18

Lessons Learnt, Wisdom Passed On

‘Healing is a matter of time, but it is also a matter of opportunity.’

—Hippocrates

I have been a relentless seeker all my life. I am as curious as a beaver. As resolute as a woodpecker.

Now that I am healed, I wish to help others. I am curious to learn how I was cured so that I can pass on my learnings to you.

I was afflicted by stage-IV cancer that had metastasized. (Yes, it wasn’t stage-III cancer as I had thought all along. I only discovered this when my lab results came out post the 10 December surgery.) I know many such patients who did not survive. Somewhere, I feel the survivors’ guilt. But I push it down, wanting to rejoice in the here and now.

Knowledge is power and being forearmed means being safe. So let me step back a little and allow you to absorb the knowledge I got from my conversations with my two life saviours—Dr Chi and Dr Makker.

Below is an excerpt of my conversation with Dr Chi:

MK: In your experience what kinds of patients do well in late stages of ovarian cancer?

Dr Chi: There are multiple factors that can predict how well a patient will respond to treatment when diagnosed with advanced ovarian cancer. These prognostic factors include:

MK: Why do you think I did well?

Dr Chi: You did well because you are young and healthy with a good nutritional status. The tumour was responsive to surgery and sensitive to chemotherapy. You received state-of-the-art surgery as well as post-operative chemotherapy.

MK: What do you have to say to those who get diagnosed with late-stage ovarian cancer?

Dr Chi: The diagnosis of advanced ovarian cancer is not a death sentence. However, there are only two factors that the doctors or patients can control once the diagnosis is made: How much cancer is left behind after surgery and what type of chemotherapy is given. Hence it is crucial that once you are diagnosed with ovarian cancer, you have to go to a centre of excellence. You did that and got the most optimal outcome.

I also had a few questions for Dr Makker.

MK: Doctor, could you please tell me about my first chemo, the allergic reaction I had and your treatment for the same?

Dr Makker: On 8 January 2013, you were given an intravenous infusion following which you complained of stomach pain, heat, sudden nausea and lower back pain. The chemo infusion was then stopped.

We restarted your chemo approximately one hour later after we treated your allergic reaction and you tolerated the rest without any issues. You had a high blood pressure of 149/103 and a heart rate of 128 when the episode started which then improved to 110/80 and 100 when the episode abated. After this you were okay.

MK: Doctor, what is your advice to patients diagnosed with cancer, especially those with late-stage diagnosis?

Dr Makker: Manisha, my general advice varies depending on their stage and also the genetic risk factors.

We always try to bolster our patients’ confidence as they learn of the diagnosis and also try to provide a great deal of emotional and psychological support [I can vouch for this as she was a great source of support during my treatment and after. She is the same with all patients.]. We also have social workers and case managers who provide a great deal of support.

A diagnosis of cancer and chemotherapy can be daunting, so we tell our patients to take things one day at a time and to focus on taking care of themselves (sleep, follow the right diet, be spiritual, exercise). We remind them that this is a marathon and not a sprint. We tell them to be proactive in communicating their needs. We also ensure that all patients get genetically tested so that we know whether there is a genetic predisposition to their disease. Further, we encourage patients to be well-read and educate themselves regarding clinical trials, especially in cases where the cancer recurs.

In terms of categories, we do that once the treatment is complete. We see how they are doing then. Patients who have disease recurrence within six months of completing their initial platinum/taxane-based chemo, that’s the group we worry the most about, and it is this group that does the least well. But there is a great deal of work that is being done with regard to clinical trials for this population of patients and also for those with more indolent diseases.

***

I remember how Dr Makker would consistently urge me to step out and enjoy the sights and sounds of New York. She encouraged me to exercise and suggested some options for clinical trials as well. She is constantly in touch with her patients and replies to all my emails. She suggested that I get a doctor in Mumbai whom she can constantly be in touch with. Wherever I am, whether in India or Nepal, Dr Makker makes sure I am doing well. Both Dr Chi and Dr Makker have set the highest benchmark for a patient–doctor relationship.

As for my questions, they continue to be numerous. Part of me desperately wants answers:

Why am I fine and why did my cousin, who was struck by cancer at the same time, pass away?

What is my role in this second chance at life?

Why did I get cancer in the first place? God dammit! Why couldn’t my lessons have been less painful?

My questions might appear ignorant, but they are an attempt to understand life’s deeper mysteries. They are born out of my journey of pain.

So the picture is clear. I survived because of all the support, medical expertise and my will power to do well.

Let this be a learning moment for all of us. Cancer can be overcome by making different choices, by being equipped with the right knowledge and having a solid support system. Unlike the Westerners, we Asians are fortunate to still have our family network intact to support us in crises.

