Contributed by a cancer survivor, Ms Chua Mui Hoong living in Singapore.
Note : This story was first published in The Sunday Times, 9 March 2003, and
is reproduced here with permission from the author.
Don't come back for Dad's funeral, you'll just make mum more upset
`I THINK you've got breast cancer there,' blurted the radiologist, a petite woman with curly black hair and crinkly blue eyes.
I flinched. The room stilled. I felt cold.
`Maybe,' I thought, staring vacantly up at the ceiling, `she doesn't know what she's talking about.'
I was lying on the examination couch, right arm behind my head, right breast exposed, nipple pointing at the ceiling.
The news was a complete shock. A breast lump had appeared to be growing and I had finally decided to get it checked out.
I was 33, with no family history of breast cancer and no risk factors (apart from being a woman and childless).
I had had two ultrasounds and four mammograms that morning at the doctor's insistence.
In a daze, I listened as she droned on. I needed a biopsy, where a needle is used to extract tissue to be examined in a laboratory. Only a biopsy can give a definitive diagnosis.
`But it looks like cancer to me, I'm pretty sure about it,' she said.
My heart sank. From that moment on, I lived with cancer as a reality.
The ironic side of me whispered: 'She looks like a competent radiologist but she sure has lousy patient skills.
`I wonder how many people hear their first diagnosis of breast cancer like you, half-naked, lying on the examination couch.'
THAT was March 19, 2002, in Boston.
I was nine months into a Master's programme in Public Administration at the Harvard University's Kennedy School of Government.
News of that magnitude takes time to sink in.
A sense of disbelief prevailed. Me, cancer? The most serious illness I had ever had was chicken pox.
I felt a sense of irritation and indignation. I was annoyed most of all at the disruption to my travel plans.
I had put a deposit down for a cruise in Alaska in May, after my examinations. I was due to fly to San Francisco in a few days' time, during Spring break.
My sister and I were discussing plans for her to bring our niece and nephew to visit me during Commencement (as graduation is called in America) in June.
Now, travel and party plans had to be put on hold till the diagnosis was sorted out. Cancer wreaks havoc on your normal life and routines.
As the news began to sink in, the feelings surfaced.
I feared a lingering death from cancer. I have always had a morbid streak and frequently thought about dying, but academic thoughts about death entertained from a distance are very different from the fear of dying when it stares you in the face.
After the fear came the Why Me questions.
Luckily, Florence, a friend who had breast cancer a few years ago, had given me this pearl of wisdom: `Don't keep asking why you got it. Remember it is very common nowadays.'
Breast cancer is indeed common: in the United States each year, 200,000 women are diagnosed with it, and about 40,000 die from it. In Singapore, each year 1,000 women hear the dread diagnosis and about 250 die from it.
Still, the odds of someone my age - 33 - getting breast cancer are about one in 3,000. That is like buying three 4-D numbers and one of them hitting the first prize. I was singled out, indeed.
But if I were to play the odds game, I reckoned, I would have to ask Why Me for a lot of other things.
Why had I been so blessed with friends and love and family and an interesting career?
What are the odds of an immigrant peasant's daughter from Swatow, China, making it to Cambridge and Harvard universities?
It didn't make sense to ask Why Me for the bad things and not the good things in my life. Put that way, Why Me never had a chance to get rooted.
It was hardest to cope with the uncertainty. I had many questions: Am I going to die? Has the cancer spread? Is it operable? Will I lose my breast? What will the treatment be like? Will it be painful?
The next few weeks were the worst weeks of my life.
Many cancer patients find the initial weeks after diagnosis the most difficult. You are confused and frightened. You have lots of questions but no one has any answers yet.
You navigate unfamiliar hospital and insurance administrations. You feel many things, none of them coherent. And through everything is the constant, nagging fear: You know you may die, perhaps in pain, and very soon.
In the meantime, I was sent for a series of tests and scans to find out the extent of the cancer.
I made my way to major Boston hospitals, traversing long corridors leading to fearsome-sounding places like Departments of Nuclear Medicine. Most of the tests were neither invasive nor painful. But one terrified me.
I went for a bone scan which would show up any tumour larger than 1 cm around the bone structure.
I lay flat on my back while the camera scanned an image of my skeleton into the computer, complete with buzzing coloured patterns and lights.
I was convinced the colours showed spots where the cancer had metastasized, or spread, to the bone.
Knowledge is a double-edged thing. I knew half the women with metastatic breast cancer die in two years. I feared not reaching 35. As I lay immobile for the scan, tears streamed soundlessly, effortlessly, from my eyes. The 20-minute scan seemed never-ending.
But it was a false alarm created by my own fears. Minutes after the test, I saw the radiologist, who told me there was no sign of cancer in the bones.
