At the dentist

25072012.1623

There are going to be moments, and today I had such a moment, when I will forcefully feel the pain of having no parents... And I can only say, it is so very, very painful...

I went to the dentist, one recommended by mum, to see what can be done about my wisdom teeth. There are four which should be removed, for it will only be a matter of time till they start hurting. The big problem is, the bottom two wisdom teeth are growing horizontally, which is rare and will prove to be tricky (dangerous) to remove.

Back in Canada, the dentist told me to have them removed. But the dentist I saw today, who had helped my brother almost a decade ago with his wisdom teeth removal, told me an alternative and better solution. He recommends keeping the wisdom teeth but instead removing the teeth which are directly next to the wisdom teeth on either side of my jaw. After that, I can adjust the wisdom teeth to fill the gap left behind by the removed teeth. The roots of the teeth he recommends removing are already damaged by the horizontally placed wisdom teeth compressing on them, so he says if you remove the wisdom teeth, it will only be a matter of time till you have to remove the damaged teeth. "Why pay more and go through teeth removal twice if you don't need to?" he told me to go home and think about things, and somehow even though I've just met him, I have a lot of confidence in him. Perhaps because he came so highly recommended by my own late mother.

A lady, also a mother who was there with her son, overheard our conversation. Out of good will, she said: "Go home and ask your mama about it. You don't have to remove the wisdom teeth as other dentists tell you to..."

I know she meant well. I said nothing, but her words made me feel sudden pain and loss. I have no one to ask now. No mother who can advise me, no parent with whom I can consult from now on whenever I make a life-changing (or in this case, potentially life threatening...) decision. I really felt like crying, and telling them: "My parents are both gone... Who can I ask now for advice...?"

I thanked the dentist for his expert opinion, and said I'd go home to consider things. I left the dentist and became so sad. The streets of Taipei just felt emptier, much emptier...

Talk with the doctor

The doctor came around the usual time of a little past seven in the morning. He greeted mum, and asked her the usual questions of how she has been doing, what she has eaten and how much she excreted. It's important to keep track of all that goes in and comes out.


Before he turned to leave, he gestured to me and mouthed to me to follow him. Just me. "We never talked about what happened during the operation last week, did we?"

No, we didn't. I am anxious to know, but for several days, even till today, I was/am so worn born the tension building up to the surgery that all I needed to know was whether mum could eat again.

The doctor led me to a room and sat down at a computer. The bypass surgery was a success, and they managed to do what they set out to do, which is reroute the intestines so that mum can ingest food and drink again. The vomiting and diarrhea is normal in the beginning, and should with time subside and disappear once mum's bowels get used to the redirected flow through her body. After all, the body has been used to the "natural" flow for so many decades, and asking it to get used to a change of course takes time.

The good news is that the situation is not as severe as they suspected inside (but, still it is severe. The spread of cancer always is ...). The cause of mum's vomiting is not a recurrence in the colon, as diagnosed earlier, for the colon is very 'clean' still, even six years after her initial diagnosis and operation to remove part of the colon. The problem lies in the duodenum, the beginning section of the small intestines. The doctor showed me a power point presentation of mum's case, for it has been discussed by a number of doctors including one from internal medicine. One slide contained a picture of mum's belly with an incision. In the opening, a bundled mass of pink and red came out (WARNING: graphic pictures of what the image looked like). There was a bit around 15cm or so which the doctor pointed to and said was the 'infected' part of the duodenum.

The doctor said that section is removable. They did not do it during the last procedure for the risks associated with it is high, and they could not perform the removal when she was in a terrible condition (she still is very frail...). The doctors recommend that after mum's health is stable that perhaps she can undergo treatment to remove the cancerous part of the duodenum.

"Another surgery..." I thought to myself. Just when we thought it has finished, the doctor came back with news of another possible surgery. There is a reason why he only told me, and has not told mum yet. For it is probably too much of a shock just after one surgery to let the patient in on the possibility of another surgery coming up. It was already a shock to me, and made me rethink my plans in the coming period, and over the coming year. I thought I could make plans to go back to my own life and start pursue my dreams again, but one talk, and a lot of my imaginations and plans are now on shaky grounds..

It will be a risky operation, but if removed, then at least that bit of the body will be rid of a major source of cancer. "Fifty-fifty..."

"What do you mean by that?"

