One of my patients from Tarlac, Marco, texted to ask if he could come to the clinic. He was about to take this new chemotherapy drug, and he wanted me to personally teach him how to do it. It sounded like a whole lot of effort just to make me watch him pop a pill in his mouth, but sure. It would be a momentous occasion after all, a celebration, as he was finally able to get a sponsorship for his very expensive chemotherapy pills from PCSO. Whether the drug would work or not was not yet an issue. In the hierarchy of worries, figuring out how to finance the treatment is the primary worry. Once we get past that, then we can start focusing on other things, like the actual cancer.

            The trek to gather enough funds for these shiny, cutting-edge medicines can be properly categorized as a quest. At 48, alone and infirm, Marco was not in the best condition to be going around Manila, sleeping on make-shift cots to keep his spot in the queue, making sure that he always looked miserable enough to be pitied, but he did not really have a choice.

After I gave him the required papers, Marco had to commute to the sweepstakes office to file them himself. Said papers include a medical abstract, chemotherapy protocol, medical certificate, progress report, and chemotherapy prescription. Some screeners are harder to please than most literary or medical journal editors—if you label a document as a “Clinical Abstract” instead of a “Medical Abstract” they will summarily reject it and require the patient to go back to the hospital to have it replaced. The requirements also kept on changing and mutating depending on the person receiving them, that at some point I infuriatingly labelled each page as “Medical Certificate/Medical Abstract/Clinical Abstract/Progress Report”—underlined, bold, italicized. We suspect that some screeners only look at the titles.

On the day of the release of the guarantee letter, Marco took a jeep through a torrid November rain along Taft Avenue. The waters were starting to rise by the time he got in, and the thought of getting infected with leptospirosis lingered in his mind. A neighbor, Mrs. delos Santos, contracted leptospirosis a few years ago when she jumped into the flood during Milenyo. The current was taking her pig away, but she was able to lasso it with adrenaline-fueled dexterity and pull it back to safety. In the two weeks that she was in the ICU she had to undergo dialysis, be seen by all sorts of specialists, and be on industrial strength antibiotics. She died leaving behind an elderly father, two kids, and five piglets.

An accident along Padre Faura stalled the traffic for almost twenty minutes. Marco started getting fidgety, the prolonged sitting starting to feel like torture. People sneer at him like he is a total diva every time he sets up a fluffy pillow on every surface he sits on, but it stopped bothering him a long time ago—better to be stared at rather than yelp every time the jeepney hits a bump, a sharp hump, or worst of all, a pothole. Not one to shy away from piquant descriptions, Marco describes the slightest pressure on his butt as like getting fucked in the ass with a dildo wrapped in barbed wire. Or when he’s talking to someone who may not be receptive to such graphic imagery, he would say that it’s like having pushpins embedded in his ass, as if it’s any less graphic. None of the sterile medical textbook descriptions of “gnawing”, “stabbing”, “piercing”, or even “lancinating” does the pain from the tumor any justice.

 The rains started to subside, and Marco watched in horror as beggars started sticking in their arms through the thick jeepney tarp. The heat inside the cramped vehicle was starting to make him dizzy, but the driver insisted that they keep the tarps down as it would rain again soon. Marco ignored the beggars as his chest started to ache. A month ago he developed herpes zoster, and now that the lesions were adequately healed there was still some kind of electrical sensation shooting through his chest wall. When I first told him that he has herpes he vehemently denied having unprotected sex, and I had to clarify that this kind of herpes is merely some form of reactivated chicken pox, not the STD. Not that he had any recent sexual intercourse at all, protected or unprotected, with the colostomy bag making him feel very conscious naked.

Rectal pain, post-herpetic neuralgia, humidity, the prospect of getting turned away by the agency for the tiniest documentary technicality. Marco even forgot his umbrella and boots, so factor in the risk of getting attacked by leptospiral spirochetes. Had this been biblical times he felt like he would have contracted dreadful boils all over his body as well—courtesy of Satan, who else—just to complete the Job archetype.

The office was about to close by the time he arrived. It didn’t matter, he got the sealed guarantee letter. The next step was to go to the drugstore indicated on the letter to claim the crystal shard, I mean the chemotherapy drug, but it was already getting dark. He decided to go home and save it for the following day.

***

Marco sat in front of me all smiles. He had his bottle of mineral water ready. I would have happily listened more intently to all the gory details of his quest, the fireballs he had to dodge, the trolls he had to outwit, and so on, but there were more patients waiting. He took out the hallowed drug from his fanny pack. I expected a box with at least twenty-eight tablets. He showed me a tiny zip lock plastic bag with one capsule inside.

“After I take this capsule, when do I have to take it again? A month?” he asked. “I would have enough time to file a new set of papers before then.”

My stomach dropped. I asked for a copy of the documents I gave him just to make sure I didn’t make a mistake. He let out an audible gasp as I showed him my instructions on the prescription: 1 capsule once a day for 28 days, followed by 14 days of rest, then repeat. He suddenly remembered that I explained it as such, and we both realized that it was such a long time ago when we discussed the need for this second-line treatment. The painful process just to get the blasted drug has taken us this long. We anxiously went through the papers and discovered that he only got approved a P10,000 grant. Each sunitinib capsule was P8,500, so the drugstore gave him one capsule. In a tiny zip lock bag.

Marco swallowed the pill anyway and tried to feel what P8,500 was like swimming in his stomach. Nothing special, as expected. I watched in pity as Marco sat there, disheveled, gaunt, hungry. What should have been a cause for celebration became a cause for uncertainty. I would have to give him more copies of clinical/medical abstracts, so he can once again go around submitting it to Malacañang, to the Office of the Vice President, to the provincial Kapitolyo, to PCSO, to the senators, DSWD, and so on. We have become so used to this culture of mendicancy, that Marco would have to become one of those children sticking their arms inside the jeep, on a much bigger scale.

I asked Marco to take his lunch first while I print more copies of his documents. He was still smiling as he walked away, quipping that he might get better funding this time around, now that the elections are a few months away.

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