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 of 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.

On Being a Patient

I opened my eyes as I slowly regained consciousness. I looked around and I was alone in some kind of cubicle where the curtains were drawn close. I was lying in a stretcher with nothing on but a flimsy hospital gown. I felt cold and naked. Wrapped around my left arm was a blood pressure cuff, and attached to my chest were leads of a heart monitor. In the back of my right hand was a small catheter inserted through my skin, while intravenous fluids infusing slowly through my veins.

My mind was still foggy like I was dreaming. I felt like floating and detached, and yet I was so calm. Is this out-of-body experience? It must be the sedatives I received.

Moments later the nurse entered through the curtains and smilingly told me that everything went smoothly. Not too long after, the doctor came in and said everything turned out to be alright.

Before you think that there was something bad or serious that happened to me, it was not that. I just had my screening colonoscopy done. Nothing more.

Colonoscopy is a recommended procedure for all people above 50 years of age, to screen for colon and rectal cancer. It is through this test that small polyps in the colon, which can be pre-cancerous or early cancerous lesions, can be detected and removed. And though I am still a few years from fifty, yet with my strong family history, as my mother was diagnosed with colorectal cancer, my good friend who is a gastroenterologist, recommended that I have the procedure done early according to the American Cancer Society’s Guideline. That was more than two years ago that I was told that, but I dragged my feet to have it done. Doctors can be the worst patient you know.

When I had my annual physical exam few months ago, my personal physician also recommended that I undergo colonoscopy. Now I cannot escape the doctor’s orders. So I finally gave in. Doctors like to give orders, but not necessarily like to follow their own advice or follow the orders they were given.

So there I was lying in the recovery room, still dazed from the sedatives I received during the procedure. As the doctor approached the stretcher where I was, it dawned on me that there was a big reversal of role. I was not the doctor in control. This time I was the patient.

The doctor came in, who was nicely dressed with his white coat on, while I was butt-naked with nothing on but a hospital gown. He towered over my bed confidently like the man in-charge, while I laid there feeling groggy and helpless. Not knowing what just happened as I was just coming out of sedation, I felt so vulnerable and invaded. If having a scope shoved down in you-know-where would not give you a feeling of invasion, I don’t know what will. And lastly, when my doctor came in to give me the news whether it be good or bad, he knew something that I don’t, and yet it concerns me, my health, my life.

So this is how a patient feels. Exposed and powerless. No option but to submit, for resistance is futile. Entrusting your life to the hands of somebody. Somebody you barely know, except for his name. Somebody that you can just hope, will take good care of you.

I am glad that I experienced being a patient, for it gave me a different kind of perspective. A point of view that I have never seen before. Though I don’t look forward of having my colonoscopy done again in about 5-10 years as what was recommended. But I admit the floating, detached, and calm feeling from the medication was some kind of “high.”

The next time I stand over patients’ bed while they lay there defenseless, with my white coat on while they are almost naked, and with facts that I know while they don’t know and yet it concerns their life – I will certainly hold it with such high esteem and with utmost reverence, that trust that was given to me.

Being patient is a virtue. In my case, being “a patient” made me virtuous.

Doctor’s Prayer

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?