Twenty - Vivaan

A/N [1]: Double upload in a single day as a thank you to my ever patient readers. Also, an extra long chapter. Hope you enjoy reading!

A/N[2]: This chapter is emotionally very heavy and intense. Part of the reason for it being so long is the complex way in the situation has been described. I have also used a lot of medical jargon in this chapter, which I have attempted to simplify in the glossary. While I have tried my best to stick to facts, no intentional disrespect is intended to any protocol or process followed at a hospital. If any detail is incorrect, please feel free to point it out and I will correct such discrepancy.

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3 weeks later...

Vivaan waited anxiously for the clock to strike midnight. As soon as it did, he dialed Payal's number.

"Happy birthday, Payal." He wished when she answered the call.

"Thank you, Vivaan!" she said, even though her voice seemed a little subdued.

"Hey, no one is supposed to be sad on their birthday." He said. "What's happening?" he asked.

"It's just, our routine midnight cake cutting did not take place." Payal said softly. "Ma was already asleep. And it is a big day tomorrow. So, we decided to do it in the morning."

"Is the fever there?" Vivaan asked.

"Yes, it only goes down when she takes the medicine. But it gets back right up after the effect goes away." Payal said.

Over the last couple of weeks, Payal's mother's condition had deteriorated, which was not a good sign. She had grown weaker by the day. The fever was ever present and the last round of testing had shown high drops in the sodium levels. Payal's mother also had to be put on blood transfusions to keep up her hemoglobin levels. The last discharge happened just a couple of days ago. And yet, the WBC count increased the moment the chemo stopped.

Dr. Maniar and Dr. Phadnis had ordered a PET scan to address the constant high fever, which was recurrent despite a drop in WBC counts. The results were disturbing. The scan showed ascites in multiple places. Both doctors had theorized that there was a high chance that the cancer was progressing, which was resulting in these symptoms. Dr. Oberoi, the doctor who had been in charge during the DVT, had a contact at Tata Memorial Cancer Hospital who had taken all the medical history to his superior. The doctors there had requested for an appointment with Payal's family to discuss the prognosis again. That appointment was scheduled on the next day, Payal's birthday.

This was the reason Vivaan had not planned anything special for Payal on her birthday. He wanted her to focus on her mother's health and not take any additional pressure. Perhaps they could go out for dinner after the hospital visit the next day.

Vivaan felt cold shiver of unease as he looked at the last blood test result on his phone, taken just a few hours ago. The count was below 10,000, in range. The fever was definitely not normal.

***

"Hey. What are the plans for today?" Adi asked Vivaan as he entered their office.

"Its just 8 am in the morning, Adi." Vivaan said, focusing on his textbook. "We might go out in the evening."

"You do that on all your date nights." Adi pointed out.

"I don't want to do anything fancy. Not now. You know the situation." He said.

"I know. But maybe this is the mood lifter she needs." Adi said.

"I did consider it." Vivaan said. "But Payal's mother needs her. She's not free enough to talk to me for long these days."

Adi nodded. "Okay, you are the best judge of the situation. I'll let you decide." He said eventually, climbing into the bunk bed and lying down to sleep.

Vivaan's phone rang at that moment. It was Aaryan.

"Aaryan?" Vivaan picked up, knowing his cousin would not call him at this time unless it was super urgent. "What happened? Is Avika okay?"

"Avika is fine." Aaryan's voice was raspy. "Bhabhi-sa's mother..." Aaryan stopped and Vivaan could sense him swallowing.

"Aaryan." Vivaan pressed. "Payal's mother what?"

"Aniket Bhai-sa had called. She had a stroke this morning. They have taken her to the nearest hospital for the emergency treatment."

Vivaan's heart sank. "When?" he asked.

"They noticed the symptoms about half an hour ago. They're at Holy Spirit, as per what Baba-sa told us just now." Aaryan said.

"I'll call you back, Aaryan." Vivaan said, picking up his pager to drop a line for the chief. His mind ran the possibilities. All the reading in the last few months on leukemia. A stroke just didn't add up.

