How does a mother spend her birthday when her daughter is diagnosed with cancer? Or undergoes life-threatening surgery?

Part I of this entry here.

After discovering a tumour from an ad hoc scan in September 2007, my parents and I met with emergency consultation the day we were scheduled to fly out to Europe for a family reunion on the Mediterranean. We met with the thoracic specialist early that Friday morning, solemn and hopeful. From the results of tests carried out the previous day, it was determined quite clearly that there was a tumour in my chest, of a size and location definitely considerable for surgical removal: the mass was obstructing the superior vena cava, condition known as SVCO (obstruction), restricting blood flow, and hence I was congested chest up. For visible symptoms to be so exaggerated — even though the good doctor only had my Dad's wallet-size family portrait of the 14 year-old me to compare — the pressure caused by the tumour was more than substantial, even dangerous. I processed the idea that every time I lied down to sleep, completely horizontally, without propping up my head and chest, there was a chance I could've slipped into a coma.

I now think about that, sometimes. Before I fall asleep, with my eyes closed, I wonder, seriously, what if I don't wake up? But that's a whole list of what ifs.

Apart from the biopsy scheduled for that same day, to ascertain histology of the tumour, and the PET scan arranged for the following Monday for an all-over screening, surgery to remove the damn thing was also 'penciled in' for Tuesday. Regardless of what this mass is, whether parts of it have congregated elsewhere, it is too large, and already jeopardising major bodily functions for it not to be removed. And if the internationally renowned expert in minimally invasive surgery believes this isn't a procedure to be done minimally, then I guess there's no choice but to get right in there.

I remember everyone tiptoed around the label 'cancer', it was the unspeakable, the dirty word. Not knowing at that point whether the tumour was benign or malignant, we were still in shock with everything happening so fast that we couldn't quite wrap our heads around the idea of the big C.


I was admitted into hospital straight after the consultation, mainly so I could sleep with my upper body raised. We often referred, unconsciously, to Union Hospital as the 'hotel'. With in-room fridge (no, not exactly a mini-bar), LCD TV with cable, DVD player, wireless internet, bath toiletries from Kiehl's, and a choice of morning newspaper, optional private nurse and bodyguard at admission, it sure as hell felt like a 5-star luxury retreat. We, of course, had a room with a view.

Ann arrived from London on Friday evening, concerned, but relieved to be able to share the apprehension and confusion my parents and I were going through. Our poor brother, on the other hand, hit jackpot scoring air miles. Despite his discovering the change of plans while on transit in Dubai, he still had to fly to Venice, and back, since his luggage was transferred directly from Australia to Italy. Four days of airport transfers, an overnight stay in Venice — at a fully booked hotel where he had to reinstate accommodation on site which we had over zealously cancelled from London — and more layovers at Dubai International later, he arrived at the hospital, worn out and unshaven, looking very much like a terrorist.

My mother accepted birthday phone calls and wishes only in brief that day, keeping conversations sweet and short. It was also her way of dealing — one of her children's constitution is under attack, the family is reeling in shock, the birthday can 'jolly well' wait.

By the weekend, my parents announced the situation to our extended family, and I called a selected few friends personally to share news of the impending surgery. It's strongly believed in my family never to impart negative news to those in celebration, a Chinese tradition that we adhere to quite earnestly. I remember the conversation online with my dear friend, Chris, on the eve of surgery, was especially difficult. It was his birthday and I didn't want to avoid chatting with him, to miss out on wishing him the best on his special day, but it was tough skirting questions like 'Why aren't you sailing through the Mediterranean already?' To prevent unnecessary concern, my usual tact, I expressly didn't want the situation to be widely publicised until after the procedure, which I believed without a doubt would be completely successful. Even then, I held off directly notifying friends celebrating arrivals of newborn, or those on nuptials.

