Breast Cancer (Annie Au’s Story)

Since mum had her breast cancer 6 years ago, she had to go back to the hospital every year after that for checkups. Last June she was telling us that the middle of her forehead would hurt, that it would not get better even after taking painkillers, and she began to vomit. My younger sister and I took her to the A&E. After a few examinations, they found a tumor in her brain, which was growing very close to the meninges. Thus the diagnosis of brain cancer was confirmed.

Some of my mother’s remaining cancer cells from her breast cancer survived, infiltrated the lymphatic system, metastasized to the brain, and hid there. It was not detected during routine checkups every year. Perhaps it was because the cells were too small to be seen clearly even under PET scans, so it was not until last year that we suddenly discovered that it had become brain cancer. It was midnight when we went to the A&E. Although they did an MRI for her, the specialist was not present, so I could only wait for the report the next day. Dr Christina Lai took over as mum’s attending oncologist once again. The next day of the incident, when Dr Christina explained to mum about the brain tumour diagnosis, mum cried. Even in her fight against breast cancer, no matter how difficult the situation was, my mum, who had never once cried, could not help it anymore this time.

The neurologist referred by Dr Christina said that because my mother was old, the risk of surgery for tumor removal was relatively high. Therefore, it was recommended to us that mum should undergo the gamma knife brain radiosurgery procedure. It was a painless procedure without the need of surgical cuts or anesthesia, and cancer cells were to be killed by precisely targeted radiation. After the radiosurgery, my mother's condition was fairlystable, and so she was discharged home to recuperate. However, something went wrong a month later. It was the day my mother had her first zone-out.

Everyone had to stay home during the Movement Control Period, and mum’s hair had grown long then, so I was cutting her hair. After some time,I found that mum, who was facing forward, was not responding to me at all. I inched forward to look at her. She seemed to be choking on vomit, her eyes widened, and she couldn't respond as I kept tapping her. It took a long two minutes for her to recover back to normal. After mum awakened from her stupor, I asked her if she remembered what had just happened, but she had no memory of it whatsoever. I took mum to the hospital again for an examination and found hydrocephalus, which means accumulation of fluids in the brain. Her hydrocephalus was very serious, which caused her to keep convulsing afterwards. During that period, she went in and out of the hospital several times, and her consciousness was pretty unstable. The neurologist finally suggested that we should not delay treatment any longer, and should decide while we were in the golden period, whether to let mum undergo surgery or not.

Because of the high risk of surgery, us four sisters who were settled in different places held a video conference to discuss this matter. If mum did not get an operation, she would continue to suffer from convulsions, up to several times a day. At that time, my mother still had her hearing and could speak, but her consciousness was sometimes dim and her eyesight became very poor. Since our childhoods, mum had disliked our quarreling and wanted all 4 of us to live in harmony. Therefore, the decision making was a very difficult process, not just because we had to make a life-or-death decision on behalf of our mother, but also because each of us held differing opinions. Our cousin brother who was also in the video, told us that no matter who came to the conclusion that an operation would be required, no one should blame the decision-maker if something went wrong with mum because of that. My youngest sister and I were the ones who accompanied my mother to hospital visits all these while. We were the ones who knew what the doctors had said, so it was difficult for our other sisters who were not present to make a decision.

Before she fell into a coma, mum told us she wanted to celebrate my youngest sister’s birthday. Mum loved it when everyone got together and had a good time. We were poor when I was young, and mum had to work abroad to support the family. At that time, my youngestsister was still very small and so was sent to relatives to help take care of her, and that’s how she became everyone's baby, as we wanted to treat her better.

When mum said she wanted to celebrate my youngest sister’s birthday, I thought maybe mum had felt that she was running out of time, and this was bolstered by the fact that she had prepared all our sisters' birthday angpaos in advance. Mum couldn't walk anymore. She lied on the bed, thought about what to write on the back of the angpaos, while my sister listened and copied.