"Adi, I'll have to go. Payal's mother suffered a stoke. I don't know any more than this. So don't ask any follow up questions." He told Adi in one go. "I'll update you later when we have time. Just cover for me." he requested.

As Adi got up to fill in, Vivaan left the office and searched his phone for Holy Spirit hospital's contact number. They had picked up a donor heart from there about 4 months ago. He had been on the team.

"Hello? Yeah, this is Dr. Vivaan Mehta from SNG hospital, Lower Parel. I'd like to know the status of a patient admitted recently." Vivaan said.

"What is the purpose?" the female voice on the other side asked.

"She's a relative. I'd like to speak with the doctor and initiate transfer as soon as possible." Vivaan said.

"You will need to speak with the doctors for this. I cannot help you here." The female voice said.

Vivaan groaned as he cut the call. He had no choice but to call Aniket.

"Bhaiya." He greeted when Aniket answered the call. "I need an update. Can you please tell me what's happened?"

"Vivaan, we still don't know for sure." Aniket said. "We noticed the symptoms about an hour ago. Payal knows about FAST. She recognized it first. Papa, Rohini and I have gotten her admitted here. She seems fine now, but nothing can be said until the MRI results come in."

"How much longer on the MRI?" Vivaan asked.

"They said it'll take an hour at the least. But it was scary Vivaan. At the onset, Ma couldn't move her left side at all. We had to half carry her downstairs to the car." Aniket said, and Vivaan heard slight tremor in his voice.

"Payal is alone at home at the moment. Can you go to her, please? I've given the update, but she'll be worried." Aniket said, after a moment.

"I'm leaving the hospital now." Vivaan said. "I'll reach your place in an hour. In the meantime, once the reports come, please send a copy to me as well. I will share the same with the neurology head at my hospital."

The morning rush hour had just kicked in, but thankfully, Vivaan had to go the opposite route in the local train. He was able to sit down and take deep calming breaths by the time Andheri arrived. He prayed that it was a minor stroke and that nothing was serious. He prayed that no further steps had to be taken.

She will be fine. She will be fine. She will be fine.

Vivaan's hands were clammy as he rang the doorbell. Payal opened the door and stood surprised. Her hair hung wet down one shoulder and Vivaan smelled the soothing scent of the agarbatti. He was confused momentarily. He thought Payal would be catatonic. But instead, everything was reversed.

"Is everything okay?" Payal asked, her surprise giving way to fear. "Bhaiya told me she was stable!"

"Yes. That is all I know too" Vivaan said, keeping a neutral tone. "He told me you were alone at home. I just came to give you company."

He stepped in and saw that the house was cleaned. A pressure cooker whistle sounded out in the kitchen, indicating that Payal was in the middle of making lunch. Something was odd. Vivaan realized it was the timing. On weekdays, everything was done by 9 am, when Payal, Aniket and Rohini left for work. On weekends though, Shah household had lazy mornings, where a big joint breakfast happened at 10.30 in the morning. Lunch was prepared much later by everyone together. Today was a Saturday, and yet everything was ready already. If he peeped in the kitchen, Vivaan was sure he would find untouched cups of tea and untouched breakfast placed in the fridge.

"Are you okay?" he asked Payal, moving closer to her and holding her hand.

"I need to finish my prayers." Payal said, moving away and heading inside to the room that was her home office as well as the puja room.

Vivaan sighed. Payal was stressing out. She had a tendency to keep herself busy and turn everything inward in such situations. That explained the clean house and the lunch being cooked. For a split second, Vivaan wondered if he should call Rohan or his mother instead.

Vivaan's phone rang at that moment, flashing Aniket's name.

"Hello Bhaiya." He greeted.

"Is Payal around you?" Aniket asked.

"She's completing her prayers at the moment." Vivaan said, sitting down on the couch. "What is it?"

"Okay, the MRI results are here. They are saying that there's multiple clots in the brain, one of them has resulted in the stroke." Aniket said.

