It was a day of bittersweet emotions when Ms Maria Noviani received her scroll at the Duke-NUS Medical School's sixth graduation ceremony yesterday.

There was a lot of joy and pride, and understandably so. It was her second degree - her first was in bioscience from Nanyang Technological University - and she had passed with flying colours. During her time in medical school, she had published extensively and won several awards, including the Duke-NUS Achievement Prize for the most outstanding third-year translational science research thesis.

The occasion, however, was also filled with sadness because she could not stop thinking about her mother, who had wanted to see her graduate as a doctor but died, aged 55, from leukaemia on April 30.

Her sadness was all the more poignant, as she had spent the last year fighting the illness with Madam Justinawati Tanoemihardjo while juggling the demands of her final-year medical studies.

After her death, Madam Justinawati's husband and four children discovered a book which contained letters to all of them. The late civil engineer's letter to Ms Noviani, her second child, runs over several pages and, among other things, exhorts her to be an exceptional doctor and do her best for her patients.

"She also told me that as a doctor, I had a lot of work to do on earth before I meet her again in heaven," said Ms Noviani.

Madam Justinawati's illness first came to light in April last year. As she had Sjogren's syndrome, an autoimmune disorder characterised by dry eyes and a dry mouth, she had to fly from Jakarta to Singapore for regular blood tests.

On one such visit, doctors were alarmed to find her white blood count abnormally low. A bone marrow biopsy was ordered and it revealed that she had an acute form of leukaemia. Even with a bone marrow transplant, she was expected to live just five more years.

The news shattered Ms Noviani who was then at Duke University Hospital in Durham, North Carolina, doing research.

Doctors advised chemotherapy as soon as possible. "She had to go through seven cycles, each lasting a month," recalled Ms Noviani, who dropped everything in Durham to be with her mother.

When her mother seemed to respond well to the treatment after a couple of months, she went back to the United States to finish her research as well as to spend a month in the haematology department at the hospital.

"I wanted to learn more about the disease and if there were treatments there which were not available in Singapore. But the treatments were the same. We are very advanced here in Singapore."

Upon her return, she toyed with the idea of deferring her final year to look after Madam Justinawati. "But my mother said she wanted to see me graduate. That was her motivation for fighting," she said.

Half a year later, good news came: Her mother had gone into full remission. But it was short-lived.

To prevent a relapse, Madam Justinawati needed a bone marrow transplant. Unfortunately there were no full matches among her family members and relatives.

A worldwide search for a suitable donor was activated. Three were found but as the surgery date drew near, all three became unavailable.

They had to settle for a half-match instead, that of Madam Justinawati's elder brother.

The bone marrow was successfully engrafted, but the patient had to battle several infections over the next couple of months. "At one stage, she was in such great pain that she said to let her go. But I told her to hang on," said Ms Noviani.

Things looked promising when doctors got the infections under control. "We were so optimistic she could go home. We were counting days to her discharge," she said. "She was planning to buy a wig and asking me where she could get an evening gown to my graduation."

On April 30, the day after Ms Noviani officially finished medical school, she received a call from SGH. Her mother had suffered a sudden brain haemorrhage.

At the hospital, she collapsed when she saw a resuscitation trolley at her mother's bed. She thought Madam Justinawati had died.

"A senior doctor helped me up and hugged me. She said: 'She is still alive. I don't think she is in any pain. We are calling the neurosurgeon to see if we can do anything.'"

But nothing could be done. She died soon after, with husband Tjiong Alep, also a civil engineer, at her side.

A couple of weeks ago, the family found a book on her table in Jakarta.

"She wrote that if we found it, it meant she had left," said Ms Noviani, adding that there were letters to her husband, all her children and even their domestic helper.

The doctor, who will be joining SingHealth's internal medicine residency next month, hopes to become a clinician scientist one day.

Her father and her younger brother were at the Duke-NUS ceremony, which saw 51 students graduating.

"I know my mother is also smiling from heaven," said Ms Noviani.