Not the end of the world

Graduating from medical school in Britain more than 20 years ago made me feel on top of the world.

During the break before starting work, I chose to go skiing, a sport I learnt to love while studying overseas.

The venue was the village of Cervinia in Italy, at the foot of the mighty Matterhorn in the Alps.

Soaring at more than 4km high, the Matterhorn is majestic but also fearsome for its unpredictable weather.

On my first day in Cervinia, I impulsively headed to the tallest peak, the Klein Matterhorn glacier, on Europe's highest cable car.

As I was not acclimatised or properly clothed, I rapidly became sick and dizzy and collapsed, frozen in the high winds.

Panting and crawling on all fours back to the cable car to descend to Cervinia was a painful struggle.

Lacking sensation in my purplish hands and feet, I sought help in the local village clinic.

There, I was treated by a young, empathetic and radiant Italian doctor and her attentive male nurse.

She diagnosed frostbite, prescribed medication and gave me instructions to aid recovery.

Last Christmas, I went with my family and friends to ski in Cervinia - my first time back since that hypothermic episode.

On a glorious sun-kissed ski day, as we were crossing a narrow trail on the breathtaking Klein Matterhorn glacier - the very same area where I had previously collapsed - a family member met with a ski accident in gusty winds and sudden low visibility.

Following a dramatic high-altitude rescue to the nearby medical post, helicopter evacuation to the main hospital down in the Aosta valley, four stitches and a computed tomography (CT) scan later, all was thankfully well.

Two days later, on Dec 21, 2012 - the day that the Mayans predicted would bring on cataclysmic or transformative events, interpreted by many to mean the end of the world - I took my injured family member to the local clinic for a change of dressing.

As I walked into the waiting room, it looked strangely familiar.

I had been here before.

As the clinic door opened, I was taken aback.

On this day of the predicted apocalypse, I came face to face with the very same doctor who had taken care of me more than 20 years ago.

Her eyes, voice and bubbly personality were unchanged.

Dr Maria Gabriella Maquignaz confirmed that it was indeed her when I showed her a vintage photo of herself and her assistant that I had scanned and uploaded on Facebook together with many other old photos.

She exclaimed: "Isn't the Internet amazing?"

She then introduced me to her 86-year-old father, a recently widowed doctor, still practising medicine together with her.

It was a heartwarming reunion and a chance for me to say thank you again.

Dr Maquignaz said her nurse had died from non-small cell lung cancer in his 50s.

Upon hearing this, I reflected on the remarkable progress made in the treatment of lung cancer over the last 20 years.

In the early 1990s, advanced non-small cell lung cancer was managed with only painkillers and supportive care.

Since then, combination chemotherapy has improved the survival rate for patients with advanced non-small cell lung cancer.

More amazingly, patients with a type of non-small cell lung cancer called adenocarcinoma may harbour an epidermal growth factor receptor (EGFR) mutation on their cancer cells that allows them to benefit from oral smart drugs that can be conveniently taken.

Gefitinib (Iressa) and erlotinib (Tarceva) offer such patients superior response and survival rate than that offered by chemotherapy.

In a recent breakthrough, a small subset of lung adenocarcinoma patients who possess a mutation in the ALK gene were found to respond remarkably to a drug called crizotinib that inhibits this gene and prolongs survival.

The discoverer of the ALK mutation and development of crizotinib, Professor Hiroyuki Mano, had accompanied the first Japanese lung cancer patient to receive crizotinib by helicopter from Tokyo to Seoul National University Hospital in South Korea, the first Asian crizotinib clinical trial site.

Within weeks, the bedbound and terminally ill young man was miraculously rescued from imminent death and walking again as most of his cancer melted away.

At the National Cancer Centre Singapore, all lung cancer patients have their cancer cell genes sequenced to detect for EGFR, ALK and other mutations, so as to tailor the best type of treatment for them.

Many who receive a diagnosis of advanced lung cancer commonly feel that the world has ended for them.

Treatment advances, although not miracle cures, can potentially give them more time on earth, sometimes for a very significant duration.

I thought about my brief encounter with Dr Maquignaz's nurse: In the last 20 years, the healer had become a cancer patient and the patient had become a cancer doctor.

Life deals out highs and lows. In a journey filled with unexpected turns, we all face dark valleys and peaks of joy.

As lives intersect again through the surprising hand of destiny, it may give us a chance to say, "thank you", "I'm sorry", "I really appreciate you" or "can you return me the Justin Bieber CD I lent you?"

After final goodbyes with Dr Maquignaz and her father, we stepped out into the evening sun that lit the enduring Matterhorn in a magical glow.

One more day to remember that life is beautiful.

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

This story first appeared in The Straits Times on March 7, 2013

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