The Journey
The Beginning
Jeremiah 29:11-13 - “For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future.”
“Doctor… I’ve been told I have nose cancer - could it be a mistake? Is the treatment very tough on the body? I can’t lose my job… my kids are still in primary school.” – Mr. M.
The initial consult in a radiation oncology clinic often overwhelms, for me as well as the patient. It usually involves an explanation of the cancer diagnosis, and of the ensuing radiotherapy treatment. There is typically no surgical option for Mr. M’s particular type of cancer, which is nasopharyngeal, so patients like him must undergo six and a half weeks of radiotherapy, using high energy X-rays to target the cancer cells. Those with more advanced cancer will also need chemotherapy. After this consultation, the long process of radiotherapy planning will begin. This includes staging scans to evaluate the spread of disease, referral to dentists and speech therapists, and the delineation of the tumour volume. It is often an anxiety-inducing process, and patients have plenty of questions and uncertainties along the way. They might be worried about their chances of being cured or whether, at any point in time, their treatment is working. It is my job as a cancer doctor to be calm, reassuring, and to answer questions to the best of my professional knowledge.
I’ll be the first to admit that I’m not the most confident person – in my younger years, I would worry a lot about things like specific questions that might arise in interviews or exams. To compensate, I would rely on my own strength and work even harder, which led to more disappointment when the results were not what I had hoped for. But by the grace of God, my perspective changed in university when I came to know and trust in Christ, and learnt that God, rather than myself, was in control. I was inspired to study medicine by my parents, compassionate professionals who found true meaning in their work. I was also attracted to medicine because of my personal desire to ease others’ suffering. As I progressed to my clinical years in medical school, I saw the full effects of a disease on a patient’s body and life, and realized that all good things, including health, are gifts from God. To be “rooted and built up in him, strengthened in the faith” (Colossians 2:7) – my trust in God has indeed been a big bulwark against anxiety and uncertainty over the years. It has certainly helped me be a better doctor and a calming presence to my patients.
The Middle
Jeremiah 17:14 - “Heal me, Lord, and I will be healed; save me and I will be saved, for you are the one I praise.”
“Doctor, my husband has very bad pain on swallowing and the skin on his neck is breaking. He doesn’t want to put in a feeding tube... can he get through two more weeks of this?” – Mrs. M.
Like most other medical treatments, radiotherapy has its short and long-term side effects. These range from the minor, like skin discoloration or taste changes, to those that can adversely affect the quality of life, such as difficulty swallowing or poor bladder control. But ultimately, once their course of therapy is over, our patients are grateful that we have kept their cancer at bay.
When I first did a rotation working with cancer patients during my housemanship, I was simply amazed by the attitude of many of these cancer survivors. I realized that in their daily lives they can tolerate many inconveniences that normal people would otherwise avoid at all costs. Some have stoma bags, oxygen support, and even feeding tubes that require care and management. Yet, they remain optimistic. Indeed, several patient support groups are made entirely of cancer survivors helping each other, paying it forward. Each day, in the patients I meet, I come to learn what truly makes life joyful in this grueling journey: a supportive family, a kind word from a staff member, the hope that their cancer will be conquered, and they will be granted a new lease of life.
Indeed, no journey in life is without its hardships, large or small. Whether it is breaking up squabbles between my two young daughters after a long day at work or ministering to my elderly grandmother whose health is becoming frail, I have learnt – in large part from my job – to look at the big picture of God’s faithfulness. As stated in 2 Corinthians 12:9 – “My grace is sufficient for you, for my power is made perfect in weakness.” Through our trials, His will is done.
The End
“Through many dangers, toils and snares, I have already come; Tis grace hath brought me safe thus far, and grace will lead me home” - Amazing Grace
“Dr Chua, I’m calling from radiology, regarding Mr. M, the patient you sent for an MRI spine. There are several vertebral metastases, and spinal cord compression in the mid-thoracic region…”
My heart sank. A few years after going through chemo-radiotherapy, Mr. M had complained of increasing back pain and was having difficulty walking. The MRI showed that the cancer had returned and spread to the bone (and as it turned out, the liver as well). I had the difficult task of breaking the bad news to him and his wife, asking him to be admitted urgently for steroids and radiotherapy to the spine. This is the hardest part of my job – where the discussion is about palliation, about control of symptoms rather than cure. In the tug of war between physicians and disease, the cancer is winning, and the most common question on a patient’s lips is: “How much time?”
When I learned I was pregnant with my second child, I was working in a hospice, caring for patients with less than three months to live. It made me incredibly conscious of the two extremes of life – the very first heartbeat, the very last breath – and how short and precious our time in this world really is. Yet, even when there is no chance of being cured, many patients and their families are surprisingly at peace. Each day, each event, is appreciated. In August 2016, one patient wanted specifically to ‘see Joseph Schooling win the Olympics’ before he passed away. Others wished for their loved ones to fly home from various countries so the whole family could be together. Or for those with no kin, they requested for someone to hold their hand as they ‘walk(ed) through the valley of the shadow of death’.
After it all ends, relatives and friends often make comments such as: “He was a good person, a loyal partner, a true friend. He had a good life, and a good death.” As an oncologist, it is part of my job to help patients who are approaching the end of life; to ease their suffering so they can pass with dignity. At the same time, I feel called to help those around me appreciate their blessings and live life to the fullest, to use the talents God has given us until the day he calls us home. My hope and prayer are that at the end of it all, we can say, to quote 2 Timothy 4:7 - “I have fought the good fight, I have finished the race, I have kept the faith.”
*the description of ‘Mr. M’ is based on various patient experiences and does not refer to a single real patient.