"The chance of survival if removed. " Thus the same chance, same risk if not removed.

I asked how long we need to consider this, and whether he could give us an idea of how quickly or badly the cancer will grow and spread. As expected, there was no time.

I went back to mum's room and she was of course curious why I was called out.

"Oh, the doctor said your surgery went well, and the situation is better than expected..." I held my self. I dared not look mum in the eyes for long. I felt like I was betraying her, lying to her by not immediately telling her the truth.

Forgive me mum, I need time to figure out how... I need time to process it myself and time to build up the strength to tell you in so many words so as not to scare you or disappoint you...

Critical

Mum has been in and out of sleep ever since she left the recovery room yesterday afternoon. Except for a brief few minutes when she sat up on the edge of the bed to cough, she's been in bed for three days. The morphine drips to reduce her pain also induces sleep, and in the brief moments when she's awake you could she her eye lids are extremely heavy and threatening to close at any time.

The first 72 hours after surgery is critical and the nurse comes ins every hour to check her vital signs and watch out for signs of fever.

So far, she's been alright, with just a higher than normal body temperature, and she's still expelling a lot of fluids through the tube leading from her stomach. The doctors have increased her dosage of IV drips and added more nutritious formulas, but over the long run, if she cannot get up and move around, her limbs will get bloated...

Back in Room 1

"Rest more," I said, "It's finished now..." I meant the torturous waiting, the unknown and the anxieties associated with a risky operation. It's all finished now, as far as now is concerned.

I don't know the outcome of the surgery, I don't know whether she is able to eat again, I don't know how bad the situation is inside. But all that news can wait. At least mum is conscious, at least mum is still clear minded, and she can still move and speak, though with difficulty due to the pain. But it's all finished (for?) now.

"It's been hard on you", mum said. Her eyelids were heavy, her face was tired looking, but there was a hint of renewed hope. Hope we've not had or felt in a long time.

I stroked her leg gently and massaged her fingers. "No, it wasn't... It has been much harder for you".

Life and death park

I came here last time with a friend who was visiting her ill grandmother. She knew that her dear grandmother did not have much more time left...

We sat on a bench in the corner of the "Life and Death Park", where there are various sculptures and art pieces dealing with life, farewell, bereavement and continuing life again. We sat here for a while until the mosquitoes chased us away.

She and I share similar experiences, for her mum also had colon cancer. She quit her studies for a year or so to be with her mum. I was grateful she shared her story with me, for I know how painful it must be to recount the final moments together with and the tragic loss of the dearest person in this world. I cannot begin to imagine how or whether I will be able to recount my story once the chapter of my life with mum in it has come to an end...

It was oppressive sitting in the waiting hall and watching the big display board flash mum's name every few minutes. She went in at 8.00, and so far, she's still in surgery. I felt my hands tremble, I felt my mind go wild with thoughts, I felt my eyes threatening to burst into tears. The waiting is torturous. The waiting is so hard, perhaps harder, to bear alone... But i was/ am not alone in that waiting area, for I am surrounded by dozens of relatives and family of other patients, who I can imagine are just as if not more anxious and scared as I am. As the saying goes here, the waiting and the uncertainty feels like you are "carrying your heart and your spleen is being hung" (提心吊膽)...

I accompanied mum down to the preparation room at 7.26. An orderly helped her onto a smaller bed, and mum was covered with a large quilt of that familiar green colour the medical staff wear in the operating room. Throughout the journey down to the third floor, the operating area, mum closed her eyes. I snuck my hand under the quilt and held onto her hand. Held onto her hand like I've never done before, like I've only done with my ex... Held onto her hand tightly and forcefully and yet gently to let her know that no matter what, I am right here, right here by her side. She went through two operations before, once in 2006 and once at the end of last year. I was not there either times. But I am here now, holding her hand.

Mum did not say much. At one point, while waiting in the area before being sent to the "secure" (contamination free) area, she opened her eyes and said: "Don't worry, the heavens will protect us. You let go of your heart (放心), a saying meaning do not worry.
I looked at her held her hand even tighter.

Mum was the last to be admitted into the operating area, where there are a total of 25 operating rooms. She was assigned room 23. They somehow managed to lose the signed copy of the consent form for anaesthesia (not a promising start...) and I had to sign another there and then. When we entered the area at almost a quarter to eight, it was so hectic, with nurses and doctors running around and shouting abbreviations and commands like it was the stock exchange. At the end, it was just mum and I, and a few assistants left.