"Clots?" Vivaan was surprised. Just then, Payal appeared. He waved her over and put the phone on speaker. "Payal has also come Bhaiya."

"Payal, Ma's medicine prescriptions are in the cabinet above the first aid box. Can you please take photos and send it to me real quick?" Aniket asked.

"I will, but what did the MRI say?" Payal asked. "What clots? Ma is on blood thinners since the DVT. She can't have clots."

"The doctor here is of the opinion that it could be an older clot that hadn't fully dissolved and made its way to the brain." Aniket said. "But it doesn't explain the other clots or the lack of cardiac symptoms."

"So, what now?" Payal asked, and Vivaan heard the mild tremble in her voice. He put an arm around her shoulders, hoping to comfort her.

"That's the bad news. The estimate is that the stroke happened around four hours ago. So there is no golden hour treatment possible. She's already on blood thinners, so its not advisable to give her thrombolytic agents to dissolve the clots. Surgery too is not a good idea. They are saying the best thing to do is wait and hope that no further damage is caused." Aniket explained.

The sinking feeling returned. He pulled up the reports on his phone, wanting to know the location of the clots.

A total of five clots visible clearly, one near the frontal lobe, two in the left cerebrum, one in the right cerebellum and one right on the brain stem. Severe tissue damage near the frontal lobe, resulting in the symptoms earlier.

Vivaan frowned. The clots were too scattered to have travelled from somewhere else in the body. It seems as though they have just formed in these places randomly.

The clot on the brain stem was a bigger worry. From his basic studies, Vivaan knew the brain stem, connected the brain to the spinal cord. Any further damage in this area could render Payal's mother unable to walk or move. It could even lead to coma. This was worse than a ticking time-bomb situation. There was no way to predict when the situation will worsen.

"Bhaiya, what do the doctors say about transferring her?" Vivaan asked, quickly forwarding the report to his contact in neurology.

"They are saying she's stable for now so if we want to shift her, now is the best time. If the situation complicates further, they will not agree to release her then." Aniket said.

"I'll initiate transfer to SNG then." Vivaan said. "I've forwarded the report to Ma's doctors-in-charge and to my contact in neurology. It's better to shift her to my hospital. Her case history is known and her doctors are here."

"I agree. How long will the process take?" Aniket asked.

"Not too long, hopefully." Vivaan said. "In the meantime, is it possible to connect me to the doctor-in-charge at Holy Spirit?"

"I'll try." Aniket said, disconnecting.

Vivaan dialed Dr. Maniar immediately, adding Dr. Oberoi as well, since he was in charge for the DVT treatment. While he updated the doctors, Payal retrieved the prescriptions and clicked photos of the same, sending the photos to her brother.

There was an awkward silence for a moment after they were both done with their respective tasks. Vivaan cast about for a lighter subject, but nothing struck him.

"Bhaiya told me you knew about FAST." He said eventually. "Good call."

Payal took a deep breath. "She hasn't wished me yet." She said.

Vivaan looked up at her, but she was looking downward. "She was trying to wish me in advance when I put her to sleep last night. I told her I wasn't having it. She was supposed to get up and wish me properly today morning." Payal's voice quivered with unshed tears.

Vivaan drew her in his arms, holding her close as she sniffled silently. He kept quiet, not knowing any words of comfort in this situation.

"I first noticed that something was wrong when she fell down on the way to the bathroom." She continued, but she was clearly crying now. "She was leaning backward onto me when I guided her outside to the hall. She didn't sit, just lay down on her side immediately. And when Bhaiya and I asked her to eat breakfast, she didn't respond. It was as if...she couldn't see or hear us."

Payal's shoulders shook as though the tension was coiling outward. She was heavily leaning into Vivaan.

"When we pulled her up to sit, I saw the left side of her face sag downward and that's when I realized what had happened." She continued after a moment. "Ma didn't though. A minute after that strange paralysis, she snapped back, and moved to drink her tea as though nothing happened. It was as though there was a memory warp. She didn't remember anything that happened in the last few minutes."

