On Valentine’s Day weekend 2015, my parents came to Guadalajara to attend my Rotary Club’s Valentine Day Art Auction. My mother mentioned she had a lump on the left side of her neck and asked if I wouldn’t mind removing it since I had removed some previously, while I was working in Chicago. Instead, I called my colleague, Dr. Juan Delgado, an oncological head-neck surgeon, to help remove it since it was in an area that was deeper and I believed that he was better trained to carry out such a procedure.
We scheduled the surgery for the next day, Sunday. We excised the mass and got the preliminary pathology results in two days. Dr. Delgado called me with the unfortunate news; the pathology report was positive for cancer and that we had to find the primary immediately. While I showered, I thought how to break the news to my mother and I prayed for God to give me the strength to be able to do it in the best way possible. One of the hardest responsibilities that we have as doctors, is to give bad news to our patients. Since this was my own mother I was giving the bad news to, the heaviness in my heart that morning was unbearable.
After getting dressed and having breakfast (the longest breakfast I ever had) I sat my mother down and told her calmly that the initial report pointed to a malignant process and that she had to undergo further testing to find out where the primary cancer originated. She bowed her head in disbelief, sighed, and shed some tears while I held her tight in my arms. The lump in my throat was also unbearable, but I promised that we’d do all that was possible to find the solution to this predicament.
I sprung into action and got her scheduled for CT scans, mammography, and blood work at the diagnostic lab RIO. I am very grateful to the doctors and staff at the Rio clinic for their help. The lab is so efficient that by mid-day we had located with a high degree of certainty the primary cancer which was in her left breast. The good news was that it was primarily in her left breast and two nodes in her neck. The bad news was that this was the beginning of a long and arduous journey for her and for our family.
My mother is a snowbird and was only supposed to be in Mexico for a couple more months but this certainly changed things. We had a family meeting and explored our options for treatment in the U.S. vs Mexico. The treatment protocols and standards of care are the same in the Mexico as they are in the U.S. Due to the fact that my mother has dual U.S./Mexican citizenship, she has access to both Medicare and Seguro Popular. The decision came down to the where my mother would have her best family support system and thus chances of recovery and thus it was decided that she wage her battle with cancer here in Mexico, with the majority of her family, including myself, close by her side.
It was eight weeks to the day from the date we removed the metastatic lymph node from her neck that my mother started her first of eight rounds of chemotherapy. Those weeks were full of heartfelt prayers, arduous testing, waiting, and fitting my mother with a central venous catheter for her subsequent chemotherapies. Being that my mother lived a very healthy lifestyle that entailed going to the gym four days per week, never smoking, rarely drinking alcohol, and having a healthy diet, besides being a devout Catholic with a generous heart, there were many times that she asked God, “Why me, why me, why me?” Now, as a physician I could have helped answer that question throwing statistics out to her as I do with so many of my patients. And being that her younger sister had breast cancer about one decade earlier, I could’ve also reprimanded her for not getting yearly mammograms as I had told her so many times. But I did realize that at this point in time, all she needed was the comfort and support that our family and prayers could afford and that no medical explanation I could give, would help.
After those eight weeks, my mother had her first consultations with her clinical oncologist and chemotherapy at the Instituto Jalicience de Cancerologia at the Old Hospital Civil in Guadalajara. My mother had grown accustomed to the modern, brightly lit hospitals of the Chicago such as Elmhurst and Northwestern hospitals with their modern cafés, elevator music and shiny pristine floors. Instead she was met by and would have to get used to a hospital with hard plastic seats for 40 patients for a waiting room of more than 200 cancer patients with varying degrees of death’s shadow being cast upon their faces. What frightened my mother the most were the children and adolescents who were too weak to walk in by themselves and were wheeled in in wheelchairs or on gurneys. The waiting room and narrow corridors were often humid with sweat of those waiting for their turns to see the doctors. The level of pain and anxiety as well as the despair hung heavy in the air. Even as a doctor who has provided care for patients it was difficult for me to walk through the halls of the Cancer Institute. My mother soon learned from other patients what it truly meant to be brave in the face of adversity and despair. In those waiting rooms and in those halls, she learned from the less fortunate how to count her blessings and truly live what life she has left, to the fullest. My mother often was hard and strict on my siblings and me while we were growing up, but we all witnessed just how this time quickly softened her heart and humbled her even more than she had been. She raised us on “tough love” and I guess that is what drove my siblings and me to succeed in the U.S. She rarely gave us hugs or nods of approval or demonstration of any sort that she was proud of our accomplishments. Being exemplary citizens and excelling in school was not only expected, it was demanded more than hugs, more than smiles or “I love you, Mom.” Now it broke my heart to see how much she was in need of all those hugs and “I love you’s” that were saved up through all those years. I can say that if anything good came about from this time, it was how we grew much closer to her and the rest of our family.
