Doctor’s Report

We were sitting in a waiting area of a posh Cancer Center building. This time I was on the receiving end of this business. I was not a provider (doctor) but rather a consumer (patient). I was accompanying my wife for her follow-up appointment with the Hematologist-Oncologist doctor.

It was a day of reckoning. We were going to get the dreaded results of her bone marrow biopsy.

Have you ever waited on a report before? A semester’s grade perhaps? Or a qualifying examination? Or a job application? Or a tax return? Nothing can compare to the anxiety level of waiting for a biopsy report.

As I looked at the people in the waiting room, I can easily identify the patients. To lighten up her mood, I told my wife that I look more as the patient than her, for I am the one with the thinning hair. Though I am not poking fun of the chemotherapy patients at all, for I only have admiration for their courage and resolve as they undergo this difficult treatment.

When we were called inside, we met with the cancer specialist. He reviewed the results of the bone marrow biopsy with us, including some fancy genetic tests that he obtained.

The doctor went into detailed medical description, for he knew I am a doctor too and speaks his language. He then concluded that the test did not show any evidence of Myelodysplastic or Myeloproliferative disorder. In simple terms, no evidence of badness to worry about. It was a good report overall.

It was such a relief!

For the past several days, we experienced silent and unspoken fear about our future. For my wife, for me, and for our family. But now, we will grow old together after all.

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my wife and I (photo taken last summer in Vail Colorado)

If there’s something good that came out of this, is that it made our bond stronger and our faith more steadfast.

As we were leaving the doctor’s office, I glanced once again at the people in that waiting room. One elderly woman who was in a wheelchair, was wearing a colorful bandana but looking glum. Another not so old lady who was wearing a fancy hat accompanied by few friends or family. One middle-aged man who looked frail and sitting alone. And some other ones I failed to describe.

What would the doctor’s report on them be? Would it be very good like ours was? Or not so good perhaps? Or would it be downright heartbreaking? I can only hope and pray for each of them.

Life. So unpredictable. Live it to the fullest. And celebrate it while you can.

Today we will.

 

Peace Be Still

A few days ago, while I was in my clinic seeing patients, I received a phone call. It was another doctor who wanted to discuss with me the results of a patient’s laboratory exam.

It is not unusual to have another doctor call me to discuss about a mutual patient. Except this one was not about a mutual patient. On the other line was the Hematologist-Oncologist (Hem-Onc) doctor. The patient he was calling me about, is my wife.

It started with a regular annual doctor’s visit. After having routine test, my wife’s Primary Care physician was alarmed by the results of the complete blood count (CBC). This prompted a referral to the blood and cancer (Heme-Onc) specialist.

After the evaluation by the Hem-Onc doctor and having the exam repeated, that’s when the specialist called me. He said that he was concerned about the elevated count of a blood component, and for some “funky-looking” cells. He recommended a confirmatory test, a bone marrow biopsy.

Bone marrow biopsy is not a very dreadful procedure but its not a walk in the park either. It can be done as an outpatient, usually under “conscious sedation” (meaning, light sleep). It entails drilling a long large bore needle into the hip bone down to the marrow, and aspirating and scraping a “sample” contents inside the bone.

The problem of being a doctor, is that you know “too much.” Too much than needed. So in my mind, I already ran down on the possible differential diagnosis. I started to play the different scenarios, their treatments and outcomes. And even though I know that it can be nothing or something benign, I couldn’t shake off the idea that it can be a myeloproliferative disorder. In layman’s term, leukemia.

My spouse’s family history was not reassuring either. Her father died of cancer in his 60’s. She has two brothers that died prematurely, one was barely 50, and the other one in his 40’s. Then her sister who was a little older than her, was diagnosed with cancer in her 40’s.

I tried to be nonchalant and positive about it when I spoke with my wife, but I think she can sense that it can be something serious. For the succeeding days prior to the scheduled biopsy, both of us were feeling the uneasiness, as if there’s angry storm clouds hanging over our heads ready to discharge their fury.

The fear of the unknown is one of man’s greatest fears. It terrifies us. It consumes us. It kills us even before we die.

Two nights before the biopsy, we both cannot sleep. My wife asked me point blankly, “Am I going to die?”

I don’t know how to answer that question. Or perhaps I don’t want to answer that question.

She told me that she’s really afraid. So in the middle of the night she asked that we kneel down in prayer.

As we prayed, I asked God to be with us as we go through this storm.

