It’s early Wednesday morning and I am sitting in a bench outside the cancer clinic. In front of me are parked vehicles and a tall mabolo tree. The clinic will not open until eight o’clock so I patiently wait. Hospital staffs pass by me to grab a breakfast at the canteen- morning shifters. I remember when my shift would start at six in the morning. I would time-in for work two or five minutes late with an empty stomach and a messy wet hair. I would later go outside to buy something to eat.
I feel very sleepy. In a day like this, I wake up at three in the morning to prepare so that after an hour and half later, Mama and I would be in the Maasin City public terminal to catch the 2-hour first trip to Ormoc City. Ever since I started my maintenance chemotherapy in October last year, I’ve always been early for my appointment. I intend to get through this day as quick as possible. Later this morning, I expect the clinic to be packed with patients and their caregivers for their appointment and out-patient treatment.
I realized sleepy is what I want to feel in a day like this. I’ve always hated watching the I.V drops drip slowly- like how my life has been moving lately. I want to just sleep the whole time of chemo- just like how I wanted my diagnosis to be just a bad, bad dream. So by the time I wake up, it’s all done. And then I’m free… at least for the next four weeks.
It’s the longest ‘freedom’ I could have for now. Four more weeks then it would be another month, then another day like this, and then another four weeks, and another time has passed. This cycle will go on until I finish my treatment in early 2019- that, if I remain in remission. I use to pep-talk myself with this sort of calendar countdown all the time. You’ll see the year will be over, I tell myself. I think I’ve discovered the power of pep-talking.
It’s August, which means that I have been in remission for twelve months now. Last year on August 19, a bone marrow aspiration was performed on me for the third time which showed I have now entered remission: 1% blasts. I looked up the word ‘remission’ in the dictionary- “a period of time during a serious illness when the patient’s health improves.”
Funny, it says I’m supposed to improve, but at that time, I wasn’t feeling any good. My depression was just spiking up and I was almost losing all of my hair. I used to hear the word remission only in movies but now that it’s happening to me, I wanted to make sure what it exactly meant for me. According to American Cancer Society, remission does not mean that the cancer has been cured; only that the patient responded to the treatment and the cancer cells can no longer be seen on tests. Reading this just made me upset and anxious.
When my doctor told me about the result, rather than be happy, my first reaction was to ask whether I still have to continue chemo or not. I had high hopes that he would say no need for further treatment because my leukemic cells have been killed but, if anything, I was disappointed when he said chemo will continue as per protocol. I was of course grateful for the result- not all cancer patients achieve remission no matter how hard they try- but I wanted desperately to get out of this situation. But I didn’t have any choice at all. I guess you can never really expect anything good with cancer. There is never an easy way out.
When I first entered OSPA Cancer Institute in May 2016, I never actually imagined myself to be coming here in a regular basis. It’s quite small to be called an institute I think, but they are just starting out. They only opened about three or four years ago and only have two oncologists on hand. One is based in Ormoc and the other one is a visiting hematologist-oncologist from Cebu City, who only does clinic every Wednesday.
The consultant that I first approached referred me to the visiting doctor after she realized there was nothing she could do with my case. I was filing for vacation leave back then and was completing the requirements including some tests when my blood count showed I was anemic. I wasn’t really alarmed when she referred me to a hematologist- oncologist, a doctor who specializes in cancer and blood diseases. I was optimist it wouldn’t be anything ‘big’ or ‘serious’- all the while not having any clue as to how serious of a monster was already living in my body.
During my first appointment, I brought all the lab results that I myself ran. They were ordered the week before. Nothing, except for the abnormal blood counts, was wrong. But it was the abnormal blood count that actually mattered. “Hmm… Basin leukemia ni…” (This could be leukemia…), was what the doctor suspected after going through the results, my history and signs and symptoms. He then scheduled my first bone marrow aspiration and biopsy (an invasive procedure that removes a small amount of fluid inside the bone – the bone marrow- and small amount of the bone itself to detect blood disorders like cancer) in Cebu.
The day before that, I was of course at work, as a registered medical technologist in one of the private hospitals in Ormoc City. Except anxiety, nothing during that day signaled me that it would be my last day at work. Well, if not for the turn of events, I would have still arrived to that day. I was in fact a few weeks away to my resignation and was already serving my last sixty days at work as per policy. I was looking forward to finally be able to “rest”, at least before I start a new journey- med school.
Everything was almost ready. My family and I were looking forward to me starting med school- something that I have kept postponing and setting aside for the past 3 years, for some particular reasons. And now, I was halted even before I was just about to finally strike. Like the red light in the traffic, only that it stayed red for a time longer than I wanted.
The months before my diagnosis were thick. I had responsibilities- lots of it- at work, outside work, at home. It was heavy back then, people were counting on me. But I’ve always considered myself as tough, so I just went with the thickness, nonetheless. I didn’t listen to my body. A few more weeks and I’ll be out of here anyways, I told myself. Only to find out the thickness will be replaced with another one- a much complicated one.
