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Alka Koli, the woman who sued Maharashtra hospital for a mastectomy

Sunday, 6 April 2014 - 2:46pm IST | Agency: dna

Her trust betrayed, her life scarred by wounds psychological and physical, Alka Koli is suing a Maharashtra hospital for a mastectomy for what turned out to be just a benign lesion. Suhit Kelkar speaks to the woman whose quest for justice permits no forgetting

The once waist-length hair is gone with chemotherapy she never needed, the body mutilated by surgery that never should have been. And Alka Koli, the 38-year-old mother of two who faces the prospect of exhuming her trauma in court, is wracked with questions.

Was she not a good woman? Hadn't she as a child worked hard to help her mother and siblings after their father succumbed to fever? Hadn't she been a pillar of strength to husband Rajendra as he went from operating a computer to owning a rickshaw? Hadn't she raised her children, Hemangi, 10, and Hrishikesh, 9, with honour and pride? Hadn't she honoured the family's ancestors? Yes, yes, yes, yes and again yes.

Her quest for justice permits no forgetting. Alka, a resident of Divale village in Belapur, Navi Mumbai, has sued the Jairaj Hospital in the Maharashtra State Consumer Disputes Redressal Forum in Mumbai. The compensation proposed: Rs50 lakh.

As the case – admitted on November 22 last year – makes its way through the system, Alka is getting on with the process of life, of coming to terms with that August day in 2012 when she went under the knife.

The scalpel's marks have now healed where her left breast used to be. One day, the scar will fade. Somewhat. There is also the mental trauma caused by the mutilation, which, too will fade away. The blood has stopped flowing, the tears will too.

"Chakkar yete (I keep feeling dizzy)," she says. Is it a side effect of chemotherapy or psychological hurt?

The dizzy spells come twice a week or so, she says.

If only it weren't for those questions, those endless questions that nag continually!

It was the summer of 2012. The hard lump in her left breast announced its presence with a lasting pain. So, on a fateful July day, Alka and Rajendra visited Jairaj Hospital, a landmark on the main road, right by the Belapur bus depot where Rajendra sometimes plies his rickshaw.

The hospital also has a pathology lab. In fact, co-proprietor Dr Rajiv Rao is a pathologist himself. His wife and colleague Dr Smita Rao is a pathologist too.

After the first examination, Jairaj Hospital recommended a mammography from Dr DY Patil Hospital in Nerul nearby. The report dated July 9 says, 'Mass lesion... suggestive of benign lesion'. That is, the report said the lump would not spread to other organs.

Alka was then given a chest X-ray and series of blood tests. In her second visit a few weeks later, she showed these to the visiting surgeon at Jairaj Hospital, Dr Prashant Athale. He concluded that the breast lump had grown bigger since her first visit.

He said it must be removed. Alka went by the doctor's advice and Dr Athale operated on and removed the lump, which would have been necessary in any case. He then had the lump checked at Jairaj Hospital's pathology lab.

Says hospital proprietor Dr Rajiv Rao: "When we put samples of the lump under a microscope, it looked like cancer."

The following month, on August 3, 2012, Jairaj Hospital issued a report saying: 'Ductal carcinoma of left breast'. In plain words, a kind of cancer that will spread to other organs with fatal consequences. Jairaj Hospital is confident about its cancer diagnosis and the treatment that must follow.

But this is what will happen a few months later: The breast will be removed. Alka will begin chemotherapy. Meanwhile, the breast lump and the removed breast will be sent to the Tata Memorial Hospital in Mumbai for double check. Tata Hospital's immuno-histo-chemistry (IHC) test is a cornerstone test for cancer. The test consists of staining the skin samples with a reagent solution which then changes colour if cancer cells are present. The IHC report dated September 10, 2012 will diagnose the breast lump not as cancer but as a benign lesion. The report will not only invalidate Jairaj's diagnoses but also lead to the conclusion that the breast removal operation is unnecessary.

Relying on the Jairaj Hospital report, Dr Athale told Alka that the only way to remove the cancer was removal of the left breast. The date of the operation was fixed for August 24.

Why didn't Alka get a second opinion on Jairaj hospital's diagnosis? "I am illiterate. I trusted the doctors," she says.

Fear and tears: two words to describe the night after Alka was counselled to get her breast removed.

That night, as many nights before, Alka wondered if the 'cancer' was a karmic price.