Suddenly I was drawn to the story of Jesus and his disciples when they were caught in a great storm* while crossing the Sea of Galilee. I saw myself struggling with the oars and the sail with the disciples. We were trying our best to keep the boat afloat……

The winds are howling. The billows are rolling. The thunders are cracking. The storm is raging. And I am terrified and trembling.

But where is Jesus?

He is asleep! How can he sleep, when we are about to be swallowed by the storm and the sea?

“Master, do You not care that we are perishing?” I cried.

When Jesus arose, he looked at me lovingly, yet he asked me why do I have so little faith.

Then he spoke: “Peace, be still.”

I looked around me. The winds are howling. The billows are rolling. The thunders are cracking. And the storm is even more raging.

But I am still.

image from here

(image from here)

(*Mark 4: 37- 40)

Looking Beyond X-rays

I looked at her chest x-ray, and knew right there and then that she didn’t have a chance. I have seen bad chest x-rays before, but this time, it was different.

I look at chest x-rays and chest CT scans every day. I review 30 or more each day. It is part of what I do for a living. And it is something that I become good at.

Ever since German physicist Wilhelm Roentgen discovered what he dubbed as “x-radiation” in 1895 we have used this technology in analyzing bones, teeth, and other organs in the human body. It also used to detect cracks in metal in the industry. Now we even use them ubiquitously in all airports for luggage inspections. That’s why bag inspectors know you packed in dried fish without opening your luggage.

But do you know that x-rays can also look into the future? It has nothing to do with radiation-emiting crystal balls.

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It was late August of last year when I went back to the Philippines, not for a vacation but for a medical emergency. The attending physician in the hospital, who knew that I am a doctor myself, led me to the radiology department to show me a chest x-ray of the patient.

It was also here in this same hospital, University of the East Ramon Magsaysay (UERM) Hospital, that 27 years ago, where I picked up a CT scan of the brain of another patient. But at that time I just started medical school. In fact I was only in my first month of my first year of medical school then. Yet even in my untrained eye, I knew that the word “tumor” is not good. Especially if it said it is in the brain.

Now I was back in that hospital, looking at a chest x-ray, one morning that August. I have gained more than 20 years of experience now as a physician. And interpreting chest x-rays has become my expertise.

The chest x-ray the doctor showed me revealed a large tumor, the size of a santol (wild mangosteen) fruit. Not just one, but three! A sign that cancer had spread. A sign of impending doom.

Somehow it felt like I was reading the patient’s obituary, way before her death.

The chest x-ray was my mother’s.

And the CT scan of the head that I picked up 27 years ago? That was my father’s. He died 3 months after I peeked on that head scan.

What is this that I was privileged to see the future through an x-ray, as it gave me an insight of what is to come? Is it a blessing, that I could have prepared for it? Or is it a curse, as I started mourning before everybody else did?

When I broke the news to my mother regarding the results of her chest x-ray, she was not surprised. It was as if she knew it already. She was serene and collected.

My mother was diagnosed with colorectal cancer 5 years ago, and underwent surgery for it. We thought we got rid it. We thought we kick cancer in the butt (no pun intended)!

But we were wrong. It came back. And with a vengeance.

My mother decided to not pursue any further treatment, like chemotherapy or radiation. For there’s no guarantee anyway that it will matter. Somehow she accepted her fate and was at peace with it.

When we took her home from the hospital she even willed herself even though she was weak to accompany me to the airport in Manila when I flew back here to the US. When I embraced her goodbye, I knew it will be our last embrace. Yet she told me, “Anak hindi ako malungkot. Masaya ako dahil nagkita pa uli tayo” (Son, I’m not sad. I’m happy that we saw each other again). She even added that I need not return for her funeral, it was enough that I saw her alive.

A little more than two months after I saw that foretelling chest x-ray, my mother died.

But there are things that the x-ray did not show. It did not show the inner strength and grace that my mother displayed on her last days. It did not show the peace and faith she had even when facing death. It did not show the confidence and hope that she had, that we will see each other again someday, in a glorious place where there’s no more grief and x-rays.

Invictus

You are a formidable foe. That we will admit. For five years we bask in the glory that we have defeated you. That we have eradicated you!

Or so we thought.

But you came back. Even with a vengeance. Now your are in a stance to take what was denied of you for the past five years. You are so ready to take your kill. You are again victorious.

But you are wrong!

You did not defeat us. We did not cower in your presence. We have fought a good fight. We looked at you in the eye and in spite of you always lurking in the shadows, we lived our lives to the fullest.

Our faith grew deeper. Our hope soared higher. Our ties grew stronger. We laughed. We loved. We lived!