They transferred her onto a ramp, for I imagine the hospital beds could not go into the contamination-free zone. The ramp was like a conveyor belt that separated the two zones, and on the other side, separated by a glass window that automatically slides up and down, a number of nurses and assistants clad completely in green received mum. Just before they took her, I held onto her hand tightly again, and kissed her on the forehead.

"Good luck! I'll be right here..." Mum replied with a nod and a faint smile.

"Relax, relax, stretch out your legs..." one of the assistants said to mum and straightened her legs, which where mangled together in a twist. I think she must have been afraid, even though earlier when I asked her whether she was afraid, she said there was nothing to be afraid of, and we have to deal with everything with equanimity.

"Sir, I'll have to ask you to leave and wait in the waiting area outside..." 

"Just another minute. I want to see..." I said as I pointed to mum, who was being slowly transported into the "secure" area on the thin trolley. Were it not for her head showing, it somehow reminded me of a body being taken to the morgue. I wanted to tap on the window to get mum's attention. I willed that she would turn her head a bit and look back, but she did not. I watched took one last look before mum her two chaperones clad in green turned a corner and vanished from sight.

I left, and was the last relative to leave the room.

Dream

After mum was wheeled into the operating room, I went up to her room to take a nap. I suddenly felt so very, very tired...

I was at the waiting area, I was not alone but with two of my cousins (from dad's side of the family). I was just sitting there waiting, playing with a piece of paper or something.

Suddenly I got up and went to the area where there is a big display board. The name of the patient being operated, what illness, the status of the patient were all displayed on there. (in the real world, there is such a display board, but it shows only the name (partly blanked out) and status of the patient: currently in operation or in recovery room).

In the dream, I saw mum's name. Behind her name in big flashing red letters, "BYPASS SURGERY", "FAILURE", "PATIENT DECEASED".

My heart tore into a thousand pieces, I broke down there and then and began howling, inconsolably howling and crying. So much pain, so much tears! My cousins rushed to hug me, but they could not touch me, for I shrugged them off and was beyond comforting. Mum was gone, and I didn't even say goodbye...

Such powerful emotions...

I woke up in a sweat.

Skype session

There were many moments when brother just looked at mum, and mum looked at brother. No words were said. Mum was still sleepy, very drowsy and tired, while brother was about to go to sleep. It's midnight in europe, and he looked tired. A couple of times, he took off his glasses and rubbed his eyes.

"Mama, you have to be strong..." brother said. That was as much as he said, and he said it several times. Again, I could feel the awkwardness, for I'm sure deep down he wanted to say much more, but he could not find the words. But I know deep down there is a heart that is racing, a mind that is frightened, and a boy longing to be at his mother's side...

"Don't worry," I said, "I'll be by her side". Brother reminded me again and again to call if there is anything.

"My mobile is on, my Skype is on. Call anytime you need to, just let me know how things go." there was a moment when it was just my brother and I speaking. He asked if I had contacted our second uncle (mum's second brother). "You know, in case something happens..."

"I know," I said, "It's been arranged. He knows."

Quarter to seven. Reluctantly, my brother hung up Skype. Mum was getting a bit irritated, and she needed to get dressed for surgery. I believe she did not sleep well, for she was a bit moody, and looked so very tired... I was disappointed, for I had hoped they would connect a bit more, perhaps say some touching things. But mum seemed to want to get back to lying down and resting.

For a few moments I massaged mum's legs, feet, arms and hands, and rubbed her back. She closed her eyes and had an expression of bliss on her face. I grabbed the family portrait I had brought with me, and places it in front of her. She took the portrait and looked at it for several minutes, studying every detail, studying our family... In the background, soothing yoga music played.

"Relax, let the doctors do their jobs. They know what they are doing, so just let go and relax..." I said. I read in a book recently that you should remind the patient to relax and ease the body, so that the muscles are not as tense and the body will be more receptive to an invasive procedure. It will make it easier for the bleeding to stop, for the body will let it's guard down, instead of resist surgical intervention and make it harder to heal.

"The deities are with us... I will recall the Bodhisattva of Mercy. And all you do for me, it's enough to make the heavens give us blessings..." mum said.

I hope so, I really do hope so.

