It took visits to six doctors for Atul Kumar Jain to discover he had something more sinister than a waning appetite and “halki-phulki khaasi” or mild cough. After five leading chest specialists dismissed the 40-year-old non-smoker’s X-ray and blood reports early last year, saying nothing was wrong, his wife Pooja Jain persisted in her search for a doctor who would tell them why her husband was suffering. “My husband said, ‘You are mad,’ but I went alone to meet Dr Arvind at nine at night to show these reports one last time,” she said.

Dr Arvind Kumar, a leading chest and thoracic surgeon at Delhi’s Ganga Ram Hospital, spotted some abnormalities. “He said that this could be either a tumour, TB [tuberculosis] or cancer,” said Pooja Jain. Five days later, on April 6, 2017, Atul Jain was diagnosed with Stage II-A cancer in his lungs. “I was going to file a case against some of the big doctors who said nothing,” said Pooja Jain. “You think we are stupid to be worried for nothing?”

Delhi is a city of survivors. It takes grit to navigate this city of 27 million that is set to grow even further, and projected to become Asia’s biggest megacity by 2028.

Atul Jain's recovery is nothing short of a miracle and he knows it. He has pictures of himself from the surgery saved on his phone.

The Jains live with their extended family in a three-storey house in Shahdara, one of Delhi’s oldest neighbourhoods, which lies on the banks of the Yamuna, bordering Uttar Pradesh. A major grain-trading hub in the 17th century, and quite literally the “door of kings”, it was the fourth gate to the city. Shahdara is now a crossroads for three national highways and one state highway.

As the city rewrites its old margins, neighbourhoods like Shahdara are sites of upheaval, even as they are bursting at their seams. Gated housing projects with manicured lawns and the fanciest names lie within a few kilometres of Shahdara’s Jhilmil, one of Delhi’s oldest industrial areas. Malls mushroom along the snaking highways, throwing more construction dust into the air. In the neighbourhood, new floors are being added to old houses in lanes so densely packed it is hard to spot the sun.

The Jains live in one such lane. At the door, 14-year-old Samyak Jain hands callers his visiting card. Since Atul Jain was diagnosed with cancer, the teenager has been taking care of his father’s garments and electrical components business that is run out of the ground floor of the house. From interacting with buyers from the African Union to checking up inventory, he now does it all.

Pooja Jain's persistence in chasing doctors finally got her husband a correct diagnosis.

“Look at him!” said Pooja Jain wistfully, at their home days before Diwali. “This kid is now grown-up.” From the day his father fell ill, school took a back seat and Samyak Jain, who is in Class 9, scraped through with barely 50% attendance last year. She said that his teachers were informed of the situation at home and they have been quite supportive.

But given that they belong to the Jain community, where sons typically follow in the father’s business, it would not be surprising if he dropped out of school entirely. “His birthday was on the last day of his dad’s chemotherapy,” said Pooja Jain. “He did not cut a cake or throw a party. He just wanted to spend time with his father and massage his aching feet.”

Many costs of cancer

Cancer takes a toll, in more ways than one. “His hair started falling out, he would get angry,” said Pooja Jain. “Financially and emotionally we all took a hit.”

When Atul Jain’s scans first came in, he did not have health insurance. Pooja Jain’s Rs 2 lakh health insurance policy covered only a fourth of the cost of the surgery to have his tumour removed. Add to that the costs of 10 days of post-operative care and chemotherapy every three weeks over and above the medicines, as well as special care at home. “[He had] only Bisleri water, a special diet,” said Pooja Jain. “I wanted the best for him.”

Business clients started to keep their distance and fault lines showed in their family over finances. “Once people hear cancer, they assume it is all over,” she said. “Zindagi zeher ban gayi thi”. Life became poison.

Atul Jain is a proud survivor and insists on showing his surgery scar.

Pooja Jain is no stranger to the disease – she lost her mother to breast cancer only four years ago after caring for her, along with her two other sisters. “When they said they had to operate on Atul immediately and then do chemo, the whole world stopped for me,” she said.

Atul Jain’s tumour was large. “Luckily for him, we detected it in time,” said Arvind Kumar in the first week of November. The doctor is busier than ever at this time of the year. He had just returned from a World Health Organisation air pollution summit in Geneva that India’s leading policy-makers chose to skip. “Atul lives in an area that is highly polluted,” he said. “He was literally born a smoker, as is every newborn in Delhi. In Delhi, breathing kills.”

He compared his data from 1988, when he first began his practice, to the last six years between 2012 and 2018. “The contrast is too stark to ignore,” he said. In the eighties, out of 10 patients he would treat for lung cancer, there would be only one non-smoker, with the rest being smokers. “[The ratio is] one smoker and one non-smoker now,” he said.

According to Kumar, in the last few years, lung cancer has galloped to become the number one kind of cancer that affects men in India today, and is increasing rapidly in its incidence among non-smoker women and children. He has also found that one-third of all lung cancer patients were being misdiagnosed.

According to WHO’s latest report, air pollution claims 7 million lives a year, and in 2016, lead to the death of 1,00,000 children under 5 in India alone.

Whether it is with the Lung Care Foundation that he started in 2015 to make information and care available to “care and cure 2.6 billion lungs”, Arvind Kumar has been taking to the streets to protest against India’s silent health emergency.

Atul Jain prays in his office before starting a day of work along with his nephews and brother.

Atul Jain’s recovery is nothing short of a miracle and he knows it. He is a proud survivor and insists on showing this correspondent his surgery scar. But whether this family will know normalcy again is doubtful.

Three flights of stairs separate the office and warehouse of his business. Fading energy levels have meant there is little chance that he will return to business as usual.

There is also the inconvenient fact that the family still lives in Delhi, which is currently recording the worst air quality of the year. But leaving the city is not an option. The family is gearing up to celebrate Atul Jain’s first Diwali at home after his diagnosis. “We were born in Dilli, our circle is here, we were married here, our kids study here – Dilli people want to live in Dilli,” said Pooja Jain, in the thick of activity as her in-laws milled over preparations for the festival. Much as the Jains wish they could leave Delhi on what has become one of the most polluted days of the year, Diwali is the most important festival of the season for business families like theirs.

Samyak Jain, 14, takes his father Atul Jain for some work in the neighbourhood. The teenager has been taking care of his father’s garments and electrical components business that is run out of the ground floor of their house.

“Don’t get me wrong – I love Diwali more than anyone else – the dressing up, lighting the house up,” said Pooja Jain, as she picked out new clothes for her husband to wear, while ducking into the kitchen to make sure there are enough boxes of almond barfi and rasgullas being stacked for guests. But they won’t be bursting crackers on Diwali. “My kids did not burst any crackers last year [either], they understand that their dad is sick because of pollution. After what we have been through, we do not want anyone else’s family to suffer.”

Will Delhi do the same for them on Diwali?

Pooja Jain and Samyak Jain look through Atul Jain's old X-rays and scans at their home in Shahdara, Delhi.
Atul and Samyak Jain wait at the Sir Ganga Ram Hospital in Delhi before an appointment with Dr Arvind Kumar.
Father and son on their way home after the check up at Sir Ganga Ram hospital.
Atul Jain descends the stairs at Sir Ganga Ram Hospital after a check-up. Two days after the operation to remove his tumour, he was advised to walk up and down these very stairs for exercise. “I did not think I would manage but I guess there is such a thing called will power. By the third day of recovery I was going up and down at least three four times a day.”

All photographs by Ishan Tankha.