And that you cannot take away from us.

So tell your friend, Death, that we are not afraid of him too. “O death where is thy sting, o grave, where is thy victory?”

The body may be broken, but not our spirits. As for you, Cancer, you never conquered us! slide.001 * Invictus is Latin for unconquered. It is also a poem by 19th century English poet William Ernest Henley. He wrote the poem while he laid in a hospital bed battling a life-threatening illness.

** Dedicated to my mother, on her last dance.

A Perfect Day

I was on-call last weekend. It was not particularly busy that I was drowning in work, but enough to keep me occupied in the hospital most of the days during the weekend. I had more toxic calls before, so I really cannot complain.

I was making my rounds in the hospital and making headway on my long list of patients to see. I have seen all the ICU patients and working on the rest of the patients in the hospital. On my way to the other side of the hospital, I passed the crossway that overlooks the center garden of the hospital.

I stopped for a while and gazed longingly at the garden.

our hospital's central garden

our hospital’s central garden

It was already early in the afternoon. It was sunny, but the temperature outside was not hot, nor was it cold. It was just right. It was early September after all, when summer and autumn are in their crossroads.

It was a perfect day to be outside.

I could have been outside. I could have been sitting outside in that garden with the beautiful flowers in bloom. I could have been outside shooting hoops with my son. Or could have been outside having barbecue with my friends. Or could have been outside riding my bike on some engaging bike trail. Or could have been outside just lying on a hammock under a tree. I could have been outside……

Instead, I was inside the hospital walls. Working.

The next stop on my rounds was the Oncology floor. I entered the room of our patient who has history of rectal cancer and was treated several years ago. But now found to have his cancer come back with vengeance, spreading to his lungs. I was suddenly reminded of my mother who has the same circumstances.

My patient was having difficulty breathing. It was quite obvious that even with high flow oxygen he was struggling. Every movement was an effort. He has been hospitalized for some time now, with no clear indication of when he can go home. Or will he ever?

As I entered his room, he was looking at the window. He was looking at the same central garden that I was looking at, a little while ago. Perhaps he had the same thoughts that I had: I could have been outside enjoying this beautiful day.

But he can’t. And perhaps he never will.

That’s when a thought dawned on me. There’s a reason why I am not outside. I was placed here inside these hospital walls, for a sacred duty to care and give comfort for people who cannot enjoy a beautiful day outside, just like today.

It was a perfect day indeed.

********

(*photo taken with an iPhone)

 

Handiwork of Love

Do you like crochet? (Pronounced crow-shay.) No, it’s not a country in Southeastern Europe, that is Croatia. And no, it’s not something that you eat, that’s croissant. Crochet is a handicraft in which yarn is weaved into a patterned fabric using a hooked needle.

Now we’re clear.

Years ago when we were still in Florida, I received a dainty crochet blanket as a gift. It was made by one of my patients. She learned that my wife and I were expecting a baby boy, and thus she lovingly made a baby blanket for us.

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my son’s crochet blanket

Crocheting and knitting are endeavors that need basic skills, some appropriated time, and a great deal of patience. It also takes vision on how the finished piece would look like while you’re still working on it. Sometimes it is hard to foresee the beautiful final art when what you only have is a small knitted mess, an entangled needle, and lots of balls of yarn.

When my patient gave the baby blanket to us, she told me that it took her a longer time to finish it as she was not as fast as she used to. You may be amazed if I tell you that my patient was ninety-one years old at that time! And frail too. With her advanced age, failing eyesight and with her arthritic hands, it was really a labor of love.

The more amazing part was, according to the patient’s daughter, halfway through the project, she made an error on the pattern but realized it much later. So she uncrocheted (is that a word?) or undo the piece up to the area of the mistake, and weaved it back over again.

What have I done to deserve this gift? I am not sure.

My son is now eleven years old. The crochet blanket sits in our closet. But I cannot give it away, as I know how painstakingly it was created. It is like an heirloom now. Maybe someday my son will use it for his own baby.

More recently, I received another knitted piece. It was a lovely table cover. It was done by a lady that was recovering from cancer. I know that she just finished chemotherapy then, as her hair have not grown back fully, when she gave the gift to me.

However, the lady was not my patient. Her husband is. I diagnosed him with Idiopathic Pulmonary Fibrosis (IPF) – a deadly debilitating lung disease that has no known treatment at this age of modern medicine. Oxygen and comfort measures are the only things we can offer. Most patients die within 3-5 years after the diagnosis. And the sad part is as the lungs progressively fail, they suffocate to death.