The purpose of my book would not be complete without talking about the triggers that I feel were the cause of my cancer. I strongly believe that our emotions play a huge role in creating our reality. Emotional health is therefore crucial in keeping illnesses away. I am no doctor, but do indulge me while I play counsellor and analyse my life.

Lack of Gratitude

In the midst of my film career, while I was at my peak, I suddenly felt a deep sense of disengagement. I had everything and yet felt low.

Working on twelve films in a year, eighteen hours every single day, with three shifts in three different corners of Mumbai exhausted me. I could not handle Mumbai’s traffic jams. I could not handle the fact that I was not allowed to explore the countries we went to due to shortage of time and my workload. I could not handle myself. Was it burnout?

Maybe, but I admit I was left with no gratitude for the blessings I had. I simply did not value my good fortune.

My Emotions

I felt chaotic, and my emotional life reflected that. I latched on to romantic relationships because I felt unhappy and unloved. Instead of nurturing myself, I began seeking out nurturers. Not only did I never get them, but they left behind a lot of toxicity which I had to deal with myself. I think this build-up of emotional toxicity finally made my body collapse.

Lack of Receptivity

Somewhere down the line, I had become numb. Numb to my own emotions and to that of my family’s. I refused to listen to them. They saw me suffering, but I could not see what they (particularly my loving mother) were going through, seeing me in this state. I partied mindlessly and slogged mindlessly in my attempt to numb my own numbness. I was tired of my routine, of my heartbreaks, of the unforgiving paparazzi. Blind, stubborn and ignorant, I simply drifted along thoughtlessly.

Hormone Treatment

It hit me one day that I was about to turn forty. My body clock was ticking. I wanted babies desperately. But I knew I needed to get married fast. The man I was dating then did not see a future with me. So I dropped him and got married in a hurry. I badly wanted a home and children. It clearly was the wrong reason to get into such a sacred relationship. Much to my sorrow, it did not work out. When I felt it disintegrating, I thought perhaps a baby would make it work.

Emotionally, I was at my lowest then. Everything was going wrong. Why was my dream of a happy home collapsing? Yes, kids would save this marriage, I thought. I was not able to conceive naturally, so I went ahead and took IVF (In Vitro Fertilization) injections. Little did I know what havoc they would wreak on my body. I was BRCA-1 positive. Was it the injections that triggered my ovarian cancer? I would never know for sure as this has not been proven medically.

Wrong Lifestyle

For a decade, I had abused my body. The poor lifestyle I had been leading made my body susceptible to diseases. Had it not been cancer, some other malady would have struck me. In hindsight, on a dark, lonely night, I still wonder what it could have been and whether it would have been better or worse.

Emotional Turmoil

I have always been an emotional person, ruled by my heart and not my head. The shame of previously failed relationships was enough to make me want to make my marriage succeed. But I was also ignorant of the ways of the world. Looking back, I kept asking myself many questions.

What if I had responded differently to that argument? What if I had done the expected thing then? What if I had not been drinking? Would I have still got married had I known a nightmare awaited us?

The ifs kept going round and round in my mind like a giant Ferris wheel. But, as is always the case, one’s hindsight is always 20 by 20.

My experience has made me wiser. To all those women who feel stuck in their relationships, I have a piece of advice. Try as hard as you can, but if it seems like a situation beyond repair, please do not suffer silently. Don’t let societal shame or pressure keep you tied to a situation. Ask for help. Reach out. If you keep on enduring it silently, your body will become a host to potential diseases.

None of us know why some of us get cancer and others don’t. None of us know why some succumb to it and others recover to tell the tale. All I know is that I am one of the lucky ones and will use my life to help other women who need to learn from my experience.

I shall continue reading and seeking more answers from those who are learned or knowledgeable. And I shall continue appealing to people to change their attitude towards cancer. I feel angered by the way people treat those afflicted by it.

I remember a poverty-stricken mother telling me how her only child had been ostracized by her community after he was diagnosed with cancer. All sorts of stories began floating around, including that everyone should stay away from the ‘infection’! I want people to stop shaming those who have cancer or telling them that it is all due to their karma or past sins. All this is hogwash and nobody has the right to pass judgement on anyone afflicted by it. It is not only cruel, but criminal to do so.

Medical science is still trying to uncover the cause of cancer and it’s cure. Until then, let’s look after our bodies well. Let’s give it the gift of healthy nutrition and a balanced lifestyle.

Let’s be compassionate to the stricken. Let’s spread hope. Let’s heal each other through love and kindness. God knows the world needs more of that!