To Live!

He had been told he had cancer. “Operate. Or die” Dr Y wore a worried frown as he anxiously sat before me. A middle aged man slightly older than myself, he was dressed simply and came with his sister whom I immediately recognized – she had seen me on many occasions before. She looked just as worried.

What on earth was this man from KL doing here in Penang to see me? There are plenty of doctors and hospitals in KL, I thought.
Slowly his story began to unfold.

He had been successful many years ago in Penang. Wealthy, married, with a loving family.
But then, things went wrong with the business. Rather than drag his family into his problems, he lived in KL for many years alone, in self imposed exile. He hadn’t seen them for ages.
He had to survive as a toilet cleaner and as a dishwasher.
He reinvented himself as a legal academician.
He published papers, many papers in academic journals.
He was known internationally in his area of specialisation.
Over the years, he rebuilt himself and his reputation as a doctor of law.

As his new career developed, so his health deteriorated.
He had a heart condition. One of his heart valves needed replacement. He shrank away from the thought of open heart surgery and his cardiac doctor in KL (Dr C, a friend of mine) tried his best to keep him going with blood thinning medicines (Warfarin).

One day, he noticed fresh blood when he opened his bowels. Dr C referred him for a scope. A gastroscopy (OGDS) was done and he was told everything was OK. The bleeding settled but returned a year or so later. This time, he went to a private hospital. He had a colonoscopy done. The news was not good. He had bowel cancer.

It got worse.

His CT scan showed his cancer had spread to the right lobe of his liver. Thankfully, there didn’t seem to be anywhere else involved.
But his bowel cancer had progressed almost to the point of obstruction. Something needed to be done. Soon.

As he sat wringing his hands in front of me, I gently went through what we had to do.
I had him see one of our cardiologists to make sure his heart was strong enough to withstand surgery.
Then there was the issue of his blood thinning medicines. What’s good for the heart is not that good for surgeons and there was the risk of bleeding during surgery.

If he made it through bowel surgery, he would have to have chemotherapy because the cancer had spread to the liver. That would be several months of uncomfortable injections, possibly with side effects.

After all that, we’d reassess him, redo his scans and if there was no further spread of the cancer elsewhere and only the liver was involved, we might refer him for major liver surgery to remove the cancer deposits there.

Finally, if he made it through all that AND there was no further evidence of cancer in his body, he should go and have his open heart surgery to replace the faulty valve.

Wow.

That’s 3 major operations, cancer, chemotherapy and heart disease!
But it had to be done, as he was rapidly heading towards bowel obstruction.

So, we started with the bowel resection – laparoscopically.
His operation went well and at the time of operation, I was able to confirm the cancer had spread to the liver but also that there didn’t seem to be any other spread elsewhere.
Because his operation was laparoscopic the incisions were small and his recovery swift.

After he got over surgery, I referred him to an oncology colleague for chemotherapy. Dr Y however chose to have his chemotherapy treatment at another private hospital in Penang. He was given, amongst other things Erbitux, a new drug for colon cancer.

Dr Y never complained. His journey was long, painful, difficult and hazardous, not to mention expensive*. Almost all other patients in his position would be worried sick, completely absorbed in their own condition, full of questions about their illness and prognosis.

Not Dr Y.

Facing two potentially lethal conditions and the stark reality that he might not be around forever, he focused his thoughts instead on how he might use his remaining time most usefully, helping others. Not just members of his own family but his students, strangers, society in general. He launched himself feverishly into his work, determined to share as much of his knowledge and experience with others as possible while he was still able to do so. To benefit others, to benefit society. He supervised postgraduate students. He gave public talks to raise funds for cancer patients. He helped organise the funding of his unmarried aunt’s cancer operations, enduring being ‘spat at’ by some fair-weathered friends for being a business failure. He accepted it all.

It reminded me of a Japanese film called Ikiru (“To Live”) by the late director Kurosawa.
The main protagonist, Mr Watanabe had stomach cancer. Up to that time, he had led a pointless life as a grey bureaucrat, unloved by his son, alive but not really living.
When he learns that he is doomed, he tries to punish himself for all his wasted years. He then embarks on a project to help his community, working tirelessly and selflessly as his final days approached.
He was more alive in those final months than he had ever been in his entire life.

And now Dr Y.
I had not thought I’d meet someone like that in my professional career. My admiration for him just grew.

3 months after his chemotherapy, we repeated his scans and that showed no further progression of his cancer.

So we referred him for liver surgery to remove the cancer that had spread to the right lobe of his liver.
Guess what?
He sailed through that too.
He had had it done at a private hospital in KL and came to my clinic to show off the scar.
Because the liver is a much bigger organ, the scar was bigger but no matter, the important thing was that he had done it, survived it and came out free of cancer!

We are now going to repeat his PET scans in a few months and if that is clear, he is going to go for his open heart surgery to replace that faulty valve.

Dr Y has now moved back to Penang to be with his family, his loving wife always by his side.

One day, Dr Y encountered a man sitting on the floor in a corner of a shopping complex.
He was poor.
He was disabled.
He was without his limbs (perhaps a result of Thalidomide?).
He was selling phone cards.

He was exactly the sort of person we all too often walk by without seeing, without even realising their existence.

Yet, he was happy and contented, observed Dr Y.

Why?
The man answered that although he was without limbs he was otherwise healthy, though he was not wealthy he had enough to eat, to survive, and for that he was thankful.
Dr Y sat with him for hours, helping him sell phone cards and sharing the journey of his illness.
The man told him to keep fighting, to never ever give up.

Perhaps Dr Y has found the secret to living, to being alive.

 

*Fortunately his close friends whom he had avoided out of shame came together to help fund all his operations.

 

Dr Y, looking cheerful after successful liver surgery!
Dr Y, looking cheerful after successful liver surgery!