“When Pain Whispers Fear”- An Adolescent Case That Marked The Beginning

“When Pain Whispers Fear”- An Adolescent Case That Marked The Beginning

– Dr. Dhanashri Kudal, Chhatrapati Sambhaji Nagar

It was my very first adolescent case as a Consultant at the State Cancer Institute. I was reviewing my list of new consults when his name appeared. He was 18, barely a man, yet already weathered by a storm most adults would find overwhelming. A known case of Acute Lymphoid Leukaemia (ALL), he had endured multiple cycles of chemotherapy. His disease had relapsed, this time with central nervous system (CNS) involvement. 

The primary haemato-oncologist had requested a Palliative Medicine consultation:

“He’s not responding to ongoing medications for pain,” the note said. “Uncontrolled headache, neck pain. Please review.”

I walked toward the ward, my mind was busy assembling fragments of his history, clinical parameters, and potential interventions. But nothing quite prepared me for what I saw when I entered his room.

Beyond the Physical: A Layered Pain…

I found him lying in bed, visibly distressed. His face was pale, etched with suffering. He complained of an excruciating headache radiating down his neck, pain that had proved stubbornly unresponsive to medications. Multiple admissions had yielded little relief. He was unable to walk, dizzy, and entirely dependent on his family for even the most basic tasks of daily living. After reviewing his history and the limited response to tramadol, paracetamol, and dexamethasone as given already by the primary team, I shifted him on morphine and gabapentin, carefully titrating the doses in the hope of achieving meaningful relief. His suffering extended far beyond the physical; it was emotional, psychological, and existential.

A Mother’s Redefined Wish…

Later, I spoke with his mother. Her eyes reflected years of resilience, tempered now by exhaustion. She understood the prognosis, multiple relapses, and now, no further curative chemotherapy options. But her hope had shifted. She no longer wished for a cure, only comfort. She wanted to see her son walk again, eat on his own, and sleep through the night without pain. 

“He hasn’t gotten out of bed in weeks,” she whispered. 

I assured her that while we might not change the trajectory of the disease, we would do everything in our power to improve the quality of his remaining days.

The next day, I went to review him, but his bed was empty. He had been discharged due to a family emergency. In this resource-limited setting, where I was working to establish a fledgling Palliative Medicine department, I searched for any way to trace him. A week passed, and still no news.

A walk towards hope…

Then one day, he walked into the outpatient clinic, literally walked in, accompanied by his mother, both wearing wide smiles. It was hard to believe this was the same boy. He told me the medications had helped tremendously. He was walking, eating, sleeping, and managing daily activities independently again. Their gratitude was evident, the transformation, humbling.

With each follow-up, his pain improved. We gradually tapered his morphine and other analgesics, and at the advice of the primary team, he was started on Dasatinib. He began routine reviews and settled into a rhythm.

Days turned into weeks.

Every Flare a Warning…

Each time his pain flared up, he and his mother would rush to the outpatient clinic. But it wasn’t just the physical discomfort they feared; it was what the pain symbolised. To them, every ache was a whisper of relapse, a harbinger of loss, a reminder that time was fragile.

A World Held Together by Two…

During one of our conversations, his mother shared more of their story.

“He’s my youngest,” she said. “The only one left with me.”

His father and two brothers had died years ago, before the cancer diagnosis. “He is my whole world,” she said softly. “Even if the disease is advanced, I just want him by my side.”

And in that moment, I understood something profound. Their repeated visits were not only about controlling pain and other symptoms. They were about preserving hope. About clinging to one another in a world that was slowly shifting under their feet. The pain represented more than biology; it symbolized the threat of separation. A mother fearing the loss of her only support. A young man fearing the theft of his future, his responsibilities, his dreams. We addressed their concerns. 

A Continuing Chapter…

He continues to visit the outpatient clinic with his mother, their bond as strong as ever. His pain is now well controlled on a tailored regimen of medications, adjusted over time with care and precision. But what is even more striking is the change in him.

He stands taller not just physically, but emotionally. There is a quiet resilience in his voice, a calmness in his eyes. He asks informed questions about his medications, participates in decisions about his care, and expresses his needs more clearly. He is more aware, more in control, not of the disease itself, but of how he chooses to live with it.

And his mother, always by his side, continues to be his anchor. Their shared journey is one of grace, mutual support, and a fierce commitment to each other’s well-being.

Their story reminds me that palliative care is not a farewell, it is a way forward. A path that does not deny suffering but walks alongside it with compassion, clarity, and hope.

This case was not just about managing symptoms. It was about understanding what pain truly means to patients and their families. Sometimes, pain whispers louder than diagnosis; it whispers fear, love, loss, and the desperate hope for one more day of normalcy.

Author’s disclosure: No conflict of Interest

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References

1. Downing, J., Jassal, S. S., Mathews, L., Brits, H., & Friedrichsdorf, S. J. (2014). Pediatric Pain Management in Palliative Care. Pain Management, 5(1), 23–35. https://doi.org/10.2217/pmt.14.45
2. Murphy PB, Patel P, Barrett MJ. Morphine. [Updated 2025 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526115/
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