Truly Happy

"No, I don't want any more chemo!"

 The adamant voice belonged to S, an attractive young lady in her late 30s, with a beautiful silk scarf tied around her head, concealing what chemotherapy robbed her of. Her make-up was neatly done up; she wouldn't have looked out of place in an upscale shopping mall. Instead, she was standing in the Oncology ward of the Singapore General Hospital.

 "I don't want any more chemo, and that's final. I just want to go home!" S was diagnosed with a locally advanced cervical cancer, which pressed on both her kidney urine tubes, causing obstruction and worsening of kidney function. A different line of chemotherapy would offer a small chance of shrinking the tumour, but S was well aware that the chances were slim as her cancer had not responded well to previous treatment regimens. Her blood counts were still slowly rising from the last chemotherapy session, but it was hardly safe for her to go home with a worsening kidney problem.

Options were discussed again – chemotherapy versus insertion of tubes to release the obstruction in her kidneys and divert the urine. The diagrams of her kidney and the tumour were drawn and redrawn – S could probably draw them herself after all this time. Neither were attractive options for someone in her prime.

S finally agreed to the latter option, buying herself some time, but stood firm on refusing chemotherapy. The despair in the eyes of her family were ill-concealed – mixed feelings at seeing a loved one reject treatment, yet knowing that treatment itself was no guarantee of a cure.

The urine tube went in uneventfully enough. S chaffed at having to learn how to care for the tube, but that good humour was due mainly to the promise of being able to go home soon. "I want to go on a trip with my family," she randomly let on one evening, as I walked by her bed on my rounds. S wanted to go on a trip with her family in her last few months – maybe Hong Kong, she mused. She knew that refusing chemotherapy meant that she would succumb to the cancer sooner, but she was hardly one to bemoan her fate. Living her life with the shadow of death at door's step was something she accepted but she wanted to live her last few months doing the things she wanted. S was soon stable enough to go home, albeit armed with a follow-up appointment with Palliative Medicine.

Two months later, my walk-in clinic session at NCC Oncology was briefly interrupted by a phone call. It was from a Palliative Medicine consultant who rang to let me know that S was coming in for some symptoms. S? That name sounded vaguely familiar then. Fifteen minutes later, in walked that same attractive young lady with her signature headscarf. This time round, looking more worn than I remembered. 

 "How are you today?" I asked. S looked at me for a moment, before recognition lit in her eyes. "Ah, it’s you again!" She was having severe symptoms of pain, nausea and vomiting. S did not want to be admitted. As my fingers tapped the keyboard for a prescription, we chatted about her recent activities. She had just returned from a family trip to Cameron Highlands. The furrows of pain in her face were smoothened for a moment as she waxed lyrical about the cool weather and strawberry picking. The grunt of the printer laboriously churning out her prescription jolted her out of her happy recounting. "Well, maybe I'll get a chance to go on another trip? Thanks again for your help!" She plucked the prescription from my hand and moved slowly out of the room. 

 I watched the door shut gently behind her as silence fell across the small consult room. Dylan Thomas' poem surfaced in my mind.

 "Do not go gentle into that good night,

Old age should burn and rave at close of day;

Rage, rage against the dying of the light..."

 It is only human to choose life over death, but what happens when the option of life is questionable in itself? How would you choose to live out your final days? 

 A death sentence chained to her neck, she chose her own path. To fulfil her final wishes. To be with her family. To be truly happy.