Catanduanes Forum

by Dr. Alvin Ravalo
A reprint without prior permission!

(Jose Rizal was right on target when he said “Don’t Touch Me!”)

I was supposed to be in Legaspi at 1pm to assist in surgery for an enlarging abdominal mass. But I didn’t make it for the 8am ferry to Tabaco as there were many patients on my morning rounds that day. So I took the 1pm ferry and reached Legaspi at 5pm and the assistant surgeon was gracious enough not to put the specimens in formalin until I arrived.

It was a plethora of masses in a variety of shapes and sizes. The ovaries were virtually unrecognizable. The section of liver had clusters of nodules embedded in it. The uterus looked like an alien creature from outer space. The omentum (the curtain-like sheet of fat covering the front part of the intestines) felt like a curtain of seashells in some tropical resort cottage.

It was a virtual Pathology Class treasure trove that I felt like a student back in med school. This was one operative procedure that would have fulfilled much of my requirements in Surgery. But I was no longer a medical student then. And this was not med school. This was the Tanchuling Hospital in 2007. And the patient was my sister.

Three and a half yrs later, on December 8, 2010, at the age of 63, she died battling this still undefeated opponent of the human race, “Cancer”. It was her daughter’s birthday the day after. Two days later, her first grandchild was brought into this world, a bouncing baby boy delivered by Caesarian Section. I used to tell myself that if she could just hold on long enough to see her apo, she would gain considerable strength to hold on a little more. But then, what? It was probably the Lord’s way of taking away her pain, and the pain of those around her in seeing her suffer more.

All illnesses of the human race start as a puzzle clouded by mystery and misconceptions. Leprosy was once thought to be a punishment for sinners. Malaria was once thought to be inhaled from foul (mal) air (aria). And Cancer was once thought, and still is, to be a product of curses cast by witches on whoever would catch their ire.

But my sister couldn’t have caught anyone’s ire. For although she was quick to say what was on her mind, she was also quick to protect those she considered under her care. Even as a 10yr old girl she was quick to lash back at anyone who dared make her 7yr old little brother cry. She was already 17 when I was born, and as such she treated me like a son. Even my grade school classmates thought so.

She took it upon herself to be my mother. And except for the childbirth and breastfeeding, she pretty much did everything a mother would do for her son. She even took the role of intimidating future mother-in-law for my then girlfriend when I first introduced my wife to my family. But true to her nature, she became my wife’s best friend. So it was my children’s fortune to have two grandmothers on their father side.

Her symptoms started as bouts of abdominal pain for less than a year before she had the surgery that I missed, although I could never be certain whether there were already symptoms she kept to herself before that. The fact that our eldest in the family of seven died from breast cancer in 1996 should have sounded off alarm bells in my brain. But the possibility of having two siblings with cancer then seemed so remote. In retrospect it would have seemed so obvious.

Cancer can take so many forms. But the fact that we all come from a union of only two cells (sperm & ovum) means that all malignancies come from only one source. There is this thing called pluripotential stem cells, the cause of a major controversy in the Bush administration but finally approved when Obama took over. It is the cell that as the name implies has a lot of potential. It can become bone, it can become muscle or it can become blood.

Unfortunately, being capable of becoming anything, it can also become abnormally fast growing and rapidly multiplying cells that serve no purpose but to eat up fuel and take up space. So it eats up the fuel that should have served as energy for the beating heart, strength for our muscles, and for the intestinal digestive process. It eats up space that should have been for the brain, the intestines, or the bone marrow. So the patient ends up having severe headache from increased intracranial pressure, abdominal distention or intestinal obstruction or anemia after the bone marrow has been displaced.

Since there are many types of malignancies, there are also many differing signs and symptoms. Cancer should not be looked upon as an “all or none” type of thing, as in “either you have it or you don’t”. Cancer is a spectrum of symptoms. On one end are those with virtually no cancer at all. On the other are the terminally ill. In between are most of us who either have beginning cancer in the cellular stage or an advanced malignancy which we are not aware of.

We all have had cancer once in our lives. But most of us recover from it before the abnormal cells are able to multiply, suppressed by an army of white blood cells called lymphocytes. It is when this army fails that the cancer prevails. And it is this suppression that will probably hold the key to solving the cancer riddle once and for all.

Survival depends on the type of cancer. There are malignancies that are very slow growing, like melanomas (skin cancer) that can stay dormant for years but suddenly take a turn for the worst when no measures can save the patient anymore. On the other hand, there are malignancies that immediately spell a death sentence upon diagnosis, like Acute Leukemias that make most medical intervention an exercise in futility.

Aside from the cell abnormalities that we have already inherited from our parents, cancers usually begin when normal cells sustain injury from toxic substances such as polycarbons (cigarette smoke that causes lung cancer or burnt food that causes intestinal malignancies), microorganisms (viruses that cause cervical cancer) or radiation (atomic bomb radiation causing blood malignancies or UV radiation causing skin cancer). These offending agents cause changes in the cell structure making them malfunction when it’s time for them to divide and multiply, so that instead of a brain cell giving rise to new brain cells capable of conducting nerve impulses, they give rise to unrecognizable cells that have no function except to multiply. It’s like the Gremlins, little monsters that multiply like mushrooms with no other mission but to wreak havoc on the community.

But unlike the Gremlins, these cells don’t announce their presence. Nor do the normal cells beside them. They are more like corrupt political officials who slowly steal from the treasury. The neighboring cells can see them growing but make no fuss about it. So the cancer cells slowly keep sucking up the life out of the host, until the time when the patient is too weak to mount a decent fight. Worse, with its compensatory mechanisms intact, the brain tricks the body into thinking that everything is alright, much like an administration that tells the people, “Ramdam na ang asenso!”, while the cancer goes about its business, sucking the coffers dry.

And then it reaches the tipping point when the administration can no longer pull the wool over the people’s heads… when all physiologic compensatory mechanisms fail to maintain the balance… when all hell breaks loose. This was the day I failed to make the 8am ferry to assist in my sister’s surgery. But then, had I reached her before she was brought to the Operating Room, it wouldn’t have made any difference, would it?