The doctor announces war at 2 in the afternoon one Saturday in February.
It was not a war she was prepared to battle, not this adversary, not on this battlefield, and positively not while wearing a borrowed hospital gown printed with pretty pink blooms.
Gia Sison never wore skirts. Her storage room was bare of florals. She strolled into hospital rooms in dark slacks and brilliant blouses, stethoscope circled inside her purse, checklists saved on her telephone. She knew how to snap out requests, how to calm a patient into submission, how to guarantee and demur, order and request. All of a sudden there she was a patient in her own hospital, helpless before a kindly nurse who gave her a folded hospital gown and guaranteed her the wait wouldn’t be long.
On whatever other day, there would have been no requirement for consolation. Hospitals console Gia. She had gone to school with the surgeon waiting outside the white-tiled room. She had strolled the wards on the floors above. She knew the 5 radiologists looking through the glass, every one of them looking for a mass that might possibly have developed inside Gia.
The voice over the microphone advised her to remain still. The plates were anticipated onto a white screen.
Gia saw the lymph nodes that had gone dim under her armpit. She saw the mass blossoming inside her left breast. She comprehended what it all meant, and for the first time in her life, Gia Sison, MD, wished genuinely that she had never become a doctor.
Outside the radiology lab, in the reading room, medical personnel gather over the plates.
Gia didn’t ask them what they thought. She didn’t get some information about biopsies or lumpectomies or the possibility the masses were benign. She made inquiry.
How long, she asked, will I have before I die?
Gia was a doctor specializing in occupational medicine. She advocated for better workplace conditions, had worked with both the Livestrong Foundation and the World Health Organization. She served employees whose complaints ran from cholesterol to cancer.
On February 25, 2013, Gia was at home, on the telephone with her dad, who had called asking for advice on employee health care. It was a long call.
Gia moved the telephone from her right hand to one side.
She felt a hard bump when her hand brushed past her breast.
She told to her dad she would call him back.
She felt the mass. It was huge, and of no specific shape. The lump moved when she pushed.
Gia Sison was a conclusive woman. She paid for bills as they came. She believed there are always two choices, yes and no. She was efficient. She had objectives. She worked hard. Indeed, even her nostalgia found its proper place, in a blog, where life lessons were ordered, identified and documented consistently.
It was a similar efficiency that drove her to that moment, under 24 hours after she found the lump under her arm, when she remained in a white room with a machine scanning her breasts.
“At that moment,” she said, “I wanted to kneel down at that hospital corridor and beg God to give me back my life.”
She got a hold of herself and turned to the surgeon. It didn’t make a difference that a biopsy was still required. Lines had been drawn. She was the soldier who ended up in enemy territory, with a broken leg and no ammunition, wailing over the radio for troops to fire on her position.
Cut off my breast, she said. Just cut it off.
Into the breach
Gia Sison had a happy childhood. She had a happy adolescence. She had, and keeps on having, a happy marriage with an emergency room doctor she joyously confesses to having courted and pursued.
She knew individuals who had cancer, had treated them herself. She comprehended it was always a tragic thing, an awful thing, and that despite the extensive list of treatments, a cancer diagnosis was always a dangerous diagnosis.
She had told patients self-breast exams could spare their lives. She had shaken her head over late detection. She was annoying and requesting and sympathetic at the same time, and all that time, she never examined herself.
It was not among her list of concerns.
The Philippines has the highest incidence of breast cancer in Asia. The Philippine Society of Medical Oncology says an expected 3 out of 100 Filipino women will get the contract before age 75. One out of 100 will die before age 75. Breast cancer is the most well-known cancer in the nation, including 16% of the 80,000 new cancer cases in 2010.
The causes for breast cancer are yet to be resolved. Heredity is a risk factor. So is age. Three quarters of all analyzed cases are beyond the age of 50, with 2 out of 3 invasive breast cancers found in women over 65.
Gia Sison’s family had no history of cancer. Her parents were healthy and alive. Gia was 43 years of age on the day of her mammogram.
On that day, frightened and out of her depth, she told herself to hold up. She removed the hospital gown. She put on her shirt. She went to a meeting. She got into the car. She made calls while she drove.
The radio was playing “Staying Alive.”