We eventually decided for mum that she should have an operation. After the operation, she still had convulsions at home, so we arranged for her to be hospitalised so that she can be professionally taken care of. The hospital gave mum medication to suppress her spasms, but her vision continued to decline; in the end she couldn't even see shadows. Mum was just lying on the hospital bed and slowly losing her ability to speak. Around this time the doctor told us that mum had two weeks left in this world. We were referred to the palliative care team, who gave us tremendous support so that mum could feel as comfortable as possible in the last leg of her life. Although everyone hoped to bring mum home, her weakness and inability to swallow food made it improbable. At the hospital, mum received an intubation for nutrition.

Gradually, mum’s convulsions could no longer be controlled. She twitched almost once every minute, her eyes always closed. We had no way of knowing if she heard us or was in a coma. A few days before my mother passed away, the palliative care team had alerted us of that in advance, and told us to inform relatives and friends to go see her for the last time. Looking at mum, I wondered if she was waiting for our birthdays, and whether she would finally feel okay to let go after she did. Because of this, I decided to celebrate my birthday early to make my mother feel more reassured about her letting go. We bought a cake, put it in front of her, and sang the birthday song.

Mum had been experiencing severe convulsions since morning that day. After the birthday celebration, my youngest sister went to sit by mum’s side and whispered in her ears. Throughout that moment, mum was abnormally motionless, without convulsions, as if she was actually listening. My sister told mother that her condition was very severe now, and if she had wanted to let it all go, she could do so without worrying about us. After listening to my sister's 15 minutes’ confession, mum’s vital signs began to drop gradually. She left us soon after.

My cousin once reminded us that when my mother was about to pass away, we shouldn’t cry, and shouldn’t hold her back, but to let her be rest assured of our strength, so that she could go well. So when mum was about to pass on, my sister and I stood quietly, talking to her only in our hearts but not out loud, holding back our tears and dared not cry. I remembered when mum was undergoing treatment, we had encouraged her by telling her we would go for trips abroad together when she got better. Since her recovery from breast cancer 6 years ago, we had brought her to South Korea, Hong Kong, Singapore, and Japan, but now it had become a promise that couldn’t be fulfilled.

My husband and I had been trying very hard to have a baby, but we never succeeded. Last year, when mum got ill, I used to motivate her by telling her to wait for me to do in vitro fertilisation, and have a baby for her to love and spoil. Mum listened to this with great expectation. That day might not ever come anymore, I was diagnosed with cancer before I could try in vitro fertilisation.

I had a strong family history of gynaecological disorders, so I went for my body checkups every year, and very vigilantly. When I was taking care of my sick mother, I felt a serious chest pain, which I believed must have been caused by overfatigue and lack of sleep. I felt a small, pointed, protruding, and mobile subcutaneous object on my chest, and it was painful when I touched it. The pain remained after my mother passed away. My husband accompanied me to see a specialist for an examination and the result came out that I had first stage breast cancer.

Before the examination, I had a vague hunch that this pain would turn out to be a monster that I could not avoid. But even with such mental preparations, I still burst into tears upon the announcement of my diagnosis. Fortunately, with my husband beside me, I was able to calmly digest all the new facts that came into light while the doctor explained my next steps. The doctor advised me to take a three-pronged approach, that is, to undergo chemotherapy and radiotherapy after having a lumpectomy operation. This was because the cancer was triple-negative, which was the most dangerous and aggressive type of breast cancer, and only 10% of breast cancer patients would get it. In addition to that, I had a strong genetic history of gynaecological cancers. Since I was very young and likely to be able to withstand aggressive treatments, the doctor strongly suggested that I should receive both chemotherapy and radiotherapy.

The six cycles of chemotherapy was a big hurdle for me. As my veins were not obvious, it was frequently a challenge to insert the intravenous drip into me. Sometimes when the needlepoint was inserted incorrectly, the chemotherapy drug would penetrate under my skin, causing my skin to look very bad. The nurse often tried several times to locate my veins, which increased my anxiety towards chemotherapy.