Three hours countdown

I suddenly heard mum groan. It was just after four in the morning. She twisted and turned in bed, and was unresponsive to my questions to her. "What's wrong? Mum, tell me what's wrong...?"

"I can't say..." Something was bothering her, but she couldn't (or didn't want to) say what it was. Was it a nightmare? Was it her sore arms or legs that are keeping her from sleeping? Was it "something else" bothering her (yes, I mean the supernatural...)? She just lay there, writhed her body in apparent discomfort. Her legs were so thin and twisted in a mangle like the plastic tubes coming put of the artery in her neck.

I did what I could think of to calm my down... I massaged her arms, her legs, her feet, her hands... With each rub, each stroke, each pull and push motion, I silently wished my touch would take away whatever was bothering mum. I massaged her with love, with the love of a child, with the devotion and dedication of a child who wishes nothing more than to calm his mother's mind and spirit a few hours before a major operation-- an operation which could very well determine mum's fate and course of life...

I can only imagine, only just imagine and even that is not close enough to what she must be feeling, what she must be thinking of fearing... The heat packs I prepared for her I placed under her shoulder blades. And suddenly, in a rare moment of clarity, mum opened her eyes. "Thank you... Thank you for everything..."

Eve of the surgery

I rushed home to quickly shower and grab some things after the doctor explained to us the procedure tomorrow. I didn't really need to go home, but there were two things I wanted to do.

I got home, and knelt before dad's portrait. "Please dad, protect mum and help her surgery to go smoothly tomorrow... May she eat and drink away, may she at least enjoy some of the privileges of living by being able to taste, to digest food naturally... May she have strength again and may she have the health to live a life of happiness..." I knelt on the floor, and kowtowed with great reverence. Tears were on the rim of my eyes. It was a touching moment of just me and dad, and my prayers...

I also prayed before the little shrine mum has set up in the dining/living room area. A thought came to me out of nowhere, again the random imagination of a naive child who daydreams in order to escape from reality at times. I thought to my self and asked the deity: " if I have accumulated any good merit points in all my life, I would cash it all in and direct all the positive karma to mum in the hope that the surgery will go well, and that she will be free from her problem of not being able to eat or drink. Take my good fortunes away, take anything from me, just let mum come out alright..."

Before I left home, I did the second thing I went home to do. I grabbed the most recent family portrait, of me on the left, brother in the middle, and his wife on the right. In the foreground is mum sitting down and holding my little nephew. Our first family portrait together. "We are family..." I once commented it the portrait. We are family, and we can grow strong, be strong together, no matter what. I took that portrait, and it is now standing at an angle where mum can see from her lying down position.

Anything, anything, absolutely anything to keep the hopes up, to keep the spirit afloat and mind at ease. As I headed back to the hospital, I sat quietly in the taxi. The scenery outside was a complete blur. All I could see and imagine were scenes of "this time tomorrow"... Will mum be conscious? Will she be in the intensive care unit? Will the procedure have gone as planned? Will the doctor come out and say to me "I'm sorry, we did the best we could..."? I was again so afraid; so anxious, such a nervous wreck...

Before sleeping, I meditated a bit in front of mum. For a few moments, I places my hand on mum's belly, ad imagined... That inside, it is not so bad... that tomorrow, the doctor will open her up and easily do the procedures they had planned... That they will be able to stitch mum ip again and that the condition will be stable for some time at least...

Pray, pray, pray...

Agreement

"... The whole body anaesthesia may cause stroke, heart attack, and she may go into shock. In her state of health, there is a high risk..." the anaesthetist explained.

"What is the probability?" My mind raced with images of mum lying there connected to a life support machine. I could hear the beeping sound of her life... I could see mum lying there unconscious, all life draining from her body... Fear, such fears!

"Five percent."

Whatever the probability, we must proceed, for it is mum's wish. There is a line handwritten by the surgeon himself "If the blockage is too severe, there is the likelihood the bypass cannot be proceeded with". That line sent fear up my spine, and for a while after reading that I felt such dread, such terrible dread... What if the surgery fails? What then?

It is mum's wish to put her life ad condition in the hands of the doctors. Buy I have to sign the consent forms. Again it feels like such a heavy, heavy responsibility.

May it be that I just signed a sentence to give mum a renewed chance at life again...

A life where she can eat again, drink again, and a chance to recover some of how lost health so she can live her days happy and free from too much pain and suffering...