She scanned her memories. She was eight when a fever carried away her father Vitthal, leaving her mother Sakhubai to manage four children. As food stocks dwindled not 15 days into the grieving period, Sakhubai went to hawk fish in the market. This was a progressive step born out of need.

To get by, Alka and her siblings washed dishes and did other domestic chores in the village.

In her teenage years Alka faced the occasional jibe about her family's low station in life. Hadn't she persisted nonetheless in earning her livelihood? Hadn't she won over her employers' heart with her dignity? Hadn't she emerged from a difficult childhood with head held high?

Yes, yes and yes again.

The breast removal operation is known as mastectomy. Alka was operated upon at Jairaj Hospital on August 24. The report issued by the hospital saying, 'Intraductal Carcinoma of Left Breast', was its own confirmation of its diagnosis. It did not have its diagnosis double-checked from another hospital.

Second opinions are considered a standard practice in Mumbai's bigger hospitals. "We generally have our reports and tissue samples double-checked with other government hospitals... usually hospitals with experience in cancer treatment," a surgeon with a government hospital told dna.

Alka was discharged from hospital six days after the surgery and advised to start chemotherapy to kill the remaining traces of cancer, if any.

Chemotherapy — the use of drugs to kill those cells in the body which divide rapidly; not only cancer cells but also normally fast-dividing cells. The loss of these normal cells gives rise to side effects like hair loss and loss of immunity to disease. Chemo impairs brain functioning too. Some of the side effects are long-lasting.

That is why Dr Nilesh Lokeshwar, oncologist, declined to proceed without further tests. He asked Alka to get herself examined at the Tata Hospital.

And so Alka went to Mumbai to the Tata Hospital, whose echoing corridors see patients from across India and Asia being shuttled into doctors' cabins, some on stretchers, others with tubes coming out of their noses, none speaking to the other, each engrossed in his private affliction.

Later, at Tata Hospital's urging, Rajendra submitted the samples of the removed lump and breast for further testing.

Back at the DY Patil Hospital in Nerul, Dr Lokeshwar suggested that Tata's report would take time and she should take a dose of chemotherapy in the meanwhile.

The dose was given to Alka on September 27, 2012, by Dr Lokeshwar's colleague, Dr Tejinder Singh.

As Alka underwent the chemo, Rajendra got the shock of his life in Tata Hospital. He was told the patient was negative for cancer. It had been established that the lump in Alka's breast was a growth called complex fibroadenoma, a tumour associated with a higher risk of cancer but not itself cancerous.

Alka and Rajendra went to show the Tata report to the stand-in oncologist Dr Singh, who stopped chemotherapy immediately.

Angry and anguished, Rajendra and Alka went to Jairaj Hospital to meet the pathologist who had signed the diagnoses of cancer: Dr Smita Rao. Alka says that the doctor asked for time to check what had happened.

Her husband Dr Rao told dna, "(In Alka's case) the complex fibroadenoma looked like cancer."

Alka says she also confronted the surgeon, Dr Athale, who said he had relied on Jairaj hospital's diagnosis of cancer. Dr Athale was not available for comment.

The oncologist Dr Lokeshwar, declined to speak to dna as the case was in court.

Apart from her needless loss of a breast, Alka now suffered from the dose of chemo. Over a period of time, her waist-length hair fell off and she complained of headaches, severe weakness and menstrual problems.

But she was determined to make a fight of it. She retained the services of a lawyer and sent notices sent to the doctors concerned.

In their reply, the proprietors and doctors of Jairaj Hospital say they diagnosed Alka with cancer "on the basis of sound medical knowledge and competence on the basis of resources and methodologies available in a standard pathology laboratory".

Jairaj Hospital further claimed that Alka had consulted another doctor who confirmed the diagnosis of cancer, a charge which she denies.

Jairaj has also accused Alka of "disguising, suppressing and withholding the true facts..." According to them, Alka's intention is to "extort an illegal amount of money/compensation..."

This accusation upsets Alka, who is awaiting her next hearing in July. She says, "I am an illiterate woman. What do I know?"

Her hand nervously flits over her chest and she says,"Such long hair I had."

It's afternoon now and Alka has just finished her bath. She sits by her husband and dries her hair. It is still just a couple of inches long, curly when it used to be straight earlier, but it is growing longer and thicker.

Life is getting back on track — but it's a slow process.

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