After more than twenty-five years as an oncologist in Kerala, I don’t have much left in me. Not hope. Not faith. Whatever I had at the start – it is gone.

I have seen too much. Too many kids brought in with tumours the size of coconuts. Too many parents sleeping on hospital benches. Too many people selling their last bit of land to pay for chemo that doesn’t work. And for what? For another few months? A few more painful days? What are we even doing?

There's this lie we keep selling – that fighting cancer is noble. That it’s about courage and strength and miracles. But that’s not what I see. I see fathers travelling 12 hours by train for a review, then turning around because they can't afford the scan. I see mothers rationing pain medicines because the government supply ran out. I see patients dropping out of treatment because they couldn't get another loan. I'm the one who has to tell them, ‘There's nothing more we can do,’ when I know damn well there always ‘is’ – if they had money.

I remember a boy named Rahul. Eight years old. Leukaemia. He used to fold paper planes in the ward. Smiled every time, even when the veins collapsed. His mother sold her wedding chain to keep going another cycle. I found her crying quietly in the temple corner of the hospital. Rahul died during a weekend. I wasn't even there for them.

People talk about survivors like they are legends. Like they beat something evil and rose victorious. But most of my patients? They don't win. They don't fight. They just endure. They pawn gold. They borrow from relatives. They die in silence. And somehow, they are made to feel like they failed.

I have told too many families not to start treatment – not because it won't help, but because it would bury them in debt. Think about that. We have built a system where people have to choose between medicine and survival of the rest of the family. And we call that healthcare.

I used to believe this work had meaning. Now I’m not sure. I still show up. Still write prescriptions. Still say – ‘Let's wait for the next scan.’ But part of me stopped believing a long time ago. Most evenings, I just sit in my car and stare at the road. I don't even know what I'm waiting for.

I don't believe in God anymore. Not after watching a father light the pyre of his 3-year-old. Not after hearing a wife whisper to her unconscious husband, ‘I'll figure it out’ - I had told her. I couldn't save him. She lost the house. If there's a God in this world, he is not in my ward.

Maybe I shouldn't say these things. Maybe it is unprofessional. But I don't care. This job has made me numb, angry, tired – and deeply bitter. What I want is not comfort or praise. What I want is honesty. I want us to admit that this work is brutal. That it breaks people. That it ruins lives – including ours. I want space for despair. Because only then can we begin to rebuild anything at all.

If you’ve ever sat in your car after clinic and cried for no clear reason, I see you. If you have ever looked at a full schedule and felt dread instead of purpose, I see you. If you have ever wondered if anything we do really makes a difference, I’m right there with you.

No way to end this. No neat resolution. Just this: it’s not okay. And maybe admitting that is the only thing that ever will be.

Author’s Note
I wrote this not to accuse or to inspire - but simply to tell the truth. After decades in oncology, this is what remains with me. Not just the science, but the sorrow. Not just the outcomes, but the cost - to patients, families, and to those of us who try to help them. This piece is not a resignation. It's a reflection. If you’ve ever felt unseen inside the healthcare system - whether as a patient or a doctor - this is for you.