DR SUSAN LOVE, author of the Susan Love Breast Book (incidentally the best resource for any breast cancer patient), described standard cancer treatment as 'slash, poison, burn'.
I have gone through the whole works over the past year.
The slashing - the operation - took place in July. The poisoning or chemotherapy, took place before and after surgery for about nine months in all. The burning - radiation - took eight weeks, from November 2002 to January this year.
It is a long, arduous journey. My friend Edie, a Jewish radio reporter, described last year as my `Jesus year', a reference to Christ's crucifixion at 33.
It was certainly a harrowing year.
My father had a stroke in Singapore two weeks after I was diagnosed. He was in hospital for five weeks, and died last May.
I learnt the news in a midnight telephone call. I was in Boston and was into my second week of chemotherapy. I had developed an infection with mouth ulcers and a fever. I was in pain from the drugs injected into my veins.
My brother told me bluntly: 'If you look sick, don't come home. Mum will be even more upset.'
I did the unfilial thing. I did not return home for my father's funeral. I think he would have understood. Still, grief and guilt were two additional burdens to cope with.
Schoolwork proved less of a burden than good therapy. Keeping up with classes kept my mind off my illness. I wrote an elaborate proposal for electoral reform in Singapore a day after my first chemotherapy treatment.
In June, I graduated along with my classmates, proud I had finished the course while going through chemotherapy, and with a decent number of A's.
It poured during Commencement, and I felt I had truly, truly, made it through the rain.
Before the operation, I went to upstate New York for a week's vacation. I soaked in the peace of the Adirondack mountains. I swam in lakes and relished being alive.
A thunderstorm cracked the sky apart that first evening, but after the storm came a perfect rainbow that arced over the mountain range.
There is a biblical story linking rainbows to symbols of hope and new beginnings. I was cheered, and reminded of a line from English mystic Julian of Norwich: 'All shall be well and all manner of things shall be well.'
That line returned to gird me in the days ahead. I went to a concert by a mountain folk singer. Amidst her songs about mountain life was one based on the writings of Julian of Norwich, called All Will Be Well. Reading my horoscope in the local Adirondack paper a few days after that, I came across this line: 'All will be well.'
I took the good omens to heart. I also had faith in my surgical team, headed by one of the top breast surgeons in America.
I e-mailed friends all over the world - Christians, Buddhists, Muslims and Hindus - with the time and date of my surgery and asked for their prayers and good wishes. In hospital, I imagined a web of prayer and love enfolding me and supporting me.
The surgery went well. I had two cuts: one across my breast to remove the cancerous lump and another cut under the arm-pit, to remove lymph nodes around the breast so they can be tested for cancer.
There was hardly any pain. By Day 2, I was off painkillers and well enough to enjoy a small plate of the char kway teow my visiting sister had trekked an hour in the summer heat to buy for me. On Day 3, I accompanied my niece Joanne to a children's concert by Anna Moo who sang animal songs. Including about cows.
The best news of all came a few days later. All the lymph nodes had tested negative: they were free of cancer. The tumour itself had shrunk from 3 cm before chemotherapy to just 0.4 cm.
But it was by no means the end of my battle.
ALTHOUGH the lymph nodes were clear, there was a chance that stray cancer cells had migrated to other parts of the body. These cells can multiply and kill you. My oncologist recommended more chemotherapy to wipe out any of those stray cells.
In August, I began another four months of chemotherapy, this time with a regimen of more aggressive drugs - adriamycin and cytoxan - than I had received before the surgery.
My hair started falling out two weeks later. My urine was tinged pink by the adriamycin. My nails became purple, as the drugs attack skin lining cells - cells of the skin, nail and gastrointestinal lining. I lost my appetite. Eating was no longer a pleasure.
Chemotherapy does terrible things to you because the drugs are literally poisonous to your body. They kill cancer cells, but also other healthy cells. They attack your immune system, making you prone to infections.
My veins were riddled with needle pricks from the chemotherapy, which is injected via an intravenous line.
I got used to feeling mildly nauseous often. I learnt that nausea is very much a mind-body thing. I wore a pink sweater and a baby blue fleece sweater once too often to chemotherapy, and had to throw them away when my brain began to associate the garments with the chemotherapy, and the mere sight of them started to make me feel sick.
The drugs caused nausea, so I needed anti-nausea drugs. These caused constipation, so I needed laxatives. A weakened immune system made me susceptible to every virus. I had a drawer full of medications. Some mornings, I was full just from popping the pills.
Chemotherapy wears down your body, but it is not so debilitating that it keeps you bed-bound, so I was able to enjoy a fairly active life.
I went for classes throughout the treatment and hung out with friends. I swam at least twice a week. Yoga made me feel more energetic and centred. Meditation rested my frenzied mind. I joined art therapy groups. Watercolour painting became a new hobby. I gave my fledgling efforts to tolerant friends.