Classic stroke symptoms. Vivaan gently rubbed his palm on her shoulder. "You did good, Payal. You did good." He whispered. "She'll be fine. Don't worry."

"I should have accepted her wishes last night." Payal said, and Vivaan felt the tears on his shirt. "I should have accepted them."

Helpless, Vivaan continued to soothe her, leaning in to kiss her forehead. "She will wish you, Payal. Her wishes are always with you." He said.

Vivaan's chest hurt at the pain visible on her face and in her voice. For the umpteenth time, he wished he could erase it somehow.

"Its going to be okay, Payal." He whispered softly.

Payal just shifted to hold his shirt in her fist, crying quietly.

***

"A cardiac ambulance will be needed." Vivaan added, as he continued updating the doctor in charge at Holy Spirit. "How is the patient's condition otherwise?" he asked.

"She's awake, conscious and stable as of now." The doctor updated him. "We have made her fast all through the night, in case of any emergencies..." he trailed off, knowing that Vivaan already knew the condition.

It was the morning of the next day after Payal's birthday. The transfer process was nearly complete. Once the cardiac ambulance was arranged, Payal's mother would be transferred to SNG. Her condition was more or less the same, with no change taking place in her vitals. That didn't reduce the risk though. Vivaan still remembered the scan from the MRI. The damage near the frontal lobe was quite severe.

Payal had slept through the afternoon and woken up around late evening, completely disoriented. Rohini had come in with Payal's father just then, so that they could both rest. Vivaan volunteered to drop Payal to Holy Spirit so she could keep her brother company. He had to get back to his hospital post that, but kept in touch with Aniket and the doctor-in-charge whenever he could.

Dr. Maniar, Dr. Oberoi and Vivaan's chief, Dr. Verma had discussed the MRI with the neurology head at length and in detail. Vivaan's theory was correct. The clots had formed randomly, not travelled from anywhere else. According to neuro head, the clots could have formed anywhere, it just so happened that the focal point was the brain.

"I think the cancer has progressed." Dr. Maniar said, gravely. "Dr. Phadnis was also saying this. It seems to have progressed, and progressed quite quickly. That can be the only explanation for what has happened."

"But for a patient already on blood thinners, what else can we do to prevent further clots?" Vivaan asked.

"That is something we will have to think through. Until then, let's hope the condition does not worsen" Dr. Maniar said. "I'll speak with my contacts. Keep me updated Vivaan."

But it seemed that the gods were not in their favor. Shortly after she was transferred to SNG, Payal's mother suffered a seizure. Vivaan's heart sank as he watched the attendants rush about, neutralizing the seizure.

"She's stable, but unconscious." Dr. Sinha, the neurology head said.

"Now what?" Vivaan asked, looking at the unconscious form of his mother-in-law. Aniket and Payal's father joined him as they met up in Dr. Sinha's cabin.

"We will have to halt all further treatment." Dr. Sinha said. "Until she is conscious."

"I don't understand." Aniket said. "Papa said she was conscious throughout the transfer. What happened between then and now?"

"Mr. Shah, is this the first seizure your mother has suffered?" Dr. Sinha asked. When Aniket nodded, Dr. Sinha's face darkened. Vivaan knew what this meant. Seizure meant deterioration. The brain damage was now showing up.

"Mr. Shah, seizures are usually a sign of brain damage. As you know, your mother has suffered from a stroke and it is likely that this seizure was a consequent symptom. If my guess is correct, this is the first of the multiple seizures she may suffer." Dr. Sinha said.

Vivaan had to give it to Aniket. He was surprisingly holding up strong.

"So what now?" Payal's father asked.

"As I told Vivaan just now, we will have to halt all treatment until she is conscious. Whatever the root cause of the stroke is, that can only be dealt with once she has recovered from the stroke's effect altogether." Dr. Sinha explained. "Recovery from the stroke is our priority. The cancer is next."

