When Jyoti Pande Lavakare’s classical vocalist mother was unexpectedly diagnosed with terminal lung cancer on Diwali 2017, her family was shocked. There had been no symptoms, no family history of such cancers. But what was even more horrifying was the casualness with which doctors – attending pulmonologists and oncologists – linked her mother’s lung cancer directly to the polluted air she had been breathing, unsurprised it had remained undetected until it reached this terminal stage.
The dark irony of the situation wasn’t lost on Lavakare, a clean air advocate who had herself only recently discovered the lethal effects of air pollution on the human body and spent the previous three years working with other concerned individuals to spread awareness around air pollution as part of a citizen awareness and advocacy platform called Care for Air that she co-founded with atmospheric scientists, healthcare administrators, public health researchers and lawyers.
Suddenly, she was living the nightmare of everything she knew in theory about the worst health impacts of air pollution – with her own mother. None of the scientific research she had absorbed on air pollution had prepared her for the real life experience of its toxic effects up close and personal. She wrote Breathing Here is Injurious to Your Health as a grief memoir to humanise the health harm from air pollution, citing science, research and evidence in every chapter, unpacking, simplifying and amplifying it for ordinary people who are unaware of this invisible killer.
January 2018
I am on my way to drop my daughter at New Delhi’s international airport for her flight back to university when my mother’s heart stops beating. This time, she isn’t going to revive, though I don’t know that yet.
“How bad is it?” my husband asks, his voice carefully neutral as he peers through the grey miasma of Delhi air and expertly navigates the crush of vehicles. I hug my daughter tighter as I look out at the ubiquitous blue metal barriers installed by the Delhi Metro Railway Corporation, half-crushed scaffolding and construction debris that have narrowed our lane, slowing us down further.
Idling traffic growls and beeps around us – two-wheeler riders in their helmets and puffy jackets, autorickshaw drivers muffled up against the January cold so that I can only see visors and eyes. The scene looks eerie and dystopian in the smoggy light of a weak morning sun. I can smell the pollution. As an active clean-air campaigner for the past four years, I have become something of an expert at this.This morning’s air feels particularly heavy with particulate matter (PM) and sulphur and nitrous oxides from the traffic. Heavy and cold. Toxic.
“Is naani worse?” asks my teenage son. I hear the concern in his voice, feel my daughter’s body tense up, my husband’s hands tighten on the steering wheel as they wait for my reply.
From the first light of that grey morning, the WhatsApp group I’m on with my siblings has been buzzing with updates about my mother, punctuating existing stress with additional sorrow. Another cardiac episode. But because there have been previous ones like this, beginning with a first, critical one 14 days go, on New Year’s Eve, during which a visiting overseas relative, a physician, quickly and efficiently jump-started her heart with epinephrine, I’m unsure how serious this is. I don’t know if her heart is resilient enough to withstand another bradycardia episode.
“I don’t know. It always sounds bad.What shall I do?” I ask no one in particular. I look at my phone again, scanning for updates, a nervous tic that I’ve recently developed. My eyes have begun to water. I can sense the beginnings of the familiar, dull pollution-induced headache kicking in as vehicular fumes find their way into the car despite the tightly closed windows.
“Don’t worry, Mom. She revived last time. She’ll be okay.”
My daughter rests her head on my shoulder, her wayward curls spilling over. I stroke them absently, chewing my lip till it hurts. She is my eldest, our family’s sweet glue, and I’ve spent the last year preparing myself to let her go. This will be her second term away, and I’ve had time to get used to her absence, of a family getting smaller, but it is still an unfamiliar feeling. I really want to see her off peacefully, spend a few calm moments of affection with her – the morning has been an anxious rush of last-minute instructions, packing, checklists and reminders, leaving no time to express love. But.
The tinny pings of WhatsApp notifications are creating a delicate mesh of invisible tension inside the car, as imperceptible as the toxic particles swirling in the air outside. I feel paralysed with indecision, torn between generations.
“Do you want to get off? Get an Uber and go to her?” my husband asks as the stalled traffic around us begins moving sluggishly, the sounds of revving and honking announcing a green light.
We are halfway to the airport when the messages increase in urgency and crescendo. So, I quickly book an Uber and get off at the next signal.
But in the short time it takes me to reach my mother, she is gone. Her body is still warm when I arrive, but her pulse is a flat line.