`This is really valuable. I'll keep it till you become a famous watercolorist,' teased some.
Most of the time, I felt well enough, but as though I was living at 50-70 per cent of my usual energy level.
Being sick forced me to slow down my pace of life. It made me re-examine my priorities.
The day I was diagnosed, I was reminded of a truth I had known at 18 but forgotten by 28: that life is essentially a journey of the spirit, and that it is one's relationship with God (in whatever form) and with those around us, that matters most. Everything else is a means to that end.
I learnt to count my blessings and to appreciate little things in life, like a phone call, a visit, a pain-free day, a good meal. Many days, paradoxically, I felt blessed. I had a network of truly loving friends, even though I was far from home.
My friend Adeline took no-pay leave to stay in Boston as my caregiver, cooking, cleaning and caring for me.
Karen, my American buddy, watched videos with me and taught me how to make angels in the snow.
Deb from Britain opened her heart and home. Hong from China brewed me Chinese herbs. Singaporean friends Christina, Mag and Sue-Ann tempted my uncertain appetite with chicken rice, yong tau foo and steamed fish.
Sara, whom I met in the chemotherapy ward, shared her summer home. Gerardo my Mexican friend accompanied me to some chemotherapy sessions and always made me laugh - even the day after my father died. Friends all over the world sent e-mails, cards, books and gifts. They all bucked me up and brought a smile to my heart.
Breast cancer is tough on women because it is a direct assault on our femininity. The breast, source of sustenance and pleasure, has become an enemy, nursing within its deceptively smooth contours a weapon of mass destruction that will kill you.
I felt betrayed by my breast initially, but later learnt to accept its frailty. When I thought I would lose it, I mourned for months, avoiding swimsuit catalogs and window-shopping. After my lumpectomy, I bought myself new bras and low-cut blouses, to 'celebrate my breasts', I told friends.
Losing my hair was also a blow, but I was well-prepared.
When my hair started thinning, I went into the cancer centre one day and had my head shaved by the volunteer hairdresser.
I donned my new wig, which swept down my back in layers, and went home thrilled with my brand new look.
I bought three wigs in all and had parties when friends tried on my wigs and we clowned for the camera. All that eased the trauma of being bald.
Today, four months after the chemotherapy ended, I have an inch-long fuzz all over my head. My hair has been compared to that of a Buddhist nun, army recruit, Bo Derek and Halle Berry.
But on days when I want to feel like a movie star, I don one of my three chic wigs. After all, I had more compliments wearing my wigs than I ever had with my real hair!
The chemotherapy was over in October. I had a month's break and then began radiation in November, going down to the hospital daily for almost eight weeks.
Many hospitals place their radiation suites in the basement, and I found out why: so the walls can be reinforced by steel to contain the radiation rays.
I always thought pityingly of my poor breast exposed to rays it required steel vaults to protect others from.
But after the painful side effects of chemotherapy, radiation was almost pleasant. On my last day, the staff gave me a certificate for completing radiation treatment. That certificate meant more to me than the one I got from Harvard.
IT HAS been almost a year since breast cancer became part of my life.
My oncologist says my prognosis is excellent and that I should expect to live to a ripe old age.
But cancer at most goes into remission; it can never be said to be cured.
While going through treatment, I was always cheered by others' stories and found comfort in talking about my experiences in support groups.
America has a strong group culture, and every doctors' waiting room became an ad hoc support group, as patients shared experiences.
In Singapore, we talk much less about illness. Friends tip-toe around the subject with me, much to my vexation sometimes. Many cancer patients share their struggles only with family members. If they get better, no one ever knows of their struggle.
Others find out only if cancer kills them.
This is why many of us know more people who have died from cancer than survived it: simply because those who have survived, don't speak about it, out of a sense of fear or superstition.
The result is more fear than is necessary, and more ignorance than is warranted.
I believe sharing information empowers patients and their caregivers.
Sharing stories gives others hope. Talking about cancer demystifies it and makes it less scary, which is why I decided to share my experience. There are more Singaporean survivor stories at www.cancerstory.com
Cancer is not all pain and despair. It opens many doors. It sheds new light on life. Underneath the emotional ups and downs were some core spiritual truths I came to claim for my own.
Whatever is allotted to you to suffer, there will be sufficient grace for you to bear.
This truth is taught in every religion; it is summed up in the Bible as this promise from God: `My grace is sufficient for thee'. Friends lightened my cancer journey and filled it with love. I will always remember my 'Jesus year' as one of grace, and as the year I travelled through pain and fear back to my spiritual centre, to the things that matter.
And what matters most? As my support group buddy Vera said: `Life is precious and love most important of all.'