleeve. Was he crying?

I remained quiet as we resumed our journey. The silence persisted. Then he spoke, almost in a whisper.
“For you, these are just headlines to talk about. For me, this is my life, my family.” There was anger in his voice and sorrow. Then he shared his story in bits and pieces.

“This has been going on for a while. Everyone thought it was localized first. That was the excuse our leaders used for a long time. Now, it is too big a fire to hide.

“Politicians don’t even bother with justifications and promises any longer. Yes, some of the drug runners get arrested once in a while and it becomes big news. Usually, they are out in a week or two. There is too much money and power at play.”

He stopped the car for a tea break. I refused his offer of a cup and waited in the car for him to return. I was disturbed. It was one thing to read from far away and arrive at righteous opinions about the deplorable state of affairs. It was another to be in the middle of it all and live life on the edge, day after day.
​
He had half a smile on his face when he returned and started the car. I asked him: “So, how do you handle this? How do you protect your children?”

“My wife I and I make a conscious effort to be not just parents but also good friends to our children. They are free to talk to us about anything. We do not rush to judge them or punish them. Thankfully, they are smart and are doing well in school. We just sit and talk. If my daughter has something to say that is strictly for feminine ears, she opts for a private conversation with her mother. My son is crazy about football, and he would rather discuss that with me, thought I am not a footballer. We have our disagreements, yet we try to keep one another happy.”

Where did he get this idea from? Did someone counsel him and his wife? Did they watch some YouTube video?

“We have been like this right from the time we married. Our family life never had a man’s side separate from the woman’s. We saw no reason to change our way even after we had children. I do not know if we are doing right or wrong. We just want to keep everything transparent. It is not about right and wrong or good and bad. We just hope that when we discuss everything in the open, we will be able to prevent any serious problem ... or at least nip it in the bud.

“Yes, we talk about the drug problem also. They have told us about a few things they have seen on the way to school. Fortunately, their school appears to be safe so far. Maybe because most of the students there come from relatively poor families. Not much money to get there. But there are some teachers in our neighbourhood who work in bigger schools. They tell us they are afraid. It is just a job for them now and they continue only because they cannot possibly get another job here.”
​
We happened to pass a church. He slowed and bowed his head. The same thing happened when we later crossed a temple and a mosque. He was conscious of my gaze and answered my unasked question.

“You have probably guessed my faith from my name. But honestly, I have lost my faith in humanity. Our only goal now is to divide and exploit. My only plea to God, wherever He is and whatever we call Him, is to help me and my family.”

We were very close to my destination. He had something more to say.

“We want our children to study well, find a good job and settle down somewhere outside. Like you, they should be able to speak English and do well to fly from place to place.”

I was on the verge of defending myself, but we had already stopped at my spot. So, I let it pass.

After I paid him, he asked my permission to contact me once the children finished their school. Maybe I could help them find a job somewhere far away from here?
​
All I could do in response was give him a long hug and walk away. I didn’t want my tears to dilute his hope.

​The birds were hailing the rising sun with their chorus. As I slowly wheeled my bag along, I tuned into their songs and focused on the gentle light in the horizon. I desperately wanted to be positive. Maybe, just maybe, God would return to reclaim His country and save His people.

When the doctor was first describing her cancer, Katie Doble, 32, stopped listening for some time. Because she had a decision to make. Should she be planning her wedding or her funeral? Her boyfriend had proposed to her just ten days earlier.

Katie went on to get married. She also prepared for her funeral but, thankfully, that must wait.
​
Her first symptom had appeared in May 2013—"a strange vertical black bar swimming through her field of vision”. It was diagnosed as uveal melanoma, a cancer of the eye. The first line of treatment involved a “radiation-emitting metal disk placed in the back of her left eye”. As feared, that led to her losing vision in her left eye.

On the positive side, her doctor said the chance of her cancer spreading was less than 2 percent. In April 2014, an ultrasound found no signs of metastasis.

Seven months later, just after Katie’s engagement, new scans revealed that her liver now had a dozen lesions. Like most afflicted with the deadly C, Katie was anxious to immediately start the treatment the physician had suggested, the one that would have given her some 16 months to live.
​
Fortunately, she had a rare advantage. Her father was a doctor, who was already exploring more promising options in the stage of clinical trials. On his advice, she refused the treatment and entered a trial at Memorial Sloan Kettering Cancer Center, New York. 

