No miracles among friends

Abstract

Sir, How often does the doctor who has taken care of you during a prolonged and difficult illness also lights your funeral pyre, then takes your ashes in a basket of flowers to the Ganges? I know of one such doctor. He cared for my sister. Years before he cared for my farther, his surgical mentor and friend. It is a very rare Hindu custom for a Brahmin daughter to light her father’s funeral pyre, but that was my father’s wish. Years later, the good doctor was a mentor to my son, then a novice intern and now a surgeon. All of this does matter. [1] What does not matter is that my sister had acute lymphocytic leukemia with an oncogene addicted BCR/ABL fusion protein where a tyrosine kinase inhibitor (TKI) of that protein is capable of producing complete remissions. [2] It does not matter because there are no acute leukemia treatment facilities in my sister’s hometown and the expense of such treatments is phenomenal, despite the directive from the Supreme Court of India that certain life-saving medicines (which includes imatanib, the first generation BCR/ABL TKI) be sold at a reduced price. Moreover, many basic unfulfilled needs in India, like malnutrition and malaria that claim the lives of millions still exsits. Making treatments available for adult acute leukemia to most Indians must take a place at the back of the line. An initial bone marrow flow cytometry and molecular screening confirmed the pre-B cell phenotype and the presence of the Philadelphia chromosome - the BCR/ABL fusion protein. Imatanib and a corticosteroid were started. There were many determinations for complete blood count (CBC) and assessment of electrolytes, renal function, and uric acid levels. There were admissions for transfusions and hydration. Pre-orbital and generalized edema initially required dose modifications and unilateral blindness [3] then