Slice Girls

by Joan Arakkal

  The consultant stretched out his legs and I was forced to tuck my feet underneath my chair. He adopted the casual air of a coffee-room chat, leaning his head back into his hands, which he had clasped behind his head. We could have been discussing his holiday plans. But, despite his relaxed and congenial veneer, he proceeded to dash my hopes of a career in hand surgery. ‘The two consultants you worked for are not happy with you.’

  With no further explanation, he went on to tell me that my service registrar position would not be renewed when my current term ended in a few months. He said nonchalantly that I would never be given a training position. At that point, I recalled a conversation I had had with him a few months earlier.

  ‘Would you continue in Perth if you did your training and were admitted as a fellow?’ he had asked.

  ‘Yes,’ I had replied.

  I would later learn that such admissions can have a significant impact on one’s career. Foreign graduates who come to Australia for short periods are given training positions, at the end of which they usually go back to their home countries. I was an Australian citizen and I was not going away.

  I was devastated but I felt I had no recourse to question the subjective assessments that had been given as meagre justifications for crushing my lifelong dream. My mind raced, searching for an explanation.

  The senior surgeon said, ‘For people like you, we need a different pathway to enter the orthopaedic speciality.’

  It was clear that the meeting was coming to a close. I rose to leave, thanking them for their feedback. The consultant stood up and opened the door for me. I resisted the desire to point out the hypocrisy – his veneer of gentlemanliness masked his archaic attitudes towards women. In a daze of disbelief, I drove home. I felt crushed as the reality of the power wielded by the bonemen sank in.

  In need of a break, I found myself on a houseboat, sailing in tranquil silence over the backwaters of Kerala. The rivers and canals that course through Kumarokam are often described as the Venice of India. Bamboo houseboats slide through canals lined with coconut trees. The angst of the previous months slowly slipped away. My disappointment at not getting the training position washed away as the houseboat sailed through brackish lagoons. I decided to find other avenues to pursue my orthopaedic career when I returned to Perth.

  Back in Perth, I rode the escalator that snaked up to the upper floor of the David Jones store. My hand rested lightly on my left breast. I still don’t know what led my fingers to the distinct, firm lump below my collar bone. As Sonia chattered away and shoppers thronged around me, all anxious to find a bargain in the January sales, I palpated the sinister mass. The escalator deposited us among starched linen, shiny crockery and sparkling wine glasses. ‘It can’t be,’ I thought, as I pressed harder on the lump. I was too well to have breast cancer. My mind looked for alternatives. Perhaps my breast was responding to hormone fluctuations. Or maybe it was a ‘breast mouse’ – a collection of harmless tissue that ran around like a playful mouse under examining fingers.

  As I stared blankly at a Noritake dinner set with an intricate Japanese design, the surgeon in me took over. ‘That lump needs to be looked at,’ said the voice in my head.

  ‘What’s wrong, Mama?’ my intuitive daughter asked.

  I held her hand a little tighter and assured her that all was well. The sparkle had gone off the china and the discounted Sheridan sheets looked back at me blankly from the neatly made beds on the shop floor. As I wove my way through the crowds, I saw the anticipation and frenzy on people’s faces as they filled their baskets with retail therapy. I made my way back to the car, already knowing my therapy was going to be very different.

  Sitting across from the general practitioner the next day, I asked how she was. I realised how jaded she was with her work when, I suspect in a fit of collegiality, she replied, ‘Tell me there is another way to make money.’

  Not entirely inspired by this confession, I expressed my concerns about the lump in my left breast. Very soon afterwards, my breasts were being crushed on a mammogram table and the tumour was revealed. The sympathetic young radiologist told me the results, and my roller-coaster journey began.