Five months into the trial, her tumors had grown. She was moved to a second arm of the trial that added a second medication to the regimen. The side effects of the combination “kicked my ass”. But she braved it. Determined to overthrow cancer as the ruler of her life, she went skydiving. As she floated down, she tasted the salt from her “happy tears”.

She had to exit the trial because the tumors continued to grow even after two months on the combination therapy.

Then she joined a second clinical trial at UCHealth, Colorado in September 2015. That too she had to leave after one treatment on account of gastrointestinal complications.
​
Given that it is not easy to access a clinical trial, and the heavy costs involved (estimated at $600 a month in 2015), most cancer patients hardly get to join one. Katie was already a unique case having participated in two. 

In November 2015, she opted for an FDA-approved treatment of radio embolization. Thirty million tiny radioactive beads called microspheres were injected into the blood vessels supplying the tumors in the right lobe of her liver. It worked! The tumors stopped growing and some even shrunk.

Heartened by this, Katie took a break to focus on building a house, “as one does when you’re trying not to die.”

​She had outlived her doctor’s first dire prediction, but the tumors were thriving in the untreated left lobe of her liver. So, she joined a third clinical trial, again at UCHealth. That trial too went on to fail.

In September 2016, they repeated the microsphere treatment, this time for the left lobe. The cancer gradually stopped growing.

One morning in May 2018, she stumbled out of bed struggling for her balance. A brain MRI revealed that the cancer had now spread to her brain. Gamma Knife radiosurgery eliminated the tumor. However, her liver tumors were growing again.
​
Going by a study published in 2019, “the four-year survival rate for Stage 4 uveal melanoma patients is only about 2 percent.” By now, Katie had taken part in three clinical trials and also received three additional treatments. Yet three or four tumors persisted. 

In July 2020, Katie started her fourth clinical trial at the University of Pittsburgh Medical Center. Dr Udai Kammula, the doctor leading the trial, had been after uveal melanoma for almost a decade, because it is “so devilishly difficult to fight”.

Dr Kammula injected her with 111 billion new T cells, after first wiping our Katie’s own immune system. A month after the procedure all tumors were gone or shrinking. The one which did not was surgically removed.

​Finally, Katie was cancer free. 

​Today, she works as a recruiter and gives talks to pharmaceutical and biotechnology companies and nonprofit cancer organizations. She lifts weights and rides her exercise bike when she and Nick are not enjoying golfing, biking and hiking.

“Had I made the choice to not get a second opinion, I would be dead,” Katie said. 

How would Katie have fared, if she were in India? Is it possible for a patient in India, handed a grim prognosis, to take a chance with an experimental remedy that is under clinical trial?

Dr Santam Chakraborty, Senior Consultant at Tata Medical Center, Kolkata, co-author of a paper on “Geographic disparities in access to cancer clinical trials in India” is not very optimistic.
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The best person to inform a cancer patient about a clinical trial possibility is their oncologist. However, as India does not have a very integrated healthcare system, the oncologist is most likely to offer trials running in the hospital they are attached to. According to Dr Chakraborty, given the limitations of the clinical trial registry in India, “finding a clinical trial which is appropriate for the patient is a difficult endeavor for the oncologist.”  

In the US and Europe, an efficient, integrated healthcare system makes healthcare records available to all centers. In India, if a patient undergoing treatment in Hospital A wants to undergo a trial on in Hospital B, they will have to undergo a full workup and could be turned away at the end of it for failing to fulfil the eligibility criteria. The patient could have avoided the hassles and the cost of transfer if the data were easily accessible to Hospital B from the records of Hospital A.

There is also the larger problem that in India, as yet, “the clinical trial scenario is not geared towards providing really cutting-edge solutions.” In advanced countries, a new therapy is researched for decades in a laboratory before it becomes eligible for evaluation in a patient.

In India, clinical trials are usually run with products already evaluated in another country. A pharmaceutical company may evince interest if and only if it is sure that there will be a market for the drug in India.
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Clinical trials in India mostly focus on finding new uses of existing treatments or evaluating efficacy of treatments that have been evaluated in the west or finding ways to make the treatment more affordable. This is in stark contrast to the scene, say in the USA, where a novel innovation could be on trial.

