Survivorship – Rediscovering Life

It’s been a little more than two years since I kept reading the biopsy report over and over in my hands, the words “Invasive breast carcinoma” not sinking in. My sister and my cousin were on either side of me as I sat on the sofa in our clinic room but at that moment, I felt like I was alone underwater, drowning and gasping for air. That state of panic, disbelief, and despair overwhelmed me. Somehow, deep down I knew for months that lump might be cancer, but I was too busy with work and life to give myself time to process what that actually meant. The fact that it could upend my life as I knew it terrified me. Denial was my friend that answered the call whenever cancer fleetingly crossed my mind. Until I couldn’t ignore it any longer. As a doctor, I was used to reading those words in a patient’s chart, and it felt very surreal that from that point forward, the patient was, and is, me. Up to now, the rollercoaster that ensued from the moment of diagnosis through active treatment and especially afterwards occasionally feels like a gut punch coming out of nowhere: did all of that really happen?

It might seem easier to be a doctor-patient, to already understand the medical jargon and expectations of treatment and of recovery. However, it was harder for my already anxious mind to know exactly what could go wrong, the risks, side effects, and everything else that doctors try to gently break and discuss with their patients. I would have loved to be blissfully unaware for a while longer. I couldn’t stop reading journals, patient stories, books and memoirs to prepare me for whatever may happen. All my life I always strived to be several steps ahead, but this I never saw coming. I quickly realized that my initial knowledge of cancer and all it encompasses barely scratched the surface. One of my goals as a doctor is to connect with my patients and try to really listen to what they’re saying and help them any way that I could. But it was only when I was on the other side of that conversation and staring at my mortality dead in the eye, did I truly understand. When a cancer patient says, “It hurts all over,” you bet every single part of their body feels like hell. When they wistfully look at the few stragglers of hair left on their head and sigh, the words, “It’s just hair,” feel like the hot edge of a knife twisting in. When someone you haven’t seen in a while (or has no clue what happened) asks, “Hey, how are you?”, you pause to consider if you should just answer “I’m good,” to get on with your day and spare them, or blow their mind with the truth they weren’t expecting and inadvertently dampen their cheerful mood. Cancer, at whatever type and whatever stage, definitely sucks, but having cancer at a young age does not make it any easier and comes with its own unique set of challenges.

People that have not experienced cancer themselves (might) think that once active treatment ends, one can already go back to their old routines and basically pick up where they left off, especially at a young age. Pre-cancer and even during treatment, I admit I also harbored that thinking. I put myself under a lot of pressure to endure the challenges, to grin and bear it, to suck it up because I thought the light at the end of the tunnel was nearing with every chemotherapy cycle, every scan, every procedure. Again, I couldn’t have been more wrong. For months as I went through egg freezing, mastectomy, chemotherapy and reconstruction surgery, I was living minute by minute, blood test to blood test, side effect to side effect, one hard decision after another, doctor appointment to appointment, scan to scan. I was in survival mode and was hanging on for dear life on a dingy boat in the rough ocean. When survivorship ensued, all the feelings and ruminations I’ve managed to simmer just beneath the surface finally burst and swallowed me whole. I felt the immense trauma hit me like a runaway train. As overwhelmed with gratitude and surrounded by love as I was, I couldn’t look at myself in the mirror, couldn’t take a selfie, couldn’t look at pre-cancer pictures without fighting back tears and thinking how happy and naïve I looked before my world flipped upside down. I felt (and still feel) immeasurably blessed to be surrounded by a fantastic team of empathetic and skilled doctors and nurses, and a support system of the most wonderful humans, dogs and cats, but fear of the unknown gripped me as I struggled feeling isolated. That driven woman who was so excited to reach career and life milestones like her peers at the age of 35 was suddenly bald, with a multitude of scars (big and small, visible and invisible), with flashes of pain all over, limping, and with word-finding difficulty and a memory of a goldfish, among other things. In a span of 10 months, every single part of my life has been radically changed, and two years on, I am still in the process of re-discovery and establishing new rhythms and boundaries.

I felt completely blindsided that I couldn’t plan a clear-cut recovery timeline once I was declared NED (no evidence of disease). It didn’t help that as a doctor, I felt pressured that I should know how to recover better, and that I can come back to work as soon as possible, all the while doubting if I could still do so. I was desperate to feel a touch of normalcy in a world that no longer made sense. Once again, my body had let me know that I needed to listen, that I could not hit the ground running when I could barely walk, literally. I couldn’t walk straight for five minutes or go up a couple of steps without my legs giving way due to myopathy from the chemotherapy and the arthralgia from the aromatase inhibitors. I couldn’t raise/move my arms and shoulders without sharp pain and limitation from frozen shoulders, with cording post-mastectomy and lymphedema on my right arm. It was devastating to face a barrage of painful and debilitating side effects (including chemo brain), but I refused to be limited to using assistive devices and pain medications. I also gained ~10kg from my medications, which made it harder to move, and frankly, harder to grasp any grain of confidence I had left. I kept looking for ways to maximize and prioritize my healing, to have several hours a week devoted to challenging my beaten body and boosting my confidence, only canceled when absolutely necessary (unlike before that such self-care things would be the first to go). While very helpful, I wanted to explore more avenues of rehabilitation outside the hospital setting, where I can feel like I’m not a patient. I tried several cancer rehabilitation and Pilates rehabilitation centers until I found ones that worked for me. I never devoted time to exercise pre-cancer but now it’s my lifeline. Initially, it was hard to say no to some people’s expectations (and my own) on how I should already be knee-deep into work/commitments after chemotherapy and surgery, but I certainly do not regret saying “Yes” to myself over and over again, this time around — a phrase I can never take lightly again.

Nowadays, I have slowly re-established my clinical practice and I find myself connecting with my patients in a much deeper and more meaningful way than ever. At the beginning I admit it was triggering when I would meet cancer patients, especially breast cancer patients with advanced staging. But I remember my therapist advising me that the best way to deal with all the emotions and triggers is to acknowledge them and just go through them. Eventually, I found that by helping them heal however way I could, I am also helping myself heal. The fear of recurrence will always be there, and scanxiety is definitely menacing, but I have the choice to control it and not let it overwhelm me. When I woke up from my reconstruction surgery as the last step in my active treatment, I vowed to myself that I will switch the narrative and channel the harrowing memories into happy ones moving forward. I didn’t survive crawling out of the gutter to just be. I survived to thrive, to live, or at least try the best I could.