Skyping with grandchild

"A-ma, good luck! Good luck! I'm cheering for A-ma!" my brother said in a baby's voice. My nephew was in his arms and smiling at the video cam. I looked at mum, and she smiled. Her eyes shimmered.

Brother could only see mum lie there, weakly, lethargically. He could also see tubes now coming out of her beck, and a big two litre bag of extra nutrients the doctor prescribed for her in preparation for the surgery. For several moments, he was silent. For several moments he rubbed his eyes. What do you say... What do you say to your mother when in a few hours' time she'll be wheeled into the operation room?

I did not tell my brother about the risks. They worry me, but they are more disclaimers to ward off liability issue just in the slightest chance something terrible should go wrong... But even a slight chance is a chance, and I do not need to worry my brother unnecessarily.

"A-ma, be strong! A-ma, good luck!" my "nephew" said. It was as if through my nephew, his dad could best express his words of encouragement and love and not feel so awkward. It's a shame we grew up in a culture in which we are not so open about our feelings, and in which we find it hard to put into words sentiments like "I love you..." But we all know those sentiments are there, even if expressed through the voice of a baby.

Mum smiled and smiled. She said very little, and mostly watched her grandchild wiggle and giggle, wriggle and throw his arms around as his dad tried to hold him steady in front of the camera.

Perhaps she was thinking: "I want to see you again... I want to hold you again..." Such longings and wishes can carry someone far, far and gather the strength needed to overcome even the most challenging of obstacles.

Call

Unexpectedly, the phone rang. I did not recognise the voice, but the lady asked for me. She said she was the social worker at Hope, the foundation for cancer welfare.

She called to see how I am doing. With a lot of attention focused on my mum, rarely do people as how I am doing. I almost cried when she asked. I forced a smile, said "I'm coping". She could hear it was a forced smiled.

"You have to eat well and sleep well. I know it's hard."

I told her about my dreams, about how I do eat, but more out of necessity than anything else. I haven't lost too much weight in the past three months, but people say I have grown thinner, visibly bonier. I know I am at the limits of my patients, I am being tested and driven to the limits of my mental and physical tolerance. Perhaps it is a good thing that I notice it, for otherwise, I might just press on and on and on and suddenly without realising it, break down. If I notice that I am frustrated, troubled, fearing even in my sleep, then I can do something about it; at least I can warn myself, warm my body and my mind, to beware, to take things easier.

It is so much harder when there is nobody at my side with whom I could talk to... There is really nobody here I am close to, with whom I can turn to and pour my frustrations and fears out.

"You have to take care of yourself, or otherwise how can you take care of your mother?" the lady kindly said. She's probably seen plenty of cases of "carer fatigue"-- situations when a carer becomes so overwhelmed s/he becomes overly burdened, depressed, angry, or perhaps even suicidal and loses interest and hope in everything. Absolutely everything.

I am getting help, for a carer is coming tonight to help out just before the operation tomorrow early in the morning. And in less than two weeks, brother and his family (the "European Support Group") are scheduled to return. I am hoping, unlike last time, they will provide some relief and allow me time off so I can go off on my own. I need it. I desperately need time on my own.

"Thank you for calling and being so concerned," I said.

"Don't thank me. I really am concerned..." she answered.

That was touching, for though we have only met and spoken twice, she could see I am struggling. Struggling from day to day, struggling to find rarer occasions to be on my own, struggling to come to terms with all the invasive treatments that seem only to make my mum ever weaker, and ever weaker...

Pre-surgery preparation

The nurse showed us a video explaining the procedure and what the patient and the relatives have to be aware of before and after the surgery.

Mum says she's seen it before, back in December when she had her last surgery. A lot of the information I know from practice, after I returned and was suddenly thrown into the "deep end" of taking care of mum.

Breathing exercises, getting out of bed, exercises of the limbs, lung expansion exercises, phloem extraction, etc, etc... To think, just three months ago, mum went through all this, and how wrong I was then to think that that would be the last major procedure mum has to go through...

I suddenly have these pangs of fear, exacerbated when I look at mum and see how sickly she is. She is so thin, so frail, in a lot of discomfort. It really pains my heart, really wrenches my soul seeing mum like this, and knowing that this time tomorrow she'll most likely be in the operation room...