"But what can be done?" Aniket asked. "At Holy Spirit, they said nothing can be done except to wait and watch."

"Yes. That is correct. We will monitor your mother." Dr. Sinha said. "Earlier, she was conscious, so she was able to control her major organs and essential functions. At present she is unconscious. We will need to monitor her period of consciousness. If she is unconscious for too long, then we may need to put her on the ventilator."

"Why?" asked Payal's father. "She doesn't have any problem with her lungs. She can breathe just fine!"

"Papa." Vivaan spoke up, keeping his voice low and calm. "Ma is unconscious at the moment. When we are asleep, the body doesn't actively monitor the essential functions. If she can't actively monitor herself, and another seizure were to occur, it may have consequences like choking or worse."

"Mr. Shah, like I said, its not an immediate recourse. We will monitor her. If she can monitor herself, the ventilator won't be required. Your wife is under sixty years of age and relatively young. It is very much possible she can pull through this." Dr. Sinha said. "Even if we do put her on the ventilator, its only to assist her with her essential functions. The machines can keep a better tab on it all if she is unconscious."

Dr. Sinha reached out to pat Vivaan's father-in-law's hand when he still looked dubious. "Aksar medical terms aur technical language se hum ghabra jaate hai. Par aap dariye mat. Aap ki patni aur aap ki family cancer jaise shaitaan se lad chuke hai, abhi bhi lad rahe hai. Aisa sirf himmat wale log kar sakte hai." The doctor smiled. "Chinta mat kijiye. Time lag sakta hai, par sab theek ho sakta hai." (Often medical terms and technical language intimidate us. Please don't be scared. Your wife and your family has fought the devil known as cancer, is still fighting it in fact. That needs a lot of courage. Don't worry. It may take time, but everything can be alright.)

Vivaan wondered if Dr. Sinha should have crossed his fingers when he said that to ward off bad luck, as Payal did. He definitely crossed his fingers when a few hours later, another seizure occurred. Unable to help it, Vivaan checked the consciousness chart when he got the chance.

Payal's mother had few small periods of waking hours. She was barely conscious. And alone mostly, since critical care rooms did not allow family to sit at the bedside. He knew she hated being alone, so when she was conscious, he visited her.

"Ma." He whispered and she focused on him. "Do you recognize me?" he asked.

A moment of silence. Then "Vivaan." She rasped out.

Vivaan sighed in relief. "How are you feeling Ma?" he asked softly.

"Tired." She whispered. "Payal... is she okay? Where is everyone?"

"Outside." Vivaan answered. "They are not allowed inside. Payal is at home, waiting for an update. Is there anything you would like to tell your family?" he asked.

She shook her head. "Tell Payal... Happy belated birthday." She whispered.

Vivaan forced his tears to not show. "I will let her know." He promised.

His mother-in-law smiled, before her eyes fluttered closed and she went back to sleep.

Vivaan came back outside, where Dr. Sinha was waiting. Dr. Sinha took the brief from him.

"She's expending too much energy in monitoring herself while awake." He said. "The effort is causing her to tire and lose consciousness faster. We really should consider the ventilator."

Vivaan nodded. It seemed like the best option to him too. He tried not to dwell on the fact that Payal's mother had freely admitted how tired she felt - something she never did in all the while he had known her. He wondered if it was just her physical body that was tired, or if she was slowly losing the will power too.

***

Payal's Kaka flew in from Ahmedabad the next day, so that there was one more person available. Payal herself had not visited the hospital even once. Vivaan was on duty, so he could not visit her. But he had asked his mother and Rohan to keep her company. She was fine, but very worried and stressed out ever since her mother was put on the ventilator.

"We have sedated her. Now the observation starts." Dr. Sinha was saying in the afternoon. "For the next 48 hours, we give Mrs. Shah's body time to adjust to the ventilator. This is critical and she must stay stable for these 48 hours. If all is well, on the third day, we will stop the sedative. If she wakes up between the third and the fourth day, we can expect a complete recovery. If she wakes between the fifth and the seventh day, we can expect a slower and possibly incomplete recovery. Some functions may be damaged. If she doesn't wake up beyond the seventh day, we will have to reconsider our alternatives."