We filled a full room that Sunday when the entire Leung family gathered for dim sum brunch. I felt a strong sense of support and generosity from my aunties, uncles, and cousins. The eyeliner that day wouldn't glide on because my eye lids, too, were swollen. Along the same vein, or rather, the lack of one, the needle for the scan the following day was administered in my left inner ankle, since my arms were too engorged to find blood flow superficially. A prick in the foot is not so newsworthy when one has their feet up, but walking back and forth to the bathroom with a needle up my ankle to pass out contrast fluid was just bloody annoying.

September 25 of 2007 was Mid-Autumn festival, also my mother's lunar birthday, and just five days since initial diagnosis. I woke up early to get ready for surgery, and wished Mom a 'happy birthday' for the second time since the weekend. She had stayed with me at the hospital the night before, on the fold-out sofa for visitors, another perk at the 'hotel'. I took extra time looking at myself in the mirror that evening, flattening my open palm against the skin in the centre of my chest, lingering over the smoothness, savouring over the even skin, accepting from the next day onwards, I would be scarred, for life. 

A mediastinal sternotomy is surgical incision of the sternum — yes, ripping open the bone that is the central pillar connecting and supporting the rib cage — through to the partition between the left and right thoracic cavities. With the size and location of the tumour, the cut would begin from just beneath my collar bone, then all the way down to the end of the sternum. Nine raw inches down my front.

Everything was hazy when I woke up. I heard voices first, even while the bed was moving. The nurses and the anesthetist were telling me to wake up. My first thought was that I couldn't breathe, probably due to the heaviness I felt in my chest. When the bed was still, I took stock of my surroundings, and then registered I was in the ICU. I laid still, and despite being too weak and numb to feel much, I knew there were tubes coming out of me: a drip in right arm; drainage tube on the right beneath the rib cage; catheter from between my thighs; something going on in my left ankle; and an injection pod on my left wrist. I stared down my front which was bandaged very lightly and neatly, but it felt incredibly heavy, almost oppressive, like a breast plate of a gladiator's armour.

The lighting in the room was disorientingly dark, I couldn't place what time of day it was. I first saw Joey and Dad, who announced that I had just won a huge battle. Then Mom and Ann. From their expressions, their intense concern, I sensed that something went beyond expectations. What happened? Mom began to speak but was so muddled and convoluted in her overwhelmed state that I just turned to Ann for complete sentences. Instead, the only thing I remember before slipping into morphine oblivion was something ethereal, a distinct physical presence on the left of the bed. It was so strong that I specifically stared at the empty spot on the floor. It was a warm, kind and loving energy. It was male, and elderly.

It was later recounted to me that the 7 hours I slept through in surgery were nothing short of a miracle. What the attending surgeon saw once I was carved open was much larger and positioned much worse than the relatively simple tumour resection that he had anticipated. The tumour, 9 cm in diametre, was situated so that it could not have been clearly and entirely detected via imaging, and had invaded into part of the superior vena cava, as well as connecting sections of major blood vessels leading to the head. He had to break away from the theatre, consult with my parents explaining the situation and offered one option: close me back up directly, administer chemo in the hope of reducing the size of the tumour, with a prognosis of just 6 months. That, to my parents, was not an option at all.

The idea of removing the damaged sections of the veins and transplanting a synthetic graft was then conceived, and my parents were required to authorise separate consent for the procedure on my behalf. The complex nature of the procedure at the most intricate area of anatomy meant the attending could not undertake this surgery on his own. It just so happened, a trusted colleague — another distinguished surgeon — was supervising in the neighbouring theatre, and could immediately scrub into mine. The hospital was not equipped with a graft of this particular shape, but there just so happened to be a suitable Y-shape ready and available at a nearby hospital. There also just so happened to be enough compatible blood reserves for my extended time (from the original plan of only 2 hours) under the knife.

I, it just so happened, lived.

On this same day of surgery, the spawn laid in Dad's aquarium hatched into hundreds of little fishes.

Highlights: Cancer Talk