I am so afraid... Never have I felt such levels of anxiety, and tomorrow I will know what it feels like to be waiting outside the operation room, to wait and wait and wait and wonder what is happening, wonder if mum is still ok, if mum is still with us... But the doctors know what they are doing, I must trust them and have faith in their professionalism. All I need to do is sign the agreement to proceed.

I will be all alone tomorrow... All alone while I wait and wait.

Killing her softly

Am I really so evil, as mum implies, and do I really want to just send her to the hospice and let her die there...?

Another eruption this morning, as mum was moody and so was I. She kept on telling me go get a carer, which I have already asked for yesterday. But since it's a big holiday coming up (Tomb Sweeping Festival) a lot of people are off and it's hard to find someone. I think she's getting irritated because I'm around most of the time. She worries that i might get too tired, but what else can i do? Now there's only me, and noone else. I'm just waiting for a call from the agency to send someone over.

Perhaps it's me who's getting irritated and frustrated of all this waiting and just seeing her get thinner and weaker, surviving only on IV drips. But really when we're together, except for music or the tv in the background, there's very little talking. I can only watch her lie there, seemingly in a lot of discomfort, and yet when I ask her what's wrong, often she doesn't say anything...

Am I doing something wrong? I'm just here standing by to do something if she needs me to. What is wrong then?

Again she said I just want to send her to the hospice and let her die. But I never said that. Why would I even want that? How terrible that would be! She said she wants to five the bypass surgery a try and that she has faith in the doctors. After she said that, I stopped raising issues about risks and about the surgery being too risky in her state of health. It's not for me to assess, but for the doctors to know what to do best and what the risks are. I can only stand by, and with what rudimentary knowledge o have of medicine, let mum know what the doctors told me and what I fear are the likely consequences...

How painful it feels to be so misunderstood...! Is the problem really me, me being stubborn and too conservative about taking risks? It's painful to see mum get so upset... I'm just trying to do my best, but she seems to think I wish her to die quickly and die a painful, slow death from starvation...

Assessment

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The doctor came in just as I was stirring from my sleep. He came with an entourage of younger doctors and didn't say much. But he was kind, caring and soft spoken when he did speak. Contrary to what he said to us about not being here this week, he was here after all. I guess he only said it to put us off waiting for him and being seen by him, but in the end mum's desperate plea moved him.

The surgeon lifted mum's clothes to feel mum's belly. I felt it before, and there is clearly a hard lump there, which with my rudimentary knowledge of medicine I can only imagine is the culprit tumour that has caused all this vomiting and mum's dramatic weight loss. The surgeon said he could operate on mum as soon as tomorrow.

"Tomorrow?" both mum and I were surprised, but the surgeon said her condition is good enough to operate, and the surgery shouldn't be too difficult. It has to be done soon though, otherwise mum will continue to get dangerously thinner and thinner.
A few moments later, after hearing the medical team converse in the corridor, the surgeon came back to say perhaps it's best to wait a bit, while in the mean time they can further assess mum's condition and review scans that were taken to better plan the surgery. They should have a "game plan" soon.

Mum's spirit immediately brightened up after the surgeon paid her a visit. It is the kind of confidence and hope she needs to undergo another surgery and to have a speedy recovery. Other than being physically fit to operate, the patient should have faith in the medical team and faith in getting better. And with this surgeon, mum has it. Perhaps, if mum does not get irreparably weak, it is all worth the long wait.

Perhaps, it will be worth all the wait and pain of all that vomiting, and all those sleepless nights worrying and wondering whether mum will make it...

Decision

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Mum and I pleaded with the surgeon. He came highly recommended, a well regarded specialist in colon and rectal surgery, who even operated on a former president. Earlier this week the same surgeon operated on mum's brother to remove a lump in his colon.
Mum waited almost two weeks to be seen by this surgeon, and she was not easily going to give up.

The surgeon explained, confirming the oncologist's diagnosis, that the cancer had spread to the duodenum and was blocking food from leaving the stomach and entering the small intestines. The vomiting is a "naturally" (it's far from natural... But it's what happens when there's a severe blockage.) reflex of the stomach to eject everything out the way it came in; through the mouth thus. It's very serious, and the doctor said it must be operated on. Either to remove the blockage, or as is very likely the case, to put in a bypass duct to redirect the flow of flood past the tumour.

At least we knew and confirmed the cause of the vomiting, even though it was very hard and difficult news to... (literally, pun intended, if it's not too crude...) digest.