"Reconsider the alternatives?" Asked Aniket.

"We may need to take the ventilator off, try another approach." Dr. Sinha said. "It's too early to say anything. For now, we play the waiting game."

Aniket nodded, though Vivaan could tell he was disturbed. Vivaan himself was uneasy. Maybe it was the string of bad news that had been coming their way so far.

"You will monitor by way of tests though?" Vivaan asked.

"We will do the MRI periodically." Dr. Sinha said.

Vivaan's pager rang. He looked up apologetically.

"I'll have to..." he started but was cut off by Aniket.

"You go. I'll update Payal." Aniket said, picking up his phone. "And any other questions, we will reach out to Dr. Sinha."

Vivaan nodded gratefully, starting off to go toward the residents' wing. He uncrossed his fingers, hoping that the warding gesture would hold and Ma would wake up once the sedative was stopped.

That night, he had just finished a very late dinner when his phone rang with a call from Aniket.

"Bhaiya. Is everything okay?" he asked.

"The MRI has showed some swelling in the brain." Aniket's tone was clipped.

Vivaan's heart sank.

"We're meeting Dr. Sinha to discuss the options." Aniket said. "Are you free?"

"I'll be right there." Vivaan hung up, wrapping his dinner items and practically jogging to Dr. Sinha's consulting room on the fifth floor.

"...drain procedure could relieve it." Dr. Sinha was saying as Vivaan opened the door of the cabin. Aniket and Rohini were seated before him. For the last couple of days, they had fallen into a routine. Payal's father would stay at the hospital during the day, and at night, Aniket and Rohini had been staying up. Payal held fort at home.

"What did I miss?" he asked.

"The MRI showed swelling in the brain here." Dr. Sinha repeated holding the scan up. "It's most likely a build up of CSF."

"So what are the next steps?" Vivaan asked. "Drain procedure?"

"One of the options, yes." Dr. Sinha agreed, turning to Aniket and Rohini. "The swelling is causing pressure on the brain stem, which is not ideal. So we surgically insert a drain to drain the fluid out. That will relieve the pressure."

"What is the other alternative?" Aniket asked.

"Nothing. We wait and watch. It is likely that it will increase with time and then the patient may slip into a coma... or worse." Dr. Sinha said.

"We can't agree to that alternative then." Rohini whispered. Her voice caught a little at the end.

"There is another problem." Dr. Sinha picked up a file - the most recent blood report. Vivaan had forgotten the cancer that caused all this momentarily.

"High WBC again?" he asked.

Dr. Sinha shook his head. "No. Interestingly, the number isn't that high. The problem is the lack of platelets. The last report shows only 30,000 platelets. No surgical procedure can be done with such low counts of platelets." He explained.

"I didn't understand." Aniket said.

"Platelets help with clotting, Bhaiya." Vivaan stepped in again. "That's how a wound heals. During surgery, to prevent unnecessary clotting, anti coagulating agents are given. But Ma has very less platelets at the moment. Any bleeding has to be immediately tended to since it won't clot easily. At this rate, she may bleed out before the procedure is complete."

"How did so many clots form then?" Aniket asked.

"We don't know." Dr. Sinha admitted. "Mrs. Shah's body seems to be going through too many different phases all at once. Probably the cancer, but we can't say for sure."

"So what should the magic number be?" Aniket asked.

"You would like to go ahead with the procedure then?" Dr. Sinha asked. "It does not guarantee anything. Even if the procedure is successful, Mrs. Shah may not wake up. The earlier timeline was only if nothing untoward happened in these 48 hours. But now that's out the window."

Aniket's hands were clenched. "My mother has always taught me to face adversities, doctor. Is tarah bina kisi ladai ke na wo jaana chahegi, na main." He said, eventually. (She wouldn't want to go without a fight, and neither would I).