Under the knife
There are 5 established psychological stages for cancer patients – denial, anger, bargaining, depression, and acceptance.
Gia avoided every one of them, and shot straight to the last. She accepted. She had no doubt she had disease.
At the point when the results came in, she was determined to have Invasive Ductal Carcinoma Breast Cancer, Stage 2A.
Within Gia’s body, normal cells were still being born, as yet developing, still living and functioning and dying to make room for new cells.
Inside her left breast, in the nodes under her armpit, gathered in the hard lump she found that evening in February, another system of cells was in quiet revolt. The cells, curved by mutation and biochemistry, walked endlessly, living and reproducing and never dying, a relentless army threatening to overpower one organ after another.
A mastectomy would increase Gia’s chances of surviving past 5 years by 70%. Chemotherapy would raise her chances by another 15.
She was relieved when the news came. It was better than the waiting. She revealed to her little girls that mother was sick, but that she would fight.
It wasn’t losing a breast that Gia feared. Long before the final diagnosis came in, she had as of now assigned her left breast as collateral damage. She feared the pain.
“I had never been confined in a hospital,” she said, “not from the time I was a fetus until I was 44 years old. And suddenly I had cancer.”
Her husband was with her when she was wheeled into the operating room. She was anxious, however happy he was there. She requested for herself a dose of Dormicum to calm her nerves.
“It was the doctor in me, still prescribing,” she laughed. “I was acting like a dictator in the ER.”
Every individual in the fluorescent-lit room was a friend. Most were from her medical school class. They played music. They gossiped about old issues. Gia was an eager member.
It was her old professor who cupped the mask over Gia’s mouth.
“I’m putting you to sleep now. It’ll be fine. God’s hands are on you.”
Gia cried, over the mask. At that point she slipped into the dark.
Gia woke up in a recovery room with a drain on her left side. She vomited from the pain relievers. She was in a Shirt, and her Shirt was free, since her left breast was no more.
She felt free, and needed out of the clinic. Out, quickly, now.
It took 3 days. She was not a decent patient.
Gia stopped practicing medicine. Chemotherapy implied she was powerless against a huge number of illnesses. Each Tuesday, she would go to the hospital at one in the afternoon to sit on a chair and look as a triple regimen of drugs dripped into a needle inserted into her right hand. Sometimes she would fall asleep. Sometimes she would watch television. More often than not, she meandered around the ward, dragging her IV behind her, talking with patients.
Her bones hurt. Her taste buds went numb. She was thankful there was no sickness.
Prior to her diagnosis, Gia’s life was loud and crowded and occupied. She watched concerts and had lunches with her mom. She shopped with her girls. She had week after week clinic obligations, consulted at hospitals, and wrote a blog that waxed poetic over YouTube singers. She attempted and failed at yoga – the quiet irritated her.
However for almost 4 months of her treatment she got herself alone. She invested the vast majority of her energy in her parents’ home, where her husband would drop her off in the morning before he went to work. She sat on the chair and watched the clock, one, two, three, and four, until five o’clock when her husband came to bring her home.
She kept herself occupied. She made bucket lists. She had decided she would live at least 5 years. She hoped for 10, but she settled on 5.
Those 5 years were entirely arranged. She would go to the beach every week, she would go to Batanes, she would go to Europe, and she would see the Eiffel Tower. She arranged the lodgings, thoroughly considered the flights, looked at travel guides, everything without exception to keep herself occupied.
By the third cycle of chemotherapy she was bored. She was mad. The impact range of her outrage exploded far and wide in every direction, swelling out against friends and colleagues and the spouse unused to seeing a sobbing wife.
She was angry that she was bored. She was furious at all her doctor friends who weren’t bored.
She wished they all had disease as well.
It was horrible, she said. She was awful. She giggles now when she discusses it. She may have accepted her cancer immediately, however her denial and the anger and the bargaining came after.
Friends helped her. Family helped her.
Two years since her diagnosis, Gia got her all-clear. She is doctor enough to know it is not an assurance. Cancer is a traitor disease, she said. Indeed, even 10 years of freedom is not motivation to trust she is cured.
Now she appreciates sunrises, and stops at windows at nightfall.
