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Doc talk: Three weddings and a funeral

This story was first published in The Straits Times on May 23, 2013

Marriage, having children and death are major milestones in life.

Joe* married without ceremonial fuss and zipped off on his honeymoon in the throes of young love.

Enjoying married life without children at first, he and his wife then decided they wanted children seven years after.

But he discovered that he had developed stage 3 colon cancer - cancer of the large intestine that had spread beyond the organ.

It was the return of a nightmare for his family. At the time, his only brother had recently died of an unexplained cardiac arrest.

There was no family history of colon cancer. Joe was an ultra-fit, non-smoking dragon boater.

A grapefruit-sized tumour and four cancer-affected surrounding lymph nodes were removed through surgery.

I gave him chemotherapy to reduce his relapse odds, estimated at more than 50 per cent without chemotherapy.

He tolerated it like a trooper, even travelling between chemotherapy cycles to Meulaboh, Indonesia, to oversee post-tsunami reconstruction work as a charity sector leader.

After treatment was completed, he thought about having children again, but feared that he could not.

He joked: "Instead of my wife giving birth to a child, I gave birth to cancer!"

I assured him that the combination treatment I gave him was very unlikely to cause infertility.

POWER OF HOPE

Then his wish came true. His wife became pregnant.

When his healthy baby daughter was born, they rejoiced.

He told me: "Guess what? I have named my daughter after one of the chemotherapy drugs I received."

My visibly surprised reply was: "You are kidding, right?"

He said: "The chemotherapy gave me a second chance at life and I want my daughter to remember this and to know the power of hope. So I have named her Xeloda."

He used to call this chemotherapy drug his "pink Tic Tac chemo candy".

I figured this was unusual but indeed special. At least he did not name her Panadol or else she might get a real headache in school.

Joe has remained cancer-free for more than seven years and should do just fine.

LIVING WITH 'TOILET RUNS'

In 2008, Ming*, who lives in Melbourne, Australia, discovered, after many days of having blood in her stools, that she had rectal cancer that had spread to four locations in her lungs.

To undergo surgery to remove the bleeding rectal tumour, the divorced single mother returned to Singapore, where her two grown-up daughters could provide comfort and care.

I gave her chemotherapy to shrink the cancer in her lungs. She responded well - two of the four spots disappeared and the rest became much smaller.

The chemotherapy did not give her hair loss, but she was fatigued.

Still, after she completed the chemotherapy, she was able to attend her daughter's wedding ceremonies in Singapore and Kelantan, Malaysia, where her son-in-law's family lived.

The rectal surgery resulted in increased bowel frequency. So while she managed to sit through the tea ceremony, she had to dart into the toilet - what she called her "toilet run" - in between the major events.

With almost wistful regret, she said she missed the bouquet-throwing at the end of the church wedding ceremony, due to yet another toilet run, one of the 20 that day.

Remarkably, the cancerous lesions in her lungs did not grow much over the following months.

Much effort to persuade her to go for surgery to remove them finally met with her consent. In March last year, she underwent surgery and has remained cancer-free since.

She is now a busy, beaming grandmother to a bouncy baby

granddaughter. She has a good 30 to 50 per cent chance of being cancer-free in the long term.

FULFILLING FINAL WISH IN STYLE

Jeremy* was a soccer-mad 25-year-old when he was struck with stage 2 colon cancer, and 28 when it returned in the pelvis in 2007.

He had Taiwanese movie-star good looks, took great care to keep neat and immaculate, and had impeccable fashion sense.

He was recommended surgery to remove his relapsed bulky cancer, but was horrified by the thought of having a colostomy or stoma bag, an external waste-collection bag that is attached to the colon through an opening in the abdominal wall.

He accepted only radiation to the cancer and also explored multiple experimental treatment methods.

As his cancer marched on, he finally agreed to chemotherapy which shrank it for a period.

But it eventually spread throughout his pelvis.

He finally agreed to pelvic surgery in 2009, which resulted in a stoma bag. In 2011, a second stoma bag was created after more surgery to avert bowel obstruction.

Our pain team helped optimise his increasingly challenging pain control.

In spite of his weakening body, he kept his spirits high, always focusing on silver linings and sharing homemade inspirational videos.

He was determined to spend every precious day with his girlfriend, who was always by his side.

He fulfilled his last wish by proposing to and marrying her.

In March 2011, he left the hospital for a proper wedding ceremony, managing to go down the church aisle on a wheelchair and with an oxygen tank, next to his beautiful bride, every breath he took a gift.

One year later, Jeremy died.

He went out in style - well-groomed, neat and immaculate, lovingly dressed - and at peace.

Cancer can derail marriages and dreams of having children.

But patients' resilience and determination can still make these milestones full of warm memories, rather than millstones around their necks.

(*All names have been changed.)

corporate@nccs.com.sg

Dr Toh Han Chong is the head and senior consultant at the department of medical oncology at National Cancer Centre Singapore

This story was first published in The Straits Times on May 23, 2013

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