My mother lost her hair after her second round of chemotherapy. The eighth chemotherapy seemed like such a distant goal and with each chemotherapy her strength would wane and she would lose more weight. From what I witnessed, the time spent in chemotherapy is not a journey I wish upon my worst of enemies. Only God knows where she found the strength to endure and persevere, but she did. She survived chemotherapy and then 30 days of radiation, only to receive what some may view as the horror of a disfiguring surgery and others view as a battle scar against breast cancer, but we doctors know it as a simply as a mastectomy.
I learned that mastectomy has a different meaning to everyone involved. My mother lost part of her physical identity as a woman on that surgical table. But her spirit was still intact and it seemed, stronger and more resolute than ever to overcome this test.
The surgical ward at the Instituto de Cancerologia was a throwback to what many say is a WWII military hospital. There was only a plastic curtain separating my mother from the bed of the next patient, who was in severe pain and whose cries of pain made it difficult for the rest of the ward to sleep. It is a social norm and expected that a family member stay by the patient’s bedside during the entire stay. The nurses being overworked and overwhelmed by the number of patients are responsible for only changing the IV fluids, dispensing meds and tending to the fresh surgical wounds. The family member is responsible for helping feed the patient, changing the bed pans and everything in between. These latter responsibilities fell on the shoulders of my father. My mother didn’t want anybody else to stay by her side but I’m sure those were some of the longest 48 hours my dad spent. He brought a bed and blanket to sleep under my mother’s bed. I can’t say it was too comfortable but it was better than sleeping in the plastic chair by my mother’s bedside.
By God’s grace my mother’s surgery went well and without any complications. The breast and nodes that were removed were all free of cancer and she was discharged in two days, while in other hospitals patients usually stay four. She was discharged because the hospital needed the hospital bed for the next patient and she was ready for the next step. Little did she know that 12 months after her initial diagnosis and recent surgery, she was only at the midpoint of her journey.
It is now October 2016, 20 months after we initially made the diagnosis. She will be undergoing her 14th of 17 immunotherapies she started 30 days after her surgery. Her hair has grown back, she has gained some weight and has slowly regained her strength. I can say that her healthy lifestyle and cardiovascular health as well as her formidable spirit helped her endure her current therapies but it was the love and support that she received from those of us in her family and her friends here in Mexico and back home in Chicago that helped nurture her spirit back to health.
As a son and a physician, I cannot say that I am grateful for my mother’s ordeal but I will say that it has enriched my experience as a human and as a physician. I found it to be true that when a person gets cancer, his/her whole family gets cancer. Besides the medicine and therapies that I learned to recommend in medical school and in post-graduate training, I have learned that a healthy dose of love and unconditional support can make the difference between simply surviving and truly overcoming this disease. We have the medicine to cure breast cancer but not to mend the broken spirits of the lonely patients I came across at the Cancer Institute.
As a son, I found out how hard it is to carry out your daily functions and perform tasks while a loved one is staring down the abyss of death when all one wants to do is prevent that person…in this case, my mother… from falling into that abyss.
Thus far, my mother’s experience has been positive and I give thanks everyday for that. My mother was diagnosed at an early stage because I was a convenient means of getting rid of that aesthetically displeasing lump in her neck. The outcome could’ve been very different if the cancer had metastasized at a less visible place in her body. I like to remind my patients and the general public that one in eight women will be diagnosed with breast cancer in their lifetimes. But I also like to tell everybody that the closest thing that we have to a silver bullet against breast cancer is early detection. Breast cancer has an over 80% cure rate and it is in large part due to those screening programs that have had in place for quite a few years now.
I can only hope that my mother’s ordeal can serve as an example and an incentive for the women in our family to get screened regularly in order to avoid going down this painful and scary journey.
During these 20 months I have also learned to be thankful for the all the people who have been by my mother’s and my side and have contributed to her success thus far. As a physician I was blessed by what I could do for my mother at a critical point in time, but I also am humbled when I realized just how small my part was in her whole process. I learned to let go and entrust other doctors with the care of one of the person’s whom I love most on this earth.
I can’t name all those whom I am grateful to for their kindness, love and support during this time. But, as a side note, my mother’s oncologist at the Cancer Institute, Dr. Limon, whom she adored was himself diagnosed with cancer when he started seeing my mother. He’s been back at work treating patients for the same disease with which he was stricken. He’s one of the many whom I am eternally thankful for for their part in my mother’s journey to recovery. I will hold each and everyone of you in my prayers. I think that with Dr. Limon’s recovery, at least one of my prayers has been heard.