She landed up at my table in the Cytopathology OPD where I was posted as a junior resident that day. She looked extremely fatigued, probably having been shunted from one OPD to another. I told her to sit and asked to have a look at her papers. She slowly bent down to pick up a cloth bag from the floor, where she had placed it. The simple act of bending down transformed her face. I could see her wince with great agony.
She pulled out her hospital records from her bag. She didn’t show me a single sheet of paper like most patients did. Her hospital records were a thick bundle of carefully stapled OPD papers. More than 200 worn out pages, very diligently maintained. This was unusual. Doctors in most government hospitals in India usually find it frustrating to find that patients have often come without bringing their previous records, or worse, have misplaced them. They have to start from scratch, not having access to previous data of investigations or procedures. Lack of details of past history can leave several unanswered questions compromising further management. But this woman was different.
I gingerly handled the yellowing fragile pages. The first record said her age was 42 years old. But these pages contained prescriptions from at least the previous 15 years, which means she was considerably older. Some junior doctor had carelessly scribbled “middle aged woman with low backache” on the first prescription, and then written some pain-killers for her. As I flipped through page after page, I realized that there was nothing much to see. All that those carefully preserved pages had, was ‘Ct all” written in different handwriting on every visit she had paid to the hospital. ‘Ct all’ is an oft-used abbreviation for ‘continue all’. Which meant that she had been on pain killers for a long time. Sporadically someone had changed her brand of medication, or ordered an X-ray. But was just the same single line- “middle aged woman with low backache” which was repeated ad nauseum.
Wasn’t it always the case? A woman who complained of backache meant nothing to anyone. Neither to her family, nor to her physician, nor to her orthopaedician. It was something no one ever took seriously. Today, I was searching on the internet for this condition, and I found an article which boasted that this condition was not ominous. It went on to say: “Low backache is a condition where the bark is worse than the bite” but almost laughed off the distress as nothing to worry about.
I imagined her, struggling to bend down to perform daily activities: to pick up something she had dropped, to get into her clothes, to mop or sweep the floor, to rinse the utensils over the kitchen sink, or simply to squat on the Indian toilet. Could a housewife defer household chores on the pretence of a backache? I can imagine the raised eyebrows and smirks which would follow this excuse. People get more attention if they complain of a headache, than if a woman complains of a backache. That is one symptom every middle-aged woman has. Ignore the rant.
“How bad is your backache?” I asked. She carefully adjusted the pallu of her saree over her shoulders and said,”I cannot turn on my side when I am lying down. Yesterday, someone was ringing the door bell and I couldn’t turn to get off the bed. I had to slide and slip off the bed in order to get up.”
Thankfully, some conscientious doctor had actually bothered to ask her to undress and performed a physical examination of her back. And he had found a soft swelling on the right side of her lower back. He had sent her to us for an FNAC. FNAC stands for fine needle aspiration cytology. It is a procedure where a thin needle is inserted into a mass, a tiny amount of cells are retrieved from it, processed, stained, and studied under the microscope. I performed the procedure and told her to return later to collect her reports.
That evening, as I examined her slides, I saw my first case of chordoma. Chordomas are rare, slow growing cancers which can occur anywhere along your spine, from the base of your skull to the base of your spine at the sacrum.
While not every woman with a backache ends up with a cancer, I remember this woman distinctly, simply because women with back pain are never a priority to anyone. Imagine the quality of her life. Fifteen plus years of living with a niggling nagging pain. Yet, it wasn’t something fancy enough to get her anyone’s attention.