Mr. Joey Santos has long been considered a “high profile” patient, not because of wealth or position, but because he has been extraordinarily compliant with all of his treatments in the past six years. Many in the hospital staff already knew him, and he already felt, with much regret, that the hospital has become his second home. At 28 years old he was first diagnosed with early stage colon cancer, and since then his battle with the disease never really let up. The cancer has recurred, responded to treatment, recurred, responded yet again to a new cocktail of chemotherapy, and so on. At this point he has already undergone 2 major surgeries, 3 varieties of intense chemotherapy regimens, microwave ablation, and a clinical trial. After the second recurrence he stopped hosting a thanksgiving party or writing a celebratory essay on social media—he has just accepted that he would have to deal with this disease all his life, and that those tiny victories should no longer give him false hope. Not that we were any less devoted to our other patients, but each new fellow taking on his case would feel especially pressured to do well and not botch anything.
I went inside Joey’s room lugging around IV bottles and other stuff for reconstituting chemotherapy. His bed was empty, and I smelled the characteristic cigarette smoke that I have already come to associate with him. The bathroom door was half-open, and inside, Joey and his partner Mike were smoking, taking turns to blow the smoke through the tiny bathroom window. They even brought a handheld electric fan to hasten the egress of smoke. “Sorry, sorry,” Mike sheepishly giggled, as he reached for a can of lavender air freshener they would always bring for such a situation. I rotely tsk-tsked this time, having already given them a sanctimonious lecture on smoking, diseases, and exploding oxygen tanks the last two times I caught them. I proceeded to instruct Joey to take a seat on the bed so I could do a physical.
It was very apparent that Joey has lost a significant amount of weight since the last time we saw him. He looked very weak, his pilgrim from the bathroom to the bed proving to be a struggle. The skin under his eyes was starting to sag, his temples were receding, his once muscular arms now emaciated. He has been involved in all kinds of sports since his youth, but he hardly touched a basketball or a badminton racquet in the past few months.
“Can you face the window,” I requested.
Under the natural morning sunlight the yellowness of his eyes was more glaring. The jaundice first became obvious two weeks ago, Mike, a registered nurse, reported. It was also around the same time when he started losing much of his appetite. Among all the symptoms of cancer the one I dread the most is anorexia, as it frequently augurs rapid descent into all kinds of organ failure. It triggers fatigue among the caregivers as well, as the patient would usually request for all kinds of food in an attempt to find something that will taste good, only to turn it away after just one taste. “Naluto ko na lahat ng pwedeng lutuin,” a caregiver would usually remark in exasperation.
Joey’s abdominal pain also started getting worse, the morphine tablets needing to be titrated up. Well-trained medical students would ask him to describe the pain: gnawing? Crampy? Piercing? Colicky? Joey would be able to answer at first, but at this intensity he could no longer find the perfect word, nor did it really matter. He once described it as like having shards of broken glass, or a mace, embedded in his entrails. Emaciation, anorexia, pain—cancer has clearly taken full control of the board and was proudly announcing this very hostile takeover.
The thing with highly recurrent malignancies is the tumors seem to be getting harder and harder to control over time, as they have acquired enough mutations to cunningly subvert treatment. This was not lost on Joey. He admitted that recently the fatigue has been horrible, that he would opt to stay in bed most of time, and that he no longer even wanted to read or watch films. The only things making him happy were having coffee and smoking with Mike. This was in contrast to how he was during the first year of his treatment, when he would do chemo, go home, give lecture as an associate professor the following day, and party that night.
My first introduction to that particular hue of yellow being a portent of disaster happened over thirty years ago when one of my classmates in grade 2, Rina, missed class for over two weeks. There were rumors, mostly among our mothers, that Rina has been hospitalized for a mysterious illness. She came back to school her usual jolly self, but we noticed that her eyes and skin were yellow. Nobody thought much about it, just that she was yellow. The teachers started talking and said she has hepatitis B, which, they insisted quite erroneously, was something she got from eating too much cheese curls, because cheese curls are bright yellow, hence the yellow everything. Three days later Rina came in with a puffy face and a huge belly, and everyone thought she was getting fat, hence, better. Over the next few days she started getting yellower and yellower, so the canteen got rid of all the bright yellow sitchiria and every yellow food for that matter. Then Rina stopped attending class. We asked our adviser what happened to her. Rina is dead, she said, and did we review our pronouns and adverbs?
None of the adults would talk about her, each of our queries quickly dismissed with irritation. We later got the sense that there was blame going around—on the mother for making poor dietary choices, the canteen for serving the food, Rina for consuming all that yellow food color that reached all the way to her eyes. Our classmate Hobill said that the mother was too devastated that she insisted on bright yellow Sunny orange and bright yellow pospas be served during the wake.
Joey seemed worried when I excused myself to call the gastroenterologist. We agreed to hold off on the scheduled treatment. The extent of the liver injury from the tumor spread made it dangerous to do chemo—the liver was already too sick to process the drugs, and insisting on it would be disastrous. Joey and Mike decided that they would stay in the hospital for a bit to optimize pain control. Having gradually come to terms with the cancer over the past seven years Joey was ready to lay out the final version of his advanced directives. He would die at home a few weeks later. One of his final requests was that his make-up be thick enough to cover the sallow-pale-jaundiced tone that his corpse would soon take. But not thick enough, he instructed Mike sternly, to make him look like a demented clown whore.