Then came the bad news.

"You can go see the surgeon who operates on you before. I have too many patients..." the surgeon said, referring to the surgeon who performed the operation to remove the original colon cancer back in May 2006, on Mother's Day of all days. Mum's face turned when she heard that the surgeon did not want to treat her. She looked so small and sad slumped away in the chair, even smaller and sadder now that she lost so much weight...

But mum has not seen that surgeon for almost six years, on account of his poor attitude and lack of compassion toward her. Mum was assigned to him by the ER ward after a routine checkup (arranged by my dad, who pushed mum to get checked...) revealed the Stage III tumour there. She did not choose him, and did not look around for a surgeon she was confident with or trusted (which is often done here... Patients can choose and pick their doctors). On a return visit after the surgery, mum complained that she was feeling very tired and drained of all energy. That surgeon replied: "Tired?! Can civil servants ever be as tired as doctors?" No need to explain why mum never went back to see him.

Mum narrated the experience to the new colo-rectal surgeon, who is the head of the department at the hospital and well respected. He was unmoved for a while, and kept on saying he simply had too many patients to deal with, and that he was simply overwhelmed with work. But mum and I persisted and tried to persuade him to change his mind. For a while, mum just sat there, and it was a tense moment, and I was half expecting, half fearing the surgeon would throw us out of his consultation room. I felt like crying.

The surgeon sat there and was quiet as mum continued to plead her case. "I've not been able to eat for three weeks, and I've waited so long to see you." The surgeon said he could not take her, for he would not be there the following week to assess mum's case, and that this would endanger mum's health. But mum pleaded more, and my aunt (who was with us, and whose husband was operated by the surgeon a few days earlier...) added a few words too. "Please doctor, we know you a good doctor, please don't refuse us..."

But something moved the surgeon eventually. When he heard mum's complaint about his colleague he finally said that there are some doctors who will only take "good patients", ie patients who have a good chance of recovery and surviving. He never mentioned mum's surgeon six years ago by name, but from his words and tone, and from the way he was forcing a smile, it was as if he was implying his colleague was one of these doctors.

Eventually, after listening to us for almost ten minutes, the surgeon finally said: "You're really willing to wait? I won't be able to do anything until the week after." The surgeon was somehow moved, and despite his initial resistance to taking the case, he relented and said he could make time and make sure a bed is freed up for mum.

And mum quickly agreed to wait. There was a look of relief on her face, as if half her worries have gone.

"You can go to ER and get some care and treatment before the surgery. Or you can go home till we call you." the nurse told us. Mum chose, of course, the latter. Home meant better sleep quality, better comfort, less noise, even if mum has not been able to sleep much and any good anywhere...

We returned home, i wondered how long it would be before we were called in, and how long it would be before mum receives some kind of treatment.

But at least we have some hope yet.

Further steps...

There it is... the cause of all of mum's misery over the past year, the cause of all the upset, sleepless nights, torturous waking moments, and mindless worrying and tears.

The surgeon who operated on mum sat us, mum, brother and I, down and explained to us what he had done and could not do. The picture clearly shows a large lump encircling the seventh section of the spine down. The "dark" bit is the large tumour measuring some 10 centimetres or so across. And clearly visible is that part of the spinal column, much of which has been "eaten" away by the cancer...

The surgery twelve days ago was a success in that that part of the spine has been cleaned and cleared of as much of the tumour as possible. The spinal column that has rotted away was removed, and replaced with an column. The doctor took out his iPhone and showed us a picture he had taken during the surgery. A large gaping wound held open by metallic supports... I could see what I believe is the nerve, a pinkish long, tube-like structure that extended from the top to the bottom of the incision. There was a lot of blood... I grimaced, and thought about how mum was in that operating room all by herself. Where was I? Still flying, still trying to rush home as quickly as I could...

But mum is not yet clear. A few sections down, around section C8 and T2 there are small traces of the cancer spreading. The kind surgeon said his job is finished, but he recommends further treatment to prevent the possibility of the small traces of the tumour from growing larger. After all, when the cancer in the spine was confirmed around this time last year, she was given the option to operate, which she put off until almost two weeks ago. Within a year, the original tumour grew from a small bit compressing on the spine to a tumour which completely encompassed that region of the spine and which had eaten away the local spinal chord... Cancer is that scary, that rapid, that ruthless...

