the healing muse

Volume 12, 2012

Susan Huang

Prime of Life Redefined

      In the summer of 2010, I was at the prime of my life. I graduated from medical school, got married to my long-time love, and started my medical internship on my way to becoming an ophthalmologist. I was young, carefree, and had been healthy all of my life. One sunny afternoon driving home from work, my hand somehow brushed up against my neck and I discovered a large firm, non-tender lymph node. I had been asymptomatic otherwise. Two months into my internship, I was then unexpectedly diagnosed with stage 4 nasopharyngeal carcinoma (NPC). My whole life and plan that I had laid out before me was turned upside-down.
      The ENT doctor broke the news to me after my biopsy returned. My first response was tears. My second response, I asked her, “What about my internship?” Being a type A personality, as most physicians were, I had a set plan in mind. I went straight through college, medical school, and started internship without taking any breaks in between. Hence, when I first went on medical leave immediately after my diagnosis, it was strange acclimatizing to the seemingly infinite amount of free time that I now had, a luxury that had not been afforded to me since grade school. It was the first time in my life where I had no plan or direction. Instead of focusing on my academic and career goals, I now had to focus on myself. Mentally, I had to come to terms with my diagnosis at an age in which I felt invincible. Physically, I worked hard to gain ten pounds on my small frame to prepare for the weight loss that I would soon incur.
      Initially, I incorporated self-doctoring while learning to adjust to a patient’s role. I searched PubMed to learn all about NPC and sought second medical opinions about treatment options. However, as I got further along in the treatment course and sicker from side effects, I succumbed more and more into the patient’s role. I no longer felt like a physician sitting in a patient’s chair during my appointments. My readings of scientific articles were eventually replaced with cancer self-help books.
      The four months of chemoradiation was immensely grueling. I was admitted to the hospital for neutropenic fever twice and was in and out of the Emergency Room during Christmas and New Year’s. A feeding tube was placed due to my inability to swallow. My only means of communication with others was through hand gestures and typing on a keyboard. I became so sick, fatigued, and frail that for months, all I could do was lie in bed with barely enough strength to stand. As my physical strength dwindled, my mental strength followed.
      Despite that, I tried to maintain a positive attitude, especially since I was told that my cancer type was very treatable. “You are so strong,” my friends would always comment. I just thought to myself though, I had to be—I had no other choice except to fight for my life. However, during my darkest and sickest moments, I could not help but feel frightened and alone even though I was surrounded by my loving husband and family taking care of me. NPC was relatively rare in the U.S., so it was difficult to find support from other local survivors who had been through a similar experience. I was also a young cancer patient, a woman in her mid-twenties. I did not fit in the pediatrics group, nor did I fit with the Head & Neck Cancer main patient population, which from my experience, seemed to consist mainly of older men.
      From a physician’s and patient’s standpoint, there was no doubt about the importance of science with the type of chemo and dosage used and the exact mapping of the radiation to best obliterate the cancer. As a patient though, I realized it was rather the humanities that played a larger role. We patients spent a few hours a day getting treatment, but we spent the remainder of the day and some of the night enduring side effects and sorting out emotions. I found comfort in the compassion of the nurses that I interacted with on a daily basis. I found strength in the support that I unexpectedly received from strangers, other cancer survivors, who had become friends and mentors.
      It is easy to feel helpless at times as a cancer patient. I took it upon myself to become more proactive in my treatment. In medical school, the main teaching points about diet and exercise were that they had an effect on diabetes and cardiac disease. As a patient, I realized that lifestyle played a role in more realms than just those two diseases. I became more mindful in de-stressing and eating more nutrient-dense food, which gave me a sense of control with my cancer. There was no hurt in being healthier, having patient empowerment, or possessing a sense of hope.
      After my treatment ended, I had a slow recovery. It took five months to return to my baseline in weight, strength, and energy level. By the time I fully recovered, it was time for me to restart my internship in July with a new class. Fortunately, my internship and ophthalmology residency programs were understanding and kind enough to save a spot for me the following year.
      The first day I returned to orientation, nervousness set in. I adapted from doing nothing except lying in bed for nearly a year to having to jump back into the demands of an eighty-hour workweek. I was anxious about rejoining society again, but even more so, I was terrified about how rusty my medical knowledge would be. I worried about having “chemo brain,” a mental fog that many cancer patients talked about. Thus, I kept myself busy playing complex puzzle games when I spent days in bed. I relentlessly studied a week before internship started as if I were taking the medical boards soon. Regardless of my efforts, I could not shake off my anxiety on the first day. As I approached the hospital, I stopped for a moment, took a deep breath and realized: I am extremely grateful to have the opportunity to feel nervous excitement at this moment and to be able to start internship again. I smiled to myself, my trepidation subsiding, and resumed my walk. The first week went by in a blur. I blended in nicely with the other freshly minted interns as we learned to navigate the system and expanded our knowledge base together.
      Come wintertime, I arrived at the halfway mark of completing internship. Aside from my short hairdo, subtle skin hyperpigmentation, and water bottle that I kept in my white coat at all times due to my dry mouth, no one could guess the taxing experience that I had undergone. I briskly walked up and down several flights of stairs throughout each day, a stark contrast from when I gasped to catch my breath from climbing just a few steps. At times, it was even hard for me to fathom that less than a year ago I was exactly where some of my patients were currently.
      As a physician again, I can unreservedly empathize and provide patients with needed emotional strength. I am cognizant of the human component of medicine. Being entrenched in academic institutions, we converse with other colleagues at times about rare “zebra” cases that we come across and how interesting they are. I remember to be humble before what I see and realize how real the diseases are to the patients. They are the ones who are living with them on a day-to-day basis, although we physicians may find them as fascinating “cases.” My unique experience as a doctor-patient has reinstated my passion for medicine to aid others in trying times and to impart hope and self-empowerment. I have found that I continually learn from my patients too, drawing from their courage and equanimity.
      I have come to realize that it is impossible to ever return to my previous normal life, but rather adapt to my new normalcy now. The uncertainty of the future or possible recurrence could never fully vanish from the back of any cancer survivor’s mind. However, that will not prevent me from moving forward or being at peace about things that are out of my control. New insights and perspectives have come to fruition during my young life. Every day is relished because I learned life is fleeting. With these notions, in addition to recommencing my career and being surrounded by loving family, I am again at the prime of my life.

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