July 16, 2009

GI June

Bombings, the threat of emergency rule, coup rumors, official visits by US security officials including the new US CIA director, and revitalized street protests against the de facto President’s maneuvers to hold on to power beyond 2010 -- all constitute major elements roiling the political cauldron in the run-up the forthcoming State-of-the-Nation address. Ordinarily they can provide more than enough material for weekly political commentary. Yet this week, I choose to write closer to home.

My psychiatrist-sister has just been diagnosed with cancer. These past weeks she has been hit by a tornado of events, thoughts and feelings brought about by the discovery of this life-threatening disease. She - and I - need to gain a proper perspective on this and according to a nondescript-looking book she shared with me, The Book of My Healing by Peggy Schmidt, writing about a serious illness or accident, can do that, apart from actually promote self-healing.

Being a doctor, June didn’t ask the question “Why me?” in a metaphysical way. It was not like her to look to God for an explanation for every catastrophe, personal or otherwise. She looked into the family medical history and there were nine other close relatives who also developed cancer with some eventually dying of it.

She reviewed how conscientious she was in having her regular medical check-ups as well as in seeking expert advice about various physical ailments. In fact she had been given a clean bill of health after undergoing a full executive check-up two months before her diagnosis.

She reflected on her lifestyle, work load and general mindset, noting her share of stress factors, bad eating habits and unhealthy practices, like daily losing precious sleep doing email or chatting on line.

She belatedly acknowledged that once a person reaches her golden years, a lot of body parts, including one’s genetic material, start to go out of kilter, causing abnormal cells to grow uncontrollably. Not even the most saintly, health-conscious and prudent person is exempt from developing the disease.

It was a seemingly endless series of tests that she had to go through to finally pin down the type of cancer, the stage and what had to be done to save her life. Being a doctor had its plus side: she was conversant with the experts and could participate with relative ease in her medical management; she could seek second and many more opinions from an array of doctor-relatives and doctor-colleagues before making critical decisions; she could do her own research or ask her bioresearcher-daughter to come up with the latest on diagnosis and treatment.

But it had its down-side too: June could not keep herself from thinking in detail about the most dire of scenarios: like not having a treatable kind of cancer and being consigned to palliative treatment; or of brain metastasis (that would be the end of her professional career); or chemotherapy turning out to be far more debilitating and crippling than the cancer itself.

For too long a time she was her own general physician: she wrote down her medical history, she ordered the tests she thought she required; she called on the specialists she thought needed to be consulted. She see-sawed from trying to be clear-headed as a doctor, with the cold objectivity she was trained to apply, to being overwhelmed by fear bordering on panic like any patient with the dreaded disease. She could not help noting the sins of omission by some of the physicians whose help she had sought and who had dismissed or missed her signs and symptoms.

Then there was the matter of cost. Chemo alone would be a hefty hundred forty thousand pesos per cycle; she needed six to eight cycles. At first she had hoped she could be included in a clinical protocol researching a new drug for the kind of cancer she had. That would have meant all or almost all of the expense of further diagnostic examinations and treatment would be shouldered by the research sponsors.

But one restriction after another stood in the way of her inclusion until she gave up trying to be the square-peg patient in the stringent round-hole research protocol. It seems only patients who have absolutely no means end up agreeing to be human guinea pigs; that is, they are research subjects first and foremost and patients second. All the delay while trying to qualify for the free treatment had eaten into June’s precious window of opportunity to get at the fast-growing malignancy. We urged her to start chemo ASAP; the money for the rest of the treatment cycles would be found somehow.

It was when the bill came that June found out that she had just contributed twentyfive thousand pesos to government coffers in her effort to get well. Yes, Sen. Mar Roxas, that’s 20% VAT on life-giving medicines despite all the government hoopla about bringing down the price of pharmaceuticals.

A doctor classmate of June quipped that it would be interesting to see how she would “process” in her mind what she was going through the way she had helped hundreds of her patients and thousands more to whom she had given stress management seminars. How would she summon the physical strength, the will power, intangible stuff like faith and hope, and always, the lightheartedness and sense of humor, to steer her through a sea of anxiety, pain and worry about the future.

As it turned out, loved ones, friends and even strangers, came forward to provide the sympathetic ear, the useful tips on mitigating the chemo side-effects, the quiet place to rest and recuperate and the indispensable financial assistance.

And June, ever the psychiatrist, teacher-researcher and gritty fighter soon summed-up some of the things she learned after her first round of chemo. As a patient who, coincidentally, is also a physician, she wrote, tongue-in-cheek, in her first email to all and sundry:

1) Don't refer to all cancer patients who took chemo and lived beyond the time frame everybody else or even their doctor thought possible as "cancer survivors". They are more appropriately called "chemo survivors" since the chemo is really more toxic than the cancer.

2) Don't let people know you have cancer until your doctor has told you what specific kind you have. Otherwise, you will be flooded by text messages asking whether they will still see you next year.

3) Be careful giving your announcement piecemeal or telling some people about your condition confidentially. It will still spread like wildfire and some people will feel hurt that they didn't merit being in your priority list.

4) If you get advice which really sounds too radical or even weird, don't argue. Just say you'll think about it.

5) Important to note. Chemo meds are "cash on delivery".

6) Not all chemo come with the famous dreaded side effects of nausea, vomiting, bleeding and hair loss. Forgive people who will tell you, the worse is still to come, for they know not what they say.

7) By the way, it really makes you feel in control if you shave your hair ahead of time. (It may not fall but...) You may even discover the new hairdo suits you and keep it beyond chemo. One suggestion: Tell the barber to set his clipper only at No. 2 not zero. You only want to look like Demi Moore not Yul Bryner!

She signed her email “June aka GI June” in humorous reference to her newly-shaved head. #

*Published In Business World
17-18 July 2009


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