The parts of the spine with traces of the spreading cancer are localised and small in comparison to the tumour that was just removed. The surgeon said it was too risky to perform surgery, and recommends a new treatment that has only been available for around a decade or so.

The Cyberknife... a form of radiotherapy which uses extremely precise and concentrated lasers to target the problem area, with less side-effects than traditional radiotherapy (which mum received back in April-early June last year...). Some claim that it is very effective, but as it is still a relatively new treatment, there has not been much clinical evidence to support its effectiveness in the long run. And of course, with cancer, every patient responds differently to the treatment...

I could see brother was obviously very effected, for he had no clue about this and was not briefed before today's meeting. I only told him that it's an important one, and that he should be there. My facebook status this morning was "Bravely face everything...", something which he "liked". Perhaps after the consultation with the doctor, he would not be so sure any more...

We asked the doctor a few more questions, and he said he would refer us to a colleague of his at another hospital. Mum can do precise MRI scans and tests in the coming days, and the files will be transferred to the other hospital, and we were advised to make an appointment with this other doctor, who happens to be the head of Neurology.

Afterwards, the three of us sat down and discussed the matter. Mum wants to press forward, to go ahead with the treatment and asked me to make an appointment with the other doctor. I made one. For this coming Saturday.

Mum was confident, and said that she wants to get better. She said hearing the diagnosis from the surgeon who operated on her, and knowing that much of the life threatening and pain-inducing tumour has been removed, she feels lie she has a renewed license to live. She proudly told the surgeon that she wants to go travel. She told him she wants to go attend my graduation in June, and said that I study at McGill... She was very confident, very proud, but brother looked deflated and sad...

And me? What was I feeling? We just have to "bravely face everything" that comes our way...

it's not over yet..

The surgery may be over, but the worst is not... Coming Monday, we will need to decide what step to take next

Completely drained....

I'm so exhausted I can barely keep my eyes open... So very tired from being awake and alert and responsive to mum's every need, and from sleeping terribly on the foldable sofa. So very tired I can type no more and must retire... And yet even when I sleep, my mind is bombarded and laden with thoughts, with dreams, with images of my ex...

There is no rest, no real rest...

For now I will just say a lot will be decided in the coming days, and it will very much be life threatening and -changing...Though the surgery was a success, but it did not completely get rid of her cancer...

Happy new year

Final half an hour of the new year. Sitting in the bright corridor of ward 172 at the Taipei Veterans General Hospital, just outside mum's room.  I never imagined I would be spending this new year in Taiwan (again...). I thought I would spend it with friends, or alone at home. But I'm glad in a way I'll be welcoming 2012 with mum, even though she's already fast asleep. On the glass window of mum's room I placed some pictures and little notes. Something I enjoy doing, and something I thought would add a little touch of humanness and care to the hospital ward. "Happy new year" one said, and the other ＂Thank you for all your hard work". The latter note is directed at everyone, the nurses and doctors who work day and night to alleviate the pain and suffering of so many. But the note is also directed at the patients and relatives who struggle everyday against illness, anxiety, and fear... We have all worked very hard... All of us... Fifteen minutes till the new year, till the old is over and done with. Overall, it's been a tough year, and filled with a lot of downs, having to face a long-drawn out breakup, the prsopect of losing the best and closest friend I have ever had, and having to continuously face mum's  deteriorating health condition and brushes with physical disability, and death... But there too have been wonderful times... My first true love, which was so deep, so real, so very beautiful... the wedding of my brother... realising the dream of traveling with mum to Canada... Taking the first step to immigrating permanently... the birth of my nephew... and completion of my thesis after three long years. It has not been easy, but life never is... Hopefully the coming year will be filled with more positive energy and beautiful moments with people who make me smile and who touch my heart, and that my hopes and aspirations will begin to be realised. The final countdown... The sprawling city before me flashes with colourful explosions and sparks. Behind the dark silhouette of the Yuanshan mountain range, the spire of Taipei 101 glows bright with an impressive display of lights and fireworks. 2012 is here finally... I look down at the world beneath my feet and silently wished... May all beings be happy, may all beings be free. May mum regain her health, may she soon recover...  May I be strong, may I be filled with the compassion and love I need, and more, to carry me through difficult and testing times...  Happy new year... May it be a happy one.