"Vivaan. What do you think?" Dr. Sinha asked.

As a doctor, Vivaan knew it was now time. The patient's body was too weak to be put under the stress of even a small surgical procedure. It would be kinder to let her go at her time. But Vivaan wasn't just a doctor. He was this family's son-in-law. And he loved his mother-in-law just as much as he loved his Ma-sa. He couldn't sit back. Even the chance of her waking up post the procedure was less than 0.2%.

"Bhaiya is right, Sir." He said carefully. "We should fight as much as we can."

Dr. Sinha sighed, as though he had realized that the son-in-law had won over the doctor in that moment.

***

It was a long night. Once Payal's father had agreed to the procedure (he was the official guardian), Aniket and Rohini were running all night - Rohini to get the administrative work completed; and Aniket to get platelets. Due to the less time at hand, they were going to transfuse the platelets perioperatively.

At 6.30 am the next morning, the procedure was completed and the patient moved back to critical care room. As per Dr. Sinha, the procedure was successful, but there was no response from the patient as of now.

Even though he had predicted this outcome, Vivaan felt gutted. The observation would start now. If there was no response post that...

He checked if he could take a leave with his chief. There was no way he could focus on work anymore. It was better to wait with the bleary-eyed Aniket and Rohini.

"What's next?" Aniket asked, taking the coffee from Vivaan.

"They will observe her for a few hours. Once the sedative wears off, they will check for markers of consciousness. Anything minute to indicate that the she may wake up. If not..." Vivaan didn't want to complete. His chest felt too tight all of a sudden.

He knew Payal would be praying at the moment. Thinking of nothing else to do, he closed his eyes in prayer too. He held no hope, but maybe, just maybe there would be a miracle. He didn't realize when the prayers transformed into wishful dreams, when the dull hum of the waiting room changed into the subtle music of his sub-conscious.

As he dozed in and out, he hoped his mother-in-law would be okay. He hoped that she fought too, just as they all were fighting for her. But his mind kept replaying the last time she was conscious. How she had said she was tired. How much fight will the body put up? Will his mother-in-law's sheer will power hold?

Around mid-morning, Aniket and Rohini went home and Payal's father and uncle joined Vivaan in his half-awake vigil. The observation period was almost complete. Dr. Sinha would we visiting soon. And he did, around fifteen minutes later. His face was stoic - free of any emotion.

"No response." He reported. "She has slipped into a coma."

Vivaan held still. "No chance at all?" he asked, just to verify.

Dr. Sinha shook his head. "She may either continue to be comatose, or she may deteriorate slowly and pass away. But waking up is a far away possibility." He sighed. "I think its time to call the relatives."

Vivaan wasn't sure what the most painful part of the rest of the day was. His family arrived shortly after he placed the call. Vivaan could barely nod at them, afraid that any comfort from them would break his composure.

Payal visited too, the first time since her mother was moved to SNG. Unlike Vivaan, she was unable to stop her tears. Vivaan watched, helpless, as Payal hugged her father and sobbed freely. Aniket hugged them both, crying too. It was the first time he had seen Aniket cry.

One by one, everyone went in to see Deepa Shah. When it was Payal's turn, she hesitated at the entrance of the CCU. Vivaan gently touched her shoulders, guiding her inside so she could stand at a distance and see her mother.

"The bandage is for the drain that was inserted." Vivaan explained. Why, he was not sure. "And the tape and tubes on the mouth are for the ventilator."

Payal shook as she held in her tears. "Does she... know?" she asked, her voice clogged. "Does she know that I'm here to see her? Can she feel me?"

Vivaan didn't want to lie, but he didn't want to break her any further. "She has always kept you in her thoughts, Payal. We should respect that, right?" he asked gently. Payal nodded, raising one hand in the air as though reaching out to her mother. A moment, then two. And then she turned away, crying freely.

The Shah family stayed in the waiting room the whole day and the evening. As the day passed, Payal and Aniket discussed on the options they had if the coma continued indefinitely. Their mother would never want to live in a vegetative state. But could they really let her go? Was it ethical? Legal? The debate didn't have an end. Perhaps that was the point. It kept them going.

