By Lance Isidore Catedral
At 4 PM, when most government offices were about to close, when cars were trapped in Metro Manila traffic, when students and employees fought for space in the MRT, the queue of new patients outside the Medical Oncology Clinic was as long as when the day had begun. On my table was the pile of new charts still unopened—each cream-colored folder bearing the name of a human being waiting to be called in.
The waiting area smelled of clothes drenched in sweat, what with the tropical afternoon heat and humidity. These people came from all over the Philippines—a country of seven thousand islands, blessed with year-long sunshine and white sand beaches and broad smiles but plagued with poverty and corruption. They brought with them tumors of different sizes and shapes, of varying degrees of aggression, in various parts of their anatomy. Perhaps many of them wondered, during this long wait, if they would live long enough to their son’s graduation or if they could still blow next year’s birthday candle.
For the rich and powerful, who could afford air-conditioned lounges in the most exclusive of hospitals, this long waiting time would be a waste, but for many of them who could barely even afford a complete blood count, this was a step closer to cure—if it existed at all.
Somewhere in the thick crowd was a woman named Faith whose folder sat at the top of the pile. She was twenty-three years old. She came from a nearby province, an hour away from Manila. As I called her name through the microphone, my voice reverberated throughout the Cancer Institute. But there was no commotion, no indication that someone was approaching the consultation room. Just as I was about to call the next name on the pile, a man—the patient’s father—told me that she was too heavy to carry, that she was in the opposite end of the hall, and begged if I could go to her instead.
Faith lay on a narrow metallic stretcher, listening to music with her earphones, a distraction from reality. Her left forearm was amputated when a tumor appeared in her wrist two years ago. The tumor was cancer—mesenchymal chondrosarcoma, the biopsy had read. She said yes, without hesitation, to amputation. She had just graduated with a computer science degree and landed a stable IT job. No cancer was going to hold her back.
Months after surgery, she felt a lump in her lower spine. It grew larger by the day, a threatening mass that would usher another chapter of her life. This time, she needed chemotherapy. She went to a private hospital where she finished four cycles of chemotherapy. It only made her a little better; the mass had not disappeared completely but was at least as big as a basketball. Her treatment—which included expensive chemotherapy medications, admission to a private room every three weeks, and expensive laboratory and imaging tests—caused a financial strain on her family. Her father was a traffic enforcer, her mother a housewife. In the Philippines, people pay for their treatment out of their pockets. PhilHealth, the government-run health insurance provider, only paid for her treatment partially. With no other options left, her family opted to bring her to a public hospital like ours.
I met her with the assurance that I would do everything I could to help her. As a practicing medical oncologist in the country’s largest public hospital, this meant me giving the best concoction of chemotherapy medications available, but this also meant I would take on the role of a social worker. What difference would an ambitious, evidence-based treatment strategy mean to her if she wouldn’t be able to get the medications she actually needed?
Cancer takes a toll, even in middle-class families. Some sell their small pieces of land, or have their kids stop schooling to save on tuition, or work additional jobs, to pay for treatment. Even curable cancers become death sentences for those who do not have the financial means.
For the next weeks, her parents and brothers would fall in line in offices of government officials who gave checks worth a few thousand pesos—not much compared to the overall cost of her treatment but, when put together, amounted to a substantial amount, sufficient to tide her for at least three cycles of chemotherapy.
“Do you want to go through with this?” I asked Faith when she got confined. Her mass had grown in size during the waiting period, and it looked like she had a massive backpack in her sacrum.
“Yes, of course,” she said. She asked if she would ever get better—the perpetual question, the answer to which was never a simple yes or no. If only life were simpler.
“Let’s hope so,” I said. “This is your best fighting chance.”
Faith’s first cycle did not go without any complications; she suffered severe neutropenia and did not feel well for many days. I discharged her after a few more days, only to have her readmitted for the next cycle.
When I go home after tiring days in the hospital, I often dream of the time when cancer will become as easily treatable as a simple skin infection and we don’t have to worry about the cost of treatment. It is a dream that pushes me, and the strong and optimistic army of physicians in the country, to do what we can, given our limited resources.
But my patients’ hope springs eternal—not just Faith’s but of most of the names in the chart pile. At the end of the day, no charts remain on my table, only unopened gifts—warm meals, fresh fruits picked from the backyard, pieces of candies, and slices of pies, whatever these patients could muster, their gratitude overflowing despite their poverty. If only to offer them, the underprivileged, a chance at a cure, all my exhaustion will have been worth it.