A rush of unhappy memories from the last three months begins to swirl. From that day in October when I got the news to a week later when my pathologist friend validated the biopsy, confirming the diagnosis, to my mother’s birthday when, instead of celebrating, she packed for her hospital admission. Then, more tests, the hope in her eyes fading as she tried to understand what was happening, then tried not to.
The first line of treatment for her lung cancer failed in mid-November, the medicine targeted to limit the growth of the cancer cells having no effect on the fluid building up in her lungs. I could sense the optimism of her attending oncologist dimming. But he was too seasoned to let her see it. “Well, it’s too bad that the EGFR test hasn’t given us the report we wanted,” he told my mother, holding her hands in his own, smiling into her anxious eyes, his jovial voice at variance with the shadow on his face. “That would have helped the Erlotinib target the cancer cells effectively. Next step: chemotherapy.”
My mother shrank back, her hopeful smile fading as she looked around for my father, shaking her head at him. It took us a week to persuade her – after we had persuaded each other, because none of us was convinced about chemotherapy to begin with and spent hours arguing, googling, debating and prevailing upon each other, convincing ourselves that we had no real choice, that we must give it a chance.
“A baby dose,” the oncologist reassuringly called it.
And so, it seeped into her blood one Saturday in November, as the sky outside turned grey and grim with smog that was building up in the city. Farmers in neighbouring states had started burning crop stubble as usual, the seething smoke beginning to shroud Delhi in the uncomfortably familiar way that typified the city’s winters. But we were too busy with our own darkening thoughts to notice that the air outside was closing in on us, like my mother’s mortality.
Why? Why her? A non-smoker with no family history of cancer. No symptoms. This question consumed me in the initial days. However, other more action-oriented questions around her immediate care took precedence in the brief moments that the doctors spared for us – including, now that the Epidermal Growth Factor Receptor (EGFR) test had failed, could we afford the next-generation sequencing test as a last resort?
One day I found myself in the hospital elevator with her attending pulmonologist. “Why?” I asked him. “Why my mother?” He looked up from his phone, his private smile fading as he recognised me and said, almost indifferently, as if I should know the answer already, “Aren’t you the daughter who works in air pollution? And didn’t you say she’s lived in north India all her life Then why are you asking this? There’s really nothing else that explains ‘why her’ except the foul air she has breathed all her life.”
I felt like he had punched me. Because, chillingly, I did know, I realised, at least in theory.Wasn’t this in the fifth slide of the introductory PowerPoint that my clean-air non-profit Care For Air (CFA) presented, the one titled “The Health Impact of Air Pollution”? My co-founders at CFA and I must have told thousands of listeners in schools, resident welfare associations (RWAs), hospitals, and even on the television panels that I’d started appearing in, how exposure to air pollution can trigger lung cancer, heart attacks, strokes, diabetes, obesity, autism and dementia, among a host of other non-communicable diseases.
How different it was, to know in your head and to know in your heart. He stepped out of the elevator. I followed. A team of nurses and resident doctors were waiting for him to begin the morning rounds.
“But there were no symptoms, Doctor. She was perfectly fine,” I could hear my voice rising. “Not even a cough. Just a little breathlessness...” But he was gone.
As I stood in the long hospital corridor, watching the disappearing trail of white-coated doctors and their nurse-attendants flow seamlessly from room to room, the words of another thoracic surgeon – with whom I had recently begun collaborating to spread awareness about pollution as a part of my clean-air evangelism – came back to haunt me.
Just months ago, Dr Arvind Kumar, who heads chest surgery at Delhi’s Sir Ganga Ram Hospital’s Centre for Chest Surgery, and I had been discussing the health hazards of breathing in polluted air and how it affected human lungs – something he had first-hand experience with, having treated thousands of lungs, healthy and diseased, in his surgical practice at the large private hospital.
“In Delhi today we are all smokers from our first breath, whether we’ve ever held a cigarette in our hands [or not]. We all have smokers’ lungs,” Dr Kumar had said, corroborating what I’d learnt from reading public health research. “This is why lung cancer cases are on the rise.”
Breathing, it seems, had become the new smoking.
Excerpted with permission from Breathing Here Is Injurious to Your Health, Jyoti Pande Lavakare, Hachette India. The book has been shortlisted in the Tata Literature Live! First Book (Non-fiction) category.