It was close to 7 pm when Vivaan received the first call. He rushed to the CCU, watching as the doctors administered medicines to keep up the blood pressure. Multiple organ dysfunction had commenced. That could only mean one thing. It seemed that Deepa Shah agreed with her children. She didn't want to continue living like this. She was giving up officially. The family took the news silently. Payal's father and uncle continuing pacing the length of the waiting room, not talking to each other. Rohini was on call with her parents, relaying her situation. Aniket had called up their relatives with the news already, now he was sitting with his head bent forward, as though waiting for something. Payal had closed her eyes, her lips moving slightly. She was deep in prayers.

Finally at 9.15 pm, Vivaan received the second call. Just like the last time, he watched helplessly as the doctors tried to resuscitate Payal's mother. Ten minutes passed, then fifteen. As the doctor finally gave up, Vivaan finally gave into his tears. He watched as the doctor called the time of death, tearing falling down relentlessly.

A comforting hand rested on his shoulder. He turned to see his chief standing beside him.

"We lost the battle; didn't we, Sir?" he asked, his voice hitching with sobs. "The cancer won."

Around them, the buzz of the hospital continued. But Vivaan felt numb. They had fought and fought as hard as they could; but to no avail. They had lost the battle.

Glossary:

ascites -  Ascites is a term used for build up of fluid in the abdomen. Ascites are a common symptom for liver disease or cirrhosis (liver degeneration due to alcohol). Ascites also indicate infection in the abdomen. In the context of this story, ascites were a complication of the cancer. The presence of ascites meant that the cancer had progressed, either causing an infection in the liver, or even causing cancers in the other organs of the body.

FAST - FAST is an acronym for recognizing the main symptoms of a stroke. F stands for face (i.e. check if the face muscles are drooping or sagging); A stands for arms (i.e. check if one arm is weaker than the other); S stands for speech (i.e. listen for slurred or unusual speech); and T stands for time (i.e. time is of importance, so call an ambulance as fast as possible). FAST helps in primary diagnosis of stroke so that the afflicted individual may receive treatment on time. FAST should be applied when anyone behaves unusually for no reason (for instance, if someone loses balance all of a sudden; falls unconscious suddenly; walks in a bent manner or tilts to the side; cannot speak, etc.).

agarbatti - an incense stick made from the Agar tree. In most Indian households, agarbatti is used for daily prayers and on special occasions. It is used to spread fragrance and good energy in the house.

frontal lobe - part of the human brain, located within the cerebrum. Frontal lobe is responsible for cognitive functions and primary motor functions.

cerebrum - cerebrum is the largest part of the human brain, located above the brain stem. It is responsible for controlling all voluntary functions of the body.

cerebellum - also known as "little brain", this is the part of the human brain, tucked behind the brain stem. The cerebellum also plays a role in controlling cognitive and movement related functions, but it is more on the involuntary side and for fine-tuning. The cerebellum integrates the sensory inputs from the other parts of the brain and the spinal cord and helps carry out the voluntary functions.

brain stem - the stalk like part of the brain connecting the brain to the spinal cord. The brain stem regulates the most critical functions of the body, such as heart functions, respiratory functions and even the sleep cycle.

CSF - stands for Cerebrospinal Fluid. CSF is a clear colorless liquid found in the tissues surrounding the brain and the spinal cord. It acts as a cushion or buffer to absorb shock and provide protection to the brain within the skull.

drain procedure - a procedure for relieving pressure on the brain. The official term used for the drain is a "shunt". The shunt is inserted surgically as a drainage system. It will move the excess fluid out of the brain and into the body for reabsorption. The draining of the fluid will reduce the swelling as well.

perioperatively - "perioperative" refers to a process being conducted during the surgical procedure. The context here is that there was no time to wait for a transfusion of platelets and then insert a shunt. Hence, the platelets were transfused while the surgical procedure took place.