The MD’s Sister (Part 1 of 3)

Maria Carmina Joyce Alferez, MD

Carla and CarminaWhen my sister, 2 years younger than me, complained of dull, constant pain on the left back area in 2011, we thought it was just because of her posture at work. Carla was then 28 years old, a smart, vibrant and levelheaded IT specialist in one of the prestigious hotels in Asia and her work meant long hours of sitting down. She was not one to easily complain about pain so when she did, my husband Zigy, an Internist, suggested to have an X-ray done. When the results came back with mass on her left lung field, we proceeded to do a CT scan. Little did we know that our lives will take a 180-degree turn and will change forever.

I am the second child in a brood of four. My elder sister Celeste is based in the United States as a physical therapist, and our youngest brother Joachim, a nurse here in the Cebu City, Philippines. I was then completing my residency training in ObGyn in 2012 and 5 months pregnant with my daughter when Carla started complaining of pain, which was occasionally relieved with analgesics. When her chest CT scan showed pulmonary tuberculosis versus metastasis, I brought her to a pulmonologist who initially treated her with anti-TB medications for 6 months (since TB is common in the Philippines). A repeat CT scan in March 2012 showed persistence of the masses on both lungs so we proceeded to do a CT-guided lung biopsy on the biggest mass (2cm) accessible. I reassured my parents and told them I’d be right back from pathology where a team of doctor friends including 3 pathologists, our pulmonologist and the interventional radiologist were fussing over the microscope.

They were very quiet and somber when I walked in. When I took a look at the microscope, I knew enough in pathology to tell me what I was looking at without anybody needing to say a word. With tears streaming down my eyes and onto the cold lenses, I could hardly find my voice to ask the pathologist, “Doc, what type of lung cancer is it?” She said she needed to scan some more slides and consult with the rest of the team but it looked like it was non-small cell lung adenocarcinoma.

My brain was racing at this point on thinking about how to break the news to my family. There will be a thousand questions I’d have to answer, emotions I’d have to cushion, and plans we would have to come up with. My heart rate was going so fast that I could not breathe. It felt like a huge wrecking ball just hit me in the chest and knocked me out. I wanted my mind to go blank for a while so I could get a grasp of the diagnosis. Why, I thought, why did it have to happen to my younger sister who never even smoked a cigarette in her entire life and had a whole future ahead of her? My legs felt like lead as I started to walk back to Imaging where my parents and sister were waiting. As I opened the door, a river of tears came flowing again. My mom said, “You wouldn’t be crying if it was just TB.”

“Carla, its cancer.” I told my sister as she was lying on the gurney after her scan. She was going to be admitted for observation overnight due to pneumothorax, a complication of the biopsy. She didn’t speak for a while and I offered to call Bud, her boyfriend then, who was based in Manila, an hour’s plane ride away. Tears were streaming down her cheeks. I could only imagine then what she was thinking and it broke my heart.

She was asking me what to do and I could only tell her that we would take this one step at a time. She was an automatic Stage IV since both lungs had cancer. Even if there were no distant metastasis, surgery was out of the question. Our oncologist was another friend of ours who remained optimistic about outcomes throughout the whole process. She reassured that lung cancer research was explosive and several new drugs are already available. I was running around the hospital to make the diagnostics run smoothly for my family. My brother was at my heels, helping me follow up and expedite the tests results. After what felt like a gazillion tests, there were no other masses elsewhere.

Our family’s heartbreak was palpable. Dad wasn’t asking a lot of questions. My elder sister felt helpless being in the US. My brother was asking why it did not happen to him instead since he’s most exposed to disease in the hospital. Mom was sobbing, saying that no parent should ever have to bury his or her child. If Carla’s cancer left a gaping hole in my heart, everybody else was in pieces.

I did not see Carla go through the stages of denial, anger, bargaining, sadness and acceptance as anyone in her shoes would feel. She mostly kept her feelings to herself. I was sure though that she was processing it with a slow and calm acceptance. Bud flew in right away and was by her side the entire time. 

Blog category: 
Awareness & advocacy
Caregiving
Young adults

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