The doctor declared war at 2 in the afternoon one Saturday in February.
It was not a war she was prepared to fight, not this enemy, not on this battlefield, and certainly not while wearing a borrowed hospital gown printed with pretty pink flowers.
Gia Sison never wore skirts. Her closet was bare of florals. She walked into hospital rooms in dark slacks and bright blouses, stethoscope looped inside her purse, checklists saved on her phone. She knew how to snap out orders, how to soothe a patient into submission, how to assure and demur, command and demand. Suddenly there she was, a patient in her own hospital, at the mercy of a kindly nurse who gave her a folded hospital gown and promised her the wait wouldn't be long.
On any other day, there would have been no need for reassurance. Hospitals comforted Gia. She had gone to school with the surgeon waiting outside the white-tiled room. She had walked the wards on the floors above. She knew the 5 radiologists looking through the glass, all of them watching for a mass that may or may not have grown inside Gia.
The voice over the microphone told her to stay still. The plates were projected onto a white screen.
Gia saw the lymph nodes that had gone dark under her armpit. She saw the mass blooming inside her left breast. She understood what it all meant, and for the first time in her life, Gia Sison, MD, wished sincerely that she had never become a doctor.
Outside the radiology laboratory, in the reading room, medical personnel clustered over the plates.
Gia didn't ask them what they thought. She didn't ask about biopsies or lumpectomies or the possibility the masses were benign. She asked one question.
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 ranged from cholesterol to cancer.
On February 25, 2013, Gia was at home, on the phone with her father, who had called asking for advice on employee health care. It was a long call.
Gia shifted the phone from her right hand to her left.
She felt a hard bump when her hand brushed past her breast.
She told her father she would call him back.
She felt the mass. It was large, and of no particular shape. The lump shifted when she pushed.
Gia Sison was a decisive woman. She paid for bills as they came. She believed there are always two choices, yes and no. She was efficient. She had goals. She worked hard. Even her sentimentality found its proper place, in a blog, where life lessons were itemized, enumerated and filed regularly.
It was the same efficiency that led her to that moment, less than 24 hours after she discovered the lump under her arm, when she stood 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 pulled herself together and turned to the surgeon. It didn't matter that a biopsy was still required. Lines had been drawn. She was the soldier who found herself in enemy territory, with a broken leg and no ammo, howling over the radio for troops to fire on her position.
Cut off my breast, she said. Just cut it off.
Gia Sison had a happy childhood. She had a happy adolescence. She had, and continues to have, a happy marriage with an emergency room doctor she gleefully admits to having courted and pursued.
She knew people who had cancer, had treated them herself. She understood it was always a sad thing, a bad thing, and that in spite of the long list of treatments, a cancer diagnosis was always a dangerous diagnosis.
She had told patients self-breast exams could save their lives. She had shaken her head over late detection. She was nagging and demanding and compassionate all at once, 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 estimated 3 out of 100 Filipino women will contract the disease before age 75. One out of 100 will die before age 75. Breast cancer is the most common cancer in the country, comprising 16% of the 80,000 new cancer cases in 2010.
The causes for breast cancer are yet to be determined. Heredity is a risk factor. So is age. Three quarters of all diagnosed cases are over 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 hearty and alive. Gia was 43 years old on the day of her mammogram.
On that day, terrified and out of her depth, she told herself to stand up. She took off the hospital gown. She put on her blouse. She attended a meeting. She got into the car. She made calls while she drove.
The radio was playing "Staying Alive."
There are 5 established psychological stages for cancer patients – denial, anger, bargaining, depression, and acceptance.
Gia skipped all of them, and shot straight to the last. She accepted. She had no doubt she had cancer.
When the results came in, she was diagnosed with Invasive Ductal Carcinoma Breast Cancer, Stage 2A.
Inside of Gia's body, normal cells were still being born, still growing, still living and functioning and dying to make room for new cells.
She took off the hospital gown with its pretty pink flowers. She put on her blouse. She attended a meeting. She got into the car. The radio was playing 'Staying Alive.'
Inside of her left breast, in the nodes under her armpit, clustered in the hard lump she found that afternoon in February, a new network of cells was in quiet revolt. The cells, twisted by mutation and biochemistry, marched on and on, living and reproducing and never dying, a relentless, indefatigable army threatening to overwhelm 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 told her small daughters that mommy was sick, but that she was going to fight.
It wasn't losing a breast that Gia dreaded. Long before the final diagnosis came in, she had already designated her left breast as collateral damage. She was afraid of 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 afraid, but glad he was there. She ordered 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."
Each person in the fluorescent-lit room was a friend. Most were from her medical school class. They played music. They gossiped about old affairs. Gia was a willing participant.
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. Then she slipped into the black.
Gia woke up in a recovery room with a drain on her left side. She vomited from the pain relievers. She was in a T-shirt, and her T-shirt was loose, because her left breast was gone.
She felt free, and wanted out of the hospital. Out, immediately, now.