“Before, all I noticed was that it was dark, and the sun was gone. Now I look outside, at the end of a day, and say, ‘Setting sun, bingo!'”
Now she bargains. Consistently, she prays. She prays to live. She prays for a lifetime. Sometimes, she prays for one more night. Each morning she is thankful for being alive.
Her life is typical, in a manner. She is back in practice, has gatherings most days, and goes to the gym to box 3 times a week. She is sad sometimes, angry other times. She rushes to catch herself – cancer is a cycle, she said. She is living gradually, carefully. She isn’t giving moments to pass. She will admit that disease changed her life, yet she will never consider it to be a gift.
“It’s bullshit,” she said.
“Breast cancer is bullshit.”
Gia sat on a seat in a wide white room. The ceilings were high. The cameras had been set. A woman with a brush powdered away the sweat under Gia’s eyes.
It was a day she had been planning for of a year. Her husband was unknowing. Her friends did not know. She has been told to her decision might be a regrettable one. She knew about women in her position who were ignored and criticized. She knew, in particular, that not very many would understand her impulse to document the ravages of her war.
Gia is not the first to expose her scars. In February of 2014, Beth Whaanga, a mother of 4 from Brisbane, Australia, diagnosed to have breast cancer at 32, released a series of photos over Facebook. The photographs indicated Waanga first in a red dress, and then near-naked in stark black-and-white, her scars appeared in sharp relief.
“Each day we walk past people. These individuals appear normal but under their clothing sometimes their bodies tell a different story,” she wrote. “The old and the young, age does not matter, self-examination is vital. It can happen to you.”
Waanga lost a hundred Facebook friends. Some called the images “inappropriate, pornographic and overly confronting.”
Facebook let Waanga’s photographs remain online, regardless of user protests.
“I don’t regret doing the campaign at all,”she told the Dispatch Mail. Many wrote back to Waanga in much thanks. Some of them were cancer survivors. Others were women who had chosen to undergo tests.
Not everybody has been as fortunate. Photographer David Jay’s capturing series of topless young breast cancer survivors were at first brought down, the same as Ann Marie Giannino-Otis of North Carolina, who uploaded photographs recording the aftermath of her mastectomy.
Otis declined to back down. The weight of the half-million signatures added to her request to forced Facebook to reexamine its decision.
“They want everything to be beautiful and it’s not,” Otis told CBS-News. “Breast cancer is not pretty. Not in the least bit,” she said.
Gia knows this. Has been told this. Each fight is burned into her skin, under the dark shirt, on the thin veins of her right hand. She has survived the brutalizing of her body by a cancer that came walking in the night, and she will be damned if she will keep it secret.
The last front of war
Gia Sison is a woman who bought headscarves much sooner than she went bald. She laughed as her daughters helped pull out her hair. She is generous and friendly, furious and impatient, and will get the telephone at all hours to dispense medicinal guidance to the occasional desperate friend. She is eager in her call for self-breast examinations and the need for early detection. She supports the utilization of mammograms beyond 45 years old. She argues more funds should be lead towards growth cancer research instead of towards simply raising awareness.
Sometimes, at the very worst of times, when another survivor loses the battle, when another woman opt to lie down and die, she will comfort herself with the conviction she is exceptional – that there is a purpose behind this.
She has discovered her central goal, she says. She needs individuals to fight.
She is asked once more, just before the camera light goes red – you are certain?
She smiles. Thrusts out her chin. Strolls to the spot under the lights at the center of the white room. And unbuttons her shirt.
There are many like her, she says. There are plenty who are afraid. There are some who hear the warning shots and flee from the field. Then there are the certain ones, the conceited ones, the women like the woman she once was, who don’t trust this can ever be their war.
Her scar travels across what used to be her left breast. A large portion of her chest has gone. She has had no reconstructive surgery, and declines to pad her bras. The asymmetry is self-evident, even when she is completely dressed. She might want, if just for this one time, to utilize the ravaging of her body as both knowledge and warning. It is possible to fight. It is possible to win.
This is the story of a woman at war. This is her photo. This is her scar. She is proud. She is strong. She has fought and won.
“I don’t have to ask what winning is,” she says.
For a cancer survivor, waking up is winning.