“Even if I were aware that a trial very relevant to my patient is being run in an institution like Memorial Sloan Kettering Cancer Center,” Dr Chakraborty said, “I can offer that to my patient here only if the same trial is being conducted at a center in India.” Most early Phase I trials done in India are for “me-too molecules”, meaning medication already established outside.
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It is mandatory for every clinical trial to be registered with Clinical Trials Registry of India (CTRI). “As a patient, I can participate in a trial if I fulfil all the eligibility criteria, provide my consent and my physician is an investigator in the trial,” Dr Chakraborty pointed out. 

Whether in India, the US or elsewhere, there is no telling if every person who enters a trial will be blessed with a positive outcome like Katie was after all her trials. While everyone’s outcome may be unique, Katie has been sharing her experience with all.

“I gave my first talk in 2017, giving an acceptance speech for The Courage Award from the Melanoma Research Foundation. That’s when I realized how much I loved sharing my story. It gives people hope. It now feels like it’s what I’m called to do. It’s my way of paying it forward and saying thank you to all of the people who have helped me along this journey. I don’t want to hoard the wisdom I’ve gained from this horrible experience and expect other people to just figure it out on their own. It’s really, really hard to navigate this. If I can help just one person and change the course of their treatment for the better, then it’s worth it.”

It is never easy for the patient and the caregivers. Who helped Katie pull through it all?

"I've always identified both Nick and my Dad as my caregivers. Nick is my moral support. And my big spoon! He takes care of me physically and emotionally. And my Dad is the one who has helped us navigate this journey and understand the decisions we’ve had to make. I designated them both as my medical powers of attorney because I didn’t want either of them to face difficult decisions alone."

Do Katie and Nick have a prescription for those who are going through such tough times, so that they can cope better? Yes! Communicate and laugh!

"We still manage to laugh our butts off!" Katie added, "one of my lasting side effects from all of my treatments and the abdominal surgery is that it really hurts when I laugh hysterically. So, when I get that keel-over, gut-wrenching laughter, I can’t breathe. And he [Nick] loves it!"

How did the bullock cart always come on time to take us to the railway station? Then I was too small to ask and too busy trying to squeeze into a tiny space among the bags and the other members of the family. Nor do I know now; even my mobile can’t tell me.

The cart would shake and sway its way for a long time past many miles of trees and farms until we reached the river. The river with clear water flowing past stones and boulders and fish that swam carefree. 

That’s where we had to get down, cross the river and walk the rest of the way to the station. The elders would get off and carry the bags, stepping confidently from one boulder to another. The whistling of the steam engine would urge us children to run, deliberately stopping once in a while to let the fish nibble at our feet. 

I look up the name of the that river. Wikipedia finds it for me.

“The Kalpathy River, also known as the Kalpathipuzha, is one of the main tributaries of the Bharathapuzha River, the second-longest river in Kerala, south India.

“One of the problems faced by the Kalpathipuzha, like most other rivers in Kerala, is illegal sand mining. This has left many pits in the riverbed, which leads to shrub growth. During summer, the river is covered by a green carpet of Water Hyacinth and other shrubs.”

I am now in a big busy city. I can see two bridges, extending the road from one bank of another river to the other. Above those is another bridge bearing the metro rail. From where I am, I can see everything, and everyone is in a rush.

No one has the time to look at the river, except when you want to fling yet another bag of garbage into it.

The water is sluggish and black wherever it is not smothered by thick swathes of water hyacinth. This river used to attract so many birds. They are missing now. Did all the fish die?
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Right below my window, they are felling more trees so that we can have another road for more people. The river appears to pause and sigh.

Fires in cities. Heavy rain in deserts. Lush green growth in Antarctica.

There are more roads and more bridges. But we can hardly move because there are too many of us. We build and build. But we get time to live only in vehicles.

The rivers now weakly carry the filth we can’t stop generating to the ocean where the mightiest predator is plastic.

We can’t go back to yesterday. Perhaps, today, we can stop and look at the river. And look after it?

​Are we already too late? Is it tomorrow, no, tosorrow already?