It took 3 days. She was not a good patient.
Gia stopped practicing medicine. Chemotherapy meant she was vulnerable to a slew of diseases. Every Tuesday, she would go to the hospital at one in the afternoon to sit on a recliner and watch as a triple regimen of drugs dripped into a needle inserted into her right hand. Sometimes she would fall asleep. Sometimes she would watch TV. Most of the time, she wandered around the ward, dragging her IV behind her, chatting with patients.
Her bones hurt. Her taste buds went numb. She was grateful there was no nausea.
Before her diagnosis, Gia's life was loud and crowded and busy. She watched concerts and had lunches with her mother. She shopped with her daughters. She had weekly clinic duties, consulted at hospitals, and wrote a blog that waxed poetic over YouTube singers. She tried and failed at yoga - the silence bothered her.
Yet for the almost 4 months of her therapy she found herself alone. She spent most of her time in her parents' house, where her husband would drop her off in the morning before he went to work. She sat on the couch and watched the clock, one, two, three, four, until five o'clock when her husband came to bring her home.
She kept herself busy. She made bucket lists. She had already decided she would live at least 5 years. She hoped for 10, but she settled on 5.
Those 5 years were strictly planned. She would go to the beach every week, she would go to Batanes, she would go to Europe, she would see the Eiffel Tower. She planned the hotels, thought through the flights, looked at travel guides, anything and everything to keep herself busy.
By the third cycle of chemotherapy she was bored. She was mad. The blast radius of her anger exploded far and wide in every direction, swelling out against friends and colleagues and the husband unused to seeing a weeping wife.
She was angry that she was bored. She was angry at all her doctor friends who weren't bored.
She wished they all had cancer too.
It was terrible, she said. She was terrible. She laughs now when she talks about it. She may have accepted her cancer immediately, but the 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. Even 10 years of freedom is not reason to believe she is cured.
Now she appreciates sunrises, and stops at windows at dusk.
"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. Every day, she prays. She prays to live. She prays for a lifetime. Sometimes, she prays for one more night. Every morning she is grateful for being alive.
Her life is normal, in a fashion. She is back in practice, has meetings most days, goes to the gym to box 3 times a week. She is sad sometimes, angry other times. She is quick to catch herself – cancer is a cycle, she said. She is living slowly, carefully. She isn't letting moments pass. She will admit that cancer changed her life, but she will never see it as a blessing.
"It's bullshit," she said.
"Breast cancer is bullshit."
Gia sat on a bench 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 half a year. Her husband was unaware. Her friends did not know. She has been told her choice may be a regrettable one. She knew of women in her position who were shunned and condemned. She was aware, most importantly, that very few would understand her compulsion to document the ravages of her war.
Gia is not the first to bare her scars. In February of 2014, Beth Whaanga, a mother of 4 from Brisbane, Australia, diagnosed with breast cancer at 32, released a series of photos over Facebook. The photos showed Waanga first in a red dress, then near-naked in stark black-and-white, her scars shown 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 photos stay online, in spite of user complaints.
“I don't regret doing the campaign at all," she told the Courier-Mail. Many more wrote back to Waanga in thanks. Some of them were cancer survivors. Others were women who had decided to undergo tests.
Not everyone has been as lucky. Photographer David Jay's arresting series of topless young breast cancer survivors were initially taken down, the same as Ann Marie Giannino-Otis of North Carolina, who uploaded photos documenting the aftermath of her mastectomy.
Otis refused to back down. The weight of the half-million signatures appended to her petition forced Facebook rethink 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 all this. Has been told all this. Every battle 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 marching in the night, and she will be damned if she will keep it secret.
Gia Sison is a woman who bought headscarves long before she went bald. She laughed as her daughters helped pull out her hair. She is generous and friendly, angry and impatient, and will pick up the phone at all hours to dispense medical advice to the occasional desperate friend. She is vehement in her call for self-breast examinations and the need for early detection. She supports the use of mammograms over the age of 45. She argues more funds should be directed towards cancer research instead of towards simply raising awareness.
Sometimes, at the very worst of times, when another survivor loses the fight, when another woman chooses to lie down and die, she will console herself with the conviction she is special – that there is a reason for all this.
She has found her mission, she says. She wants people to fight.
She is asked again, just before the camera light goes red – are you sure?
She smiles. Thrusts out her chin. Walks 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 many who are afraid. There are some who hear the warning shots and run headlong away from the field. Then there are the certain ones, the arrogant ones, the women like the woman she once was, who do not believe this can ever be their war.
Her scar travels across what used to be her left breast. Half her chest has gone concave. She has had no reconstructive surgery, and refuses to pad her bras. The asymmetry is obvious, even when she is fully dressed. She would like, if only for this one time, to use the ravaging of her body as both wisdom and warning. It is possible to fight. It is possible to win.
This is the story of a woman at war. This is her picture. 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. – Rappler.com
Photos by Jason Quibilan | www.jasonquibilan.com