A startling diagnosis

All of a sudden, I was sitting on the other side of the table from another physician, not a patient. I was not discussing my cholesterol levels, blood pressure, or anemia, but instead reviewing the implications of stage 4 ovarian cancer.

I was born and brought up in Bangalore, India, and faced many challenges as an immigrant both before and after I finished my residency and finally settled down with my family in Atlanta.
In the summer of 2018, while working a regular hospitalist shift—balancing work, home, and two small children—I started to notice random abdominal pain and bloating accompanied by right shoulder pain. The right shoulder pain was particularly bad when I lay down. I decided to make an appointment with a gastroenterologist (GI) and go from there. After examining me, my GI doctor felt my symptoms most likely were secondary to gallstones and we even talked about which surgeons I should seek out. A CT of the abdomen and pelvis was the natural next step.

I completed the CT scan one morning and went back to finish my clinical rounds. The nurse from my GI doctor’s office called and said the doctor “would like to discuss the results with you in person.” I knew right away that something was not looking good. I braced myself for the discussion and went back to see my doctor. She told me “You have metastatic lesions all over your abdomen and the primary seems to be ovarian.”

I couldn’t believe what I was hearing. The dreadful word “cancer”. My mind was flooded with questions: How? Since when? and Why me?… and so began my journey. The inevitable “Why me?” hit particularly hard since I have no family history of cancer. I was then directed to take out fluid from my abdomen for testing, medically called ascites. A sinking feeling engulfed me as I saw the amount of fluid that was drained. I knew if this was fluid from cancer it was definitely stage 4. I knew I was facing a formidable battle. Tears rolled down my face.
I quickly realized I had to put the questions and emotions aside and assume the driver’s seat of my life, my motherhood, and my treatment. I set about getting all the required scans and biopsies. I am my own advocate.

The scans were followed by chemotherapy. As we all know, the side effects are quite challenging. I was navigating through so many uncertainties, so I chose to put my trust in my physicians and the miracle of medicine. While undergoing chemotherapy, I had the chance to come back to work when I felt well enough to do so. I am so grateful I was given that opportunity. It helped me focus on other things and not just my diagnosis and treatment. Three months into my treatment, I underwent a follow-up scan that showed my tumor burden was improving and I was responding to treatment. I was finally eligible for surgery. In January 2019, I underwent the removal of my uterus, ovaries, and cancer masses in my abdominal walls. Once I recovered from surgery, I underwent additional chemotherapy. Finally, in April 2019, I was told I was in remission.

Moving forward: what I learned

Once my remission was confirmed, I shifted gears to focus on cancer recovery. My mind and body had gone through so many changes; at first, I felt like the ever-present exhaustion had become a part of me. Losing hair and dealing with skin changes was incredibly distressing but I had to put those feelings aside and focus on my ongoing maintenance treatment, sustaining my physical well-being for my family, and eventually returning to work. Now I had to balance home, children, and work, along with my regular doctor appointments and maintenance infusion treatments.

I have come a long way since that initial diagnosis. I have had a relapse since then; I went back on chemotherapy and am now again in remission.
Through this journey of five whole years, I have learned many valuable lessons, especially about making the most of our time when we are confronted with a challenging diagnosis like cancer.

When we receive a difficult diagnosis, being a professional in the medical field is in itself challenging. We sometimes know more about our diagnosis than a non-physician might, we get to read a lot about the diagnosis with our resources, but we still can’t know everything about the illness in its entirety. We have to simply trust the system and medical practitioners and believe in the miracle of medicine. Throughout this process you must be an advocate for your own health, learning how to seek and navigate good care for yourself.

Many people advised me to have a positive outlook. As important as this is, you cannot ignore negative or painful feelings like fear, anger, anxiety, and sadness. These emotions are an unavoidable part of this journey, so instead of fighting them, let them flow through you. Allow yourself to experience the emotions. Once you have shed your tears and let out your frustrations, jump back to do whatever mundane task you need to do next, be it just fixing a meal, making an appointment, or planning your calendar for the next day. Don’t worry constantly over the future—you will be more at peace if you just go on with life as it comes and hold on to the hope that we have the power to forge our own path.

One unique challenge for me was navigating through treatment for some of my patients admitted for complications of cancer when I returned to work. While I have always empathized with my patients, I felt these patients’ pain and anxiety flow more intensely through me (a difficult adjustment, indeed). But again, I found myself coping. I found that by sharing my own cancer story, in that moment, I was able to show them hope, positivity, and confidence in the medical world today. While they were hard during the conversations, those encounters gave me a sense of peace with myself and my profession. Then came my challenges with COVID-19 and navigating through the dreadful pandemic. There came an additional layer of fear and anxiety, being immunocompromised, along with yet another layer of exhaustion wearing masks and personal protective equipment at work. I just had to adapt to a new circumstance, stay well-informed, and be focused on each day as it came.

The support and love from my colleagues is something I will never forget. It was definitely challenging for the leadership to fill in my shifts, but the flexibility and thoughtfulness of my colleagues made my journey smooth and easy and the workplace a better environment for everyone. Time and time again, my coworkers and neighbors would take turns bringing a complete meal for all of my family, for which I am so very grateful. While there are so many who helped me through this journey, my spouse and my mother-in-law were the backbone of my recovery.

Last but certainly not least was the joy of taking vacations with family, which had become my priority during my treatment and recovery. To my surprise, though, I soon realized checking off places on my bucket list wasn’t enough to sustain my soul’s purpose. While downtime, travel, and togetherness with my loved ones are incredibly important, I have realized my purpose is to spread hope and healing through my journey and experience and to receive the joy of giving back. I am grateful for the opportunity to give back this love and hope for others, especially my patients. Advocating for them completes the phrase “life comes in full circles”.

My initial question—“Why ME?”— remains half unanswered, but I have found peace with myself and have been enriched through all these experiences.

Dr. Siragowni

Dr. Siragowni is a hospitalist at Emory Saint Joseph’s Hospital in Atlanta. She specializes in the care of medically complex patients and navigating their care when admitted to the hospital.