Contemplating The Fairness of Cancer’s Path: The Perspective of a Surviving Son

It is early 2003, and my mother, Meera, phones to tell me they have found an irregularity on her mammogram. I guess that’s the best term they can use for something that does not have a diagnosis yet. I tell her things will be fine and to wait and see what the biopsy shows. About a week later she calls me again to tell me the tissue sample shows DCIS, and they want to do a lumpectomy with possible radiation therapy afterwards and maybe even further treatments depending on the lymph nodes. I tell her it is the earliest stages of breast cancer, and she’s fortunate they found it at such a preliminary stage. Those annual mammograms have been beneficial for her. She confides with me that she is extremely perplexed. Breast cancer? “I’m a vegetarian. I do yoga regularly. I exercise often.” Also, no history of breast cancer exists in her family. There are certain genes that pre-dispose women to breast cancer, but because science and medicine have not yet found a definitive causal relationship between what triggers cells within the breast to become cancerous, each person given the initial diagnosis searches through the recesses of all past experiences attempting to make sense of what seems the random injustice of cancer. My mother travels this same mental path. I comfort her and tell her we have no reasons why she is diagnosed with breast cancer and now all we need to do is focus on a solution.

She is referred to a surgeon who schedules her for the lumpectomy. I have just finished my residency in Emergency Medicine and am doing my fellowship in Global Health at Brigham and Women’s Hospital and completing my Master of Public Health from the Harvard School of Public Health at the time. I have a rigorous schedule in Boston, but I want to be with my mother for the procedure. I am able to fly down for the surgery. I remember driving her to the hospital the day of the lumpectomy and trying to balance my dual roles as her personal medical consultant and as her son. I don’t want to get too technical and don’t want to throw out dry facts and statistics. Probabilities are wonderful for the objective healthcare provider, but what does a “percentage” mean to the person staring at cancer through the images of a mammogram and the haze of anesthesia? It doesn’t make much sense how you got here, does it make much sense what are the chances you get out?

The procedure goes well without any complications, and we all assume it’s time for the next step in the treatment process. I’m the only physician in my family, on either side. Neither my mother’s family nor my father’s family has a physician relative. I have gotten many medical questions over the years from relatives, and I am honored to have the training to help answer their questions. But this time it’s personal, and my mother and I are intertwined on this journey together.

I’m back in Boston and I get a call from my mother. “They don’t have clear margins.” What? It’s DCIS? It’s the early stages of cancer? Just a small bit of cancer? How can there not be clear margins? The surgeon wants to do another lumpectomy and is trying to spare my mother a total mastectomy. She goes in for the 2nd lumpectomy, but this time I’m not there for the procedure. I’m almost certain it will be successful, and the entire family, including my father, my younger brother, and my soon to be wife, can all move forward together. I get another call from my mother a few days later, and they still don’t have clear margins. Now I’m furious. How difficult can it be to get the entire DCIS excised? I don’t blame the surgeon. He’s a good surgeon and a very compassionate man, but I know we need to take this breast cancer diagnosis and the persistent presence of cancer cells to a different level.

I’m not the kind of person who wears his medical credentials openly. In social settings I introduce myself as “Mr. Kapur,” and I rarely let people know in casual settings I’m a physician. But I feel it’s time to cash in all the chips. I pick up the phone and call the Surgical Breast Section at M. D. Anderson Cancer Center. “My name is Dr. Kapur. I’m a physician at Harvard and went to medical school at Baylor. My mom has breast cancer with two unsuccessful lumpectomies, and I need you to see her.”

Thousands of people around the world have cancer. Many of them have little or no access to healthcare. Many people wait weeks or months to be seen by a specialist. Many patients travel thousands of miles to be seen by a particular physician. At some level you contemplate the fairness of all this. You wonder about the fairness of who gets the disease, the fairness of who survives the probabilities, the fairness of who has access to the best clinicians. Was I “cutting in line” by making the phone call? I wonder about all those people who don’t have access to cancer screening or don’t know where to look for assistance when they receive the initial diagnosis. It is fortunate that I know the healthcare system and I know where to turn for help, and that I can guide my mother through the mastectomy and the options for reconstruction.

My brother and I fly into town a few days before the surgery at M.D. Anderson, and my family and I discuss all the details of the procedures. Both my parents are electrical engineers, and they easily grasp the technical nuances of the surgery. It is going to be a long operation because the reconstruction will be done immediately after the mastectomy while my mother is still under anesthesia. We discuss the risks of a long operation, and she decides to have it all completed in one operation. The mastectomy and the TRAM Flap procedures go well, and almost a year later to the date, my mother watches with a large smile as Jayne and I take our wedding vows.