Needless to say, my patient, like all other IPF patients, died within a couple of years. Yet his wife, who herself was sick, gave me this beautiful knitted item, which is definitely a handiwork of love. It now sits atop one of our coffee table.

Again, what have I done to deserve this? It should be me offering inspiration and comfort to them. Instead it was I who was inspired by them.

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my knitted table cover gift

Life can be difficult and downright harsh at times. Yet this knitted creations are testaments of human love. They are constant reminder to me, that people, no matter what the circumstances they are in, can be thankful and giving. And this makes this world wonderful, despite of all the ills we find in it.

We may not all learn how to knit or crochet. But maybe we can all learn to live kindly with one another and inspire one another in a loving knit of humanity. What a beautiful handiwork that would be.

Little Girl in ICU

She was sitting in one corner of the room. With big headphones on her ear, and with an iPad in her lap, she appeared to be preoccupied and was in her own little world.

She was a 6-year-old girl, with beautiful blonde locks, sitting in one of our ICU room. Her back was turned from the door entrance and was facing towards the window. But she was not our patient. Her father was.

A couple of feet away from the little girl was her father, lying in the hospital bed. He was half-awake and half-asleep. He was obviously in distress. Every breath was a struggle that slowly zap whatever energy and life remaining in him.

He was 33 years of age, and for the past 6 years had been battling testicular cancer. And I would say that he gave a good fight. A hardy and courageous fight.

Sadly to say, the cancer was winning this battle. It now had spread to his lungs making it more difficult for him to breathe. His CT scan of the chest which I just reviewed prior to entering his room showed hundreds of big and small masses scattered throughout his lungs. The cancer had spread into his brain too causing him severe headaches.

For the past several weeks he had been in and out of the hospital. He continues to receive chemotherapy, though despite of this the cancer continues to progress. During this present hospitalization, he had been admitted to the ICU twice due to problems stemming from the cancer itself or from the complications of its treatment.

As I entered his room with my ICU team, I spoke to him and his young wife who was in his bedside, about the grim situation. We spoke in low tones, almost in whisper, keeping in mind that their little girl was in the same room.

I relayed to them that in spite of everything we have done, we have nothing more to offer, but one. And that is comfort. Meaning, we cannot cure him or treat him, but we can at least make him comfortable. We can offer medications that can take the edge off from his suffering. Something to numb his pain. Or something to blunt his sensation of air-hunger. Something to lessen the agony as he faces the inevitable.

I recommended that we transition to hospice care.

The patient and his wife agreed, as perhaps they know as well that it was time. The wife silently cried, though not so much, trying to compose herself and trying to show strength so not to upset her daughter, who was oblivious of our discussions.

As a parent myself, I can only imagine the predicament my patient and his wife were in. Oh how we wish that we can protect our young kids from the harsh realities of life. Yet I learned that it was the patient’s wish to have her daughter in his room as much as possible.

As we end our talk, the patient’s wife asked me how we doctors can deal with this kind of situations without crying. I softly answered her, “No, we do.” Or at least I speak for myself. Maybe not in front of our patients, but doctors do cry too.

When I exit the room, I glanced at the little girl. I don’t have the heart to disturb her. She was still quietly sitting in her corner of the room. Her back was still turned away from the bed and from us. She still had her big headphones on. Still busy playing on her iPad. Sheltered from what was happening a few feet away, or so it seems. And at least for now.

Does she know that her daddy will not be able to give her piggy back ride anymore? Does she know that he will not be able to chase butterflies with her again? Does she know that he will not be there to teach her how to throw a baseball or how to shoot a basketball? Does she know that her father will not be able to comfort her anymore when when she falls from her bike and scrapes her knee? Does she know that he will not read her bedtime stories anymore? Does she knows that he will not be able to tuck her in bed anymore and kiss her goodnight? Does she know that her father will not be coming home?

She will.

And I hope she has enough memories of what a father’s love is.

*******

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Post note: Two days after I had the talk with the patient and his wife, he suffered a grand-mal seizure and became comatose. He died a few hours later.

(*photo taken somewhere in Grand Teton National Park)

More Than A Game

The 2014 Winter Olympics in Sochi is officially over. For the past two weeks it provided the world something to watch. It was an entertainment to some, a distraction to others, and an inspiration to many of us.