So there, after two units of blood transfusion and a bone marrow aspiration and biopsy, I was diagnosed with acute lymphoblastic leukemia, a form of blood cancer. More transfusions came and went and Wednesdays have never been usual since then. When I received my cum laude honors in Silliman University way back in 2012, I’ve always been hopeful that the real world would indeed be tough, but to go through cancer is just… too much.
With cancer, one thing is always certain- the sense of being a burden to everyone. People my age are supposed to be earning enough or maybe just starting out, but my circumstances called for unemployment. I can’t help but be angry at myself. Health and youth are supposed to go hand-in-hand, but in my case they don’t.
When my health insurance payment were cut-off, my parents had to make a move. For cancer patients, health insurance is as important as receiving proper treatment. Going to treatment and procedures without it just doubles up the problem. Aside from my fair monthly pension from the SSS disability package, I don’t have anything else to consider as my source of income. If it weren’t for the generous donation from my aunt’s employers, my family would have probably sold properties of what little we have.
Then I found myself applying for Persons with Disability (PWD) discounts and identification card. I just had to. It helped me save a fair amount of money- from buying medicines, laboratory procedures and transportation expenses. To admit to be physically disabled is a bizarre feeling- especially for someone who wasn’t really disabled to begin with. At first, I would be uncertain in directly going to PWD and senior citizen counter of drug stores and government offices. I would hesitate to show my i.d. to van dispatchers every time I pay for my fare. Now, I’ve gotten used to the bizarreness.
I missed the days when I felt useful. I’ve always hated watching my parents work hard for our education. Though it didn’t cover all, the educational benefit from Phil. Veterans Association Office (from my late WWII veteran grandfather) and my academic scholarships every semester have always provided them relief during college. But now, there’s not much of a relief I can provide for them…
The word cancer is something that is not often talked about among normal people. If you’re healthy and you talk about it, you would never imagine it to happen to you. You know it happens to people, but it’s only for ‘other’ people, not for you.
Some people think cancer is a death sentence. Some call us ‘victims’ so they pity us. To be honest, I hate it every time people call us ‘cancer victims’ because it only means cancer is the victor and we are defeated. I believe aside from help, self- empowerment is what cancer patients need- not pity. Trust me, we’ve got so much self- pity in us that we have no room for other people’s.
In this country, most of the time, your chances of hope is determined by your financial capability to get yourself treated. Many Filipinos equate cancer with being rich. Sakit sa dato- disease of the rich, they say. I used to think cancer is for the old. But amongst all, I discovered cancer is one of the very few events in life that is non-discriminatory. It affects all people- rich, poor, middle class, educated, illiterate, young, old, strong, or weak. Cancer doesn’t really care. Many people in this country die from cancer without having gone through proper treatment. Some of them even die undiagnosed. “Mura ug kanser to iyang gikamatyan…” (I think he/she died of cancer… )- I hear people speculate.
I never felt strong every time I sit in a chemo chair, if anything, I feel lonely most of the time. For young adults, it’s more common to meet nurses your age who will attend to you, but it’s rare to find someone your age with cancer. You find yourself lost in a healthcare sandwich- you’re too old for the pediatric unit and too young in an adult oncology unit. Not a good way to experience quarter-life crisis.
When I started my chemo, there were only three of us who have the same form of cancer. The two guys, an 18 year-old college student and a 31 year-old dad, were diagnosed months ahead of me. I was the second youngest among the patients- I was just about to turn 24. When the two of them finished their weekly intense chemo ahead, I was ‘left’. I found myself interacting with patients older than me, mostly women. “Bataa pa nimu oi!” (You’re so young!), was the comment I usually get.
Where are the other young people then? Well of course they’re healthy and living life to the fullest- they don’t have cancer like you. Well, what about the other young adults with cancer? How are they going through all these? Are they also having a hard time like me? Somehow, I felt that we were placed in a silent area of the society- voiceless. I kept wondering about my probability: Am I one in one thousand young people? Ten thousand? Hundred thousand?
I realized how rare of an occurrence cancer is among young adults. In the US, about 72, 000 young people ages 15 to 39 gets diagnosed with cancer each year. That’s one every eight minutes while 10, 000 young adults die every year due to cancer. In the Philippines, there’s not even an accurate statistics gathered specifically on young adults with cancer, at least not in my level of research. I guess that’s how easily we can get lost in the healthcare system.
Cancer in the Philippines is the third leading cause of morbidity and mortality after diseases of the heart and vascular system, with most patients seeking medical advice only when symptomatic or at advanced stages. According to UP Institute of Human Genetics, 189 out of 100, 000 Filipinos have cancer while 4 die of cancer every hour or 96 cancer patients every day. That’s more than 35, 000 deaths every year. That’s a lot. I could have been among that 96 people- or maybe I will be, someday. I have to learn to live life with uncertainty now.
I startle as I hear the glass door of the clinic creak as the nurse unlocks it. Before I enter, I take a deep breath. Strange, I feel unusually calm. Although I am hoping this day would pass by quickly, I know it’s going to be a tough one. It will all be over, I remind myself.