At times like these, I always thought of mum. I had always accompanied her for her chemotherapy sessions since the very beginning, and now I became the one who had to go through it all. My mother had never cried, she had always stayed optimistic and strong, even though it might have all been an act so as not to worry us. I was not as strong as my mother, and I cried often. Sometimes I really felt like asking mum how she managed to brave through all these hardships, and longed for her to teach me the same. The doctors and nurses were very friendly and encouraged me to channel the positive energy in me, especially during chemotherapy, as a negative and pessimistic attitude could be of no help.

After chemotherapy, I experienced extensive hair loss for the first time in my life. I was really scared, and I really wanted to ask mum what I could do about it. I started to search the Internet for better quality and beautiful hats, but I realised that there were no fashionable and classy hats made specifically for chemo patients locally. During chemotherapy, our mood and morale were generally very low, and we often looked pale and weak, and these would make me feel that I should put some effort in making myself look beautiful and presentable, so that my mood could also improve. This gave me the idea of creating my own chemotherapy hats.

As a chemotherapy patient, after losing hair, it was easy to feel uneasy as our baldness attracted unfriendly attention when we went outside, and this could cause us to have low self esteem. A friend told me that I should just bravely accept all of myself, and that hair loss was not a big deal. As long as I was brave enough to face myself, what others thought could not hurt me. After accepting this fact, I thought, since I needed to wear a hat, I must wear good-looking ones, with different styles and vibes. I wanted to cater to chemo patients, who might feel that the air was too cold or too hot more easily than people who had covered scalps, patients who might have a sensitive scalp, and so on. Various considerations are required to design a beautiful and practical hat. When fighting cancer, I was also filling up mytime with assertive actions such as these. By doing so, I wouldn't have too much time left to worry and be anxious, and I could finally treat myself like a normal person again.

Radiation therapy felt much more pleasant; it began following a short period of rest after I had completed chemotherapy. The treatment time of radiotherapy sessions was much shorter than chemotherapy (my radiotherapy session only took eight minutes), and did not hurt. When I entered the treatment room for the first time, my mood was still quite unstable, because I would be reminded of mum. The treatment room was designed so that people can really relax, listen to music, or take a nap. I always got through the sessions without noticing time had passed, as it felt so relaxing in there.

Now that I have completed the entire course of treatment, the next step is to rely on my own health management and taking good care of myself. There is no medicine that I can rely on now, which does make me feel a bit nervous. The most important thing at this time is to make adjustments in my diet and lifestyle habits.

Everyone should listen to their body, because the body usually tells you that a situation has happened and that something has gone wrong. As long as you listen carefully, you can often find out what that is. As long as you are not blinded by fear, you will be able to face anything. Even if there would be hair loss, even if the treatment would be painful, these are all circumstances that we can survive through.

A doctor friend of mine supported me during my treatment by introducing me to books, encouraging me to keep a diary, and making me list out the reasons that I believed made me sick. After reading my own list, I was surprised that I had so many bad habits that were harmful to my health, such as watching TV dramas and playing video games through the night, and liking junk food. After writing those habits down, I could plan to change them one by one, and adjust my daily routine gradually.Until now, I still often look at the plans I wrote, not just to encourage myself, but also to remind myself not to repeat my past mistakes.

The advantage of writing a diary is that when I write down my feelings, they can be released right away, so negative feelings will not accumulate, and I can also train myself to be more aware of my thought patterns so as to learn to improve. Now that I can no longer rely on my mother’s strength and guidance, I have to conquer this path on my own. I have also started toshare my cancer journey on social media platforms to give some companionship, support, and guidance to people who are also working hard to fight against the disease. Mutual information sharing is always good. For example, I may suggest to prospective chemo patients to shave their hair before starting their chemotherapy, which would prevent the pain of seeing lumps of one’s hair falling out when chemo starts. This may be something that people might not have considered.

If I have a chance to dream of my mum, I want to say sorry to her. When I saw my mother for the last time in the mourning hall, I told her to reincarnate as my baby in her next life, so that it could be my turn to take good care of her. But now I am also suffering from cancer, and I would not be able to have children right now. So if my mother did come to my dream, I want to tell her, it’s okay to not wait for me. But I will continue to fight this cancer, for her and for myself too.