There were notable moments in that Olympics. One instance of spirit of sportsmanship for me was when Russian Anton Gafarov crashed hard during the cross-country skiing competition, but he still tried to finish the race with a broken ski. He was really struggling, until someone came to his rescue and replaced his broken ski. It was not his Russian team but the skiing coach of the Canadian team.

Or who can forget the crushing upset of the US by the Canadian in the finals of women’s ice hockey? The American team was leading all the way, but Canada made 2 goals in the last 3 minutes of the game to equalize, and eventually winning it in overtime.

Or maybe you were just watching what Tara Lipinski and Johnny Weir outfit would be. Besides their colorful reporting and commentaries on the sideline, they really were a fashion statement.

Being originally from the Philippines, one of the indelible moment for me, was just seeing a fellow Filipino compete in figure skating. Michael Christian Martinez, was the first Filipino figure skater, and even the first one from a southeast Asian country to compete in this specific Olympic event.  Coming from a country that never sees snow, just like the Jamaican bobsled team, he inspired us.

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Filipino figure skater

Last Friday, as I was making my way to the Endoscopy suite of the hospital to do my bronchoscopy procedures, I passed through the Radiation Oncology department. In its waiting room was a television that was showing the live action of the semifinals of US vs Canada men’s ice hockey game.

Of course we all know now, that Canada won that match. For the Americans, better luck next time. It was said that President Obama lost a wager of cases of beer to the Canadian Prime Minister. There was even a funny news item that the unofficial bet on this game, was that the loser got to keep Justin Bieber. Darn!

Anyway, as I passed through that waiting room, I stopped for a moment to watch the game. It was already 4th quarter with only a few minutes left, and Canada was leading 1-0. I watched with hopeful anticipation that something exciting would happen. But no more goals were scored, and Canada won.

As I was intently watching the game, even for a brief period of time, I happened to look around and observe the people sitting in that patient waiting room. One, was a frail woman on a wheelchair. Another one, a cachectic-looking man hooked to a small tank of oxygen on his lap. And then another one, a middle-aged woman with a brightly colored bandana covering her bald head.

None of these people were paying attention to the televised hockey game. They were oblivious to the exciting action on ice unfolding in front of them. They don’t seem to care about the battle going on.

Why? Because they have their own battle that they were fighting. A fight that was more than a game. The stakes were more than medals made of cold metals. Where losers don’t get another chance.

I hope they win.

(*photo from yahoo news)

Time Under Heaven

One Friday afternoon one of my partners signed out to me the patients in the ICU. I was taking over and would be going on-call that weekend. One of the patients endorsed to me was the patient in ICU Room 26*. Her story was quite sad, to put it mildly.

She was in her early 40’s and was diagnosed with a very aggressive type of breast cancer, several months back. She had underwent radical surgery, followed by radiation therapy and intensive chemotherapy. However, despite of all the exhaustive interventions, the cancer still proved to be more aggressive than the treatment. It continued to advance.

The cancer had spread to the lungs and pleura (sac around the lungs), causing fluid to accumulate  in the pleural space. It also spread into the pericardium (sac around the heart), also causing fluid to build up inside the pericardium. It had involved the liver and studded the peritoneum (lining of the abdominal cavity) as well, causing water to seep out into the abdominal cavity. In fact, the cancer is everywhere, that it was hard to imagine that she was still alive. Well, barely.

For the past couple of months, the patient had been in and out of the hospital, that she literally lives in the hospital than home. Due to multiple complications of the widely metastatic cancer, she had undergone several surgeries and procedures. She had surgery to put a pericardial window (made a hole on the heart sac), so fluid could drain out and would not drown the heart. We also placed  tubes on both sides of her chest to drain the fluids around her lungs to prevent her from suffocating. She underwent multiple drainage of the abdominal fluid as well, to decompress her distended, pregnant-like belly.

Several times she thought of throwing in the towel, and considered hospice care. Hospice is the type of care that focuses on comfort and palliation of terminally ill patients. In other words, it is a philosophy allowing a dying and suffering patient to pass on peacefully by letting nature takes it course. Hospice is no way the same as euthanasia, which is illegal in the US. Euthanasia is a subject on its own that I will not divulge in here, but suffice to say that I believe, is morally wrong.

But once she felt a little better she would change her mind and would like to go full court press, and be as aggressive as ever with the treatment again. She was tried on investigational treatment and was even referred to a top cancer center in the US, but had received the same disappointing verdict of “nothing else we can do.”

Now, she was transferred in our ICU for severe shortness of breath. She struggles, but still fights with every breath, clinging for dear life. Still hoping against hope, that somehow she would survive one more day or one more night.

