How I Turned the Big C into a Small c (Part 2 of 2)

Maria Carmina Joyce Alferez, MD

I can only imagine up to this day how my sister felt the day I told her she had cancer. Perhaps for her, it felt like being punched in the stomach so hard, it makes you pass out (well, the punching is still going on, by the way). Probably, for my parents, crushed does not begin to describe how they felt knowing they pretty much can't do anything for their child. The 1 year gap between Carla's diagnosis and my dad's is not enough for him to recover from his pain as a father when I, the doctor, had to tell him of his own cancer.  'Why?' and 'how come?' were questions that did not merit answers and the worst reply one could ever get as a daughter were not tears but a slumped shoulder and an obvious, dejected spirit. 

I, the doctor, now have to delicately stay in the middle to remain objective. I put on my full battle gear, my poker face and dance with cancer head on. I need to stay on top of things, managing tests, medications, paperwork, legwork, appointments, nutrition and everything in between. Unanticipated, I am now on the other side of the table, the one in the waiting room, the one who has to make the appointment. 

I am now the one whom I entrusted my patients 'processing of feelings' to, the family, the significant other, the go-to person for emotional support. And no medical book has taught me how to be exactly that. 

My typical day include bringing my daughter to school, hospital rounds, clinic, admin work and all the mundane chores in between (grocery shopping, paying the bills, managing the household). Suddenly, this role of a cancer caregiver weighs as heavily as having a perpetual patient 24/7.  Thoughts like "How is she doing today?" or "Time to order my dad's meds" or "when was her next scan again?" or "is dad out of breath?" pop into my mind in all those quiet moments during the day (while stuck in traffic, while waiting for my patient's lab results, while standing in line at the grocery).

Since I am a long distance caregiver of my sister, I usually call her when I'm on my way to the clinic or the hospital. Often times, I had to call her back because the resident is calling to refer a patient, or I'm about to park in a basement with poor signal or I just arrived at the house and my kids are rushing to meet me at the door. It felt unfair to everyone that I had to divide my time, mind and effort every day. I hoped that I could compartmentalize daily all my responsibilities to give it my full attention but that's just impossible to do. 

You see, I wished I was Wonder Woman. But I, the caregiver, know that I can't come close. 

Some days, it just gets exhausting. The mental stress and physical fatigue can overwhelm anyone in my position (maybe except of course, if you're Wonder Woman). More often than not, I am on top of things, very nicely juggling all that are required of me. But one day, during one my sister's not-so-great days, I called a close friend while in the car (during traffic) just to unburden my thoughts that I found myself crying like a baby (she, patiently listening on the other end of the line). The next thing I knew, I was parked outside my house and wiping the tears away, said to her, "well, I am going to go down this car and gather myself because it's time to be a mother now", shifting my role as naturally as shifting the gears in my car. We laughed and I put down the phone, heart a little lighter.

Can I row my boat in both the river of subjectivity (as a relative) and objectivity (as a physician)? Can I make sound medical judgment for my loved ones? Maybe. To this day, the answer evades me. But I try to be as practical and level-headed as I can be, both as a steward of science and a guardian of my family's heart.  

As Paul Kalanithi said in his book When Breath Becomes Air: “Being so close to the death and dying during residency training blinded me to their real nature, like trying to learn astronomy by staring directly at the sun. I was not WITH patients in their pivotal moments, I was merely AT those pivotal moments, observing a lot of drowning, yet learning how to float and swim myself." Exactly.

The one thing I took from our life's experiences is that I better understand now what it feels to be on the other side of the table, to be the one asking the questions, hanging on to every word of the attending. 

I now know how it feels to go home at the end of the appointment and discuss with the family our options. I realize now how "scanxiety" feels, how test results hit you like a tidal wave, how difficult it is to make plans for next month and how frightening the uncertain future is. 

I am still being educated by my experiences, slowly appreciating more the mind and heart of the patient across from me. During clinic hours, my temporal self sits in the doctors chair but my spiritual self is staring right back at me. And I know I'm able to genuinely connect.

How did I turn the Big C into a small c? I minimized it. I befriended cancer. It's just there, ingrained in our near-normal daily lives, in my clinic, in the car, in the house. At times, my sister's scans and physical pain makes it difficult to accept living with it, but we just consider it as the very annoying neighbor who keeps on asking for sugar.

Do I wish we never had 3 cancers in 6 years? Yes. Do I feel like we are unfortunate to have it? Of course. 

Do I make myself the winner in this love-hate relationship with cancer? Oh definitely! 

How can I do it? Because I can, sir, Mr. cancer! You're JUST cancer.

Every day, hope is real. Inspire others. Reach out. Be grateful. Laugh often. Smile more. Be kind. Try again... and again...and again. Count your gifts. Have faith. Find your miracles every day. 

Remember that the most difficult roads lead to the most beautiful destinations. We will not die of it but we certainly decided to live with it with a heart of peace and gratitude.


Carmina Alferez Carmina Alferez is an OBGYN. She lives in Cebu City, Philippines with her husband Zigy and their two children.

Blog category: 
Awareness & advocacy
Caregiving
Young adults

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