My partner then told me, that if I have time, maybe I could sit down and talk with her, and discuss alternative options of management, like palliative care or even hospice, and the further direction of her care.

We have heard the cliché that it is not quantity but quality that is important. Perhaps you also heard of the adage that it is not how long we live, but how we live is what matters. I am a firm believer that living is different from mere existing. Alive does not always equates with “a life.”

With the modern medical technology nowadays, we can support a person to continue breathing and his/her heart pumping, even though “life” has long been sucked out of the body. Sometimes medicine, as a discipline, do interventions just because we can do it, but may not be necessary for the best interest of an individual. I believe that there comes a time that death should be received as a repose to the suffering and not always be feared as an unwelcome guest. For death is as natural as birth to all humans. There is a time to be born, and a there is a time to die.

The next day, as I made my rounds in the ICU, I was ready with my “heart to heart” talk with our patient. As I entered room 26, I was caught unprepared with the sight I saw. The patient was silently lying in her bed with her eyes closed. Her breathing was labored as she heaved with every breath. A boy, probably 7 or 8 years of age, whom I assume was her son, was sitting very close to the bed. The boy’s head was buried in bed, muting his sobs, as he leaned against her mother’s side, while her feeble hand gently strokes his head.  It was so heart-breaking to witness: a mother who was on borrowed time, and who was in much discomfort, yet still trying to comfort her son.

All the reasonings I have in mind, and the discussions I have prepared, went out the window. Who am I to say to that boy, that his mother’s caressing hand was not worth living anymore here under heaven, even if it just for another day or even for another hour. For that boy, it was still worth it.

I walked out of ICU 26, without uttering a word.

(* room number was intentionally changed for privacy)

Battle Scar

Cancer. That’s one word that the mere mention of it can bring shivers through the spine for most people. (And I will mention that word here several times.) Especially if you or a loved one is on the receiving end of that word.

As a medical doctor, I have tackled with that word as part of my work. I have diagnosed, treated, cared, and sadly to say, lost patients with cancer. With my subspecialty, dealing with deaths from cancer goes with the territory. Lung cancer is the leading cause of all cancer deaths in both men and women. Though the most common malignancy for men is prostate, and breast for women.

Even with my daily exposure to cancer, including my training at Memorial Sloan-Kettering Cancer Center, nothing prepared me, when it was my mother who was diagnosed with it. It was always just part of my job before, but now we were on the receiving end.

I was home in the Philippines for the holidays, after celebrating 15 Christmases in a foreign land, away from home. It was then that my mother informed me that she was noticing blood in her stools for several weeks. It could be just hemorrhoids, I told her, but we needed to be sure. So I scheduled her to see a specialist. After a diagnostic procedure, my mother was diagnosed with rectal cancer. It was 2 days before Christmas.

Colorectal (colon + rectal) cancer is the third most common cancer, as well as the third leading cause of cancer related deaths in both men and women. What does Former President Corazon Aquino, Peanuts cartoonist Charles Schulz, and actress Audrey Hepburn have in common? They all died from colorectal cancer.

Former President Cory Aquino

With the advent of recommended screening for colorectal cancer, the mortality from this cancer has declined. The screening includes, yearly fecal occult blood test (checking for traces of blood in stools), sigmoidoscopy or colonoscopy every 10 years after age of 50 (or more often if high risk), and the dreaded (at least from my stand point) digital rectal exam. These screenings help diagnose colorectal tumors in their early stage.

For people who have close relatives diagnosed with colorectal cancer, they may need screening colonoscopy much earlier than age 50. I know my close friend who is a gastroentorologist, had already told me to have one, but I have not heeded his advice yet. But I would (doctors are the worst patients, you know).

Advanced age, strong family history, diet high in fat and low in fiber, smoking, heavy alcohol intake, and obesity are all related to increased risk for developing colorectal cancer. My mother has the first two risks, that is age and genetic predisposition. There is nothing you can do about that, as you cannot stop aging nor choose your family’s genes (maybe in the future we can).

After further work-up and more consultations with other specialists, my mother underwent surgery to remove her cancer. And that was twenty months ago.

Currently she is alive and healthy, and still enjoying life. In fact, she is currently visiting us here in the US for a couple of months. Though she has a constant reminder of her battle from cancer – a permanent colostomy. Yes, caring for a colostomy could be a nuisance, but for a survivor like my mother, she regards it as a battle scar. A scar that she dutifully embraced and is wearing it with pride. For she fought…..and won.

O cancer, where is thy sting?