  Like pepper and salt, good news mingled with bad in the months that followed. The good news was that the cancer had not spread. The bad news was that I had more than one lump. The good news was that it was not in the lymph nodes. The bad news was that I was developing lymphedema. And so it went on. I was the physician in the family, but now I needed healing. While my colleague’s scalpel cut away the cells that had run amok, and the oncologist poured chemicals into my veins to wipe away errant cells that may have wandered far from their group, my real healing happened in the bosom of my family.

  When the pathologist delivered the final diagnosis, I had let my tears flow. Encircling our children and me in a tight hug, Francis’s promise to beat the beast strengthened me. Always leading from behind, my brother’s quiet and calming presence also bolstered me.

  Abe had had an interesting journey after graduating from St John’s Medical College in Bangalore. For a year he worked among the tribal people of the Biligiriranga Hills in Karnataka. Living in the picturesque hills of the Western Ghats under the most basic conditions, he enjoyed many adventures. One day, while riding a motorbike downhill, he encountered a herd of wild elephants. They gave chase and he lived to tell the tale. His travels later took him to Oxford, where he joined the department of mathematics and did a DPhil in cancer spread using mathematical modelling. He continued his work at Harvard University. While there, he was interviewed by Boston Consulting Group for a management position. This job took him to Auckland and later to Sydney. After a few years, he decided to return to medicine. He was due to take up a job in a hospital in Queensland when I was diagnosed. He decided to stay in Perth for a few months to support me through the months of surgery and chemotherapy. I silently gave thanks to my parents for the gift of my only sibling.

  When my mother arrived from India, the team strengthened. Her cheerful presence, easy laughter and never-ending stories, ensured that my children’s lives retained a sense of normalcy. With kind friends, strong prayers, and nourishing and tasty food, I could immerse myself in the healing process. Surgery was followed by regular trips to the oncologist and chemotherapy suites. The strong chemicals in my veins attacked the immature but fast-growing tumour cells, but they took my hair follicles too. Jenny, our thoughtful housekeeper, protected me from the distress of falling hair by regularly sweeping away the clumps of hair on the floor. My husband likened me to Persis Khambatta, the Parsi model and former Miss India who is best-known for playing Lieutenant Ilia in movie Star Trek. Just like bald Ilia’s journey into the unknown universe, chemotherapy had taken me to places where I had never gone before.

  As the countdown to my sixth and final session of the chemotherapy approached, I noticed little baby hair stubbornly rising from my scalp. Rejoicing in this resurgence, I prayed the cancer cells would not do the same. It was now time for radiotherapy. The force and might of the silent assailant was acknowledged in this blunt force approach to cancer treatment. Sparing no ammunition, the war against cancer was undertaken with little subtlety and precision. The collateral damage was widespread.

  My radiation oncologist, Dr David Joseph, outlined the details of my radiation treatment. Until then, I had not asked why I was the chosen one in eight woman who had contracted breast cancer. With a healthy lifestyle and no significant family history, I did not appear to be a likely candidate.

  I had performed many orthopaedic operations while wearing heavy lead gowns on top of my theatre scrubs. During each operation, fractured bony fragments were pulled and coaxed into alignment and viewed with X-rays on the image intensifier screen, leaving me with a happy feeling. As I cleaned muscles that were caught between the bony fragments I held firmly with shiny steel pincers, and gently manoeuvred the fragments into place, I had felt like a kindergarten student fitting in the final piece of a jigsaw puzzle. A few more
images, obligingly shot by the theatre radiographer, were saved on the screen. To hold everything in place, I bent and contoured narrow steel plates onto bones and drilled through the holes on the plate. After I measured the depth of the screw holes, the nurses handed me the correct screws to hold the plates securely to the fractured bones. Too long, and they could damage nerves and blood vessels, too short and the plate would come loose. The goldilocks screws were placed with precision. If there was any doubt, another X-ray came to the rescue. When the last screw was applied and the splintered bone was locked into a single unit, celebratory pictures were taken.

  It was Dr Joseph’s opinion that the many years I had been exposed to X-rays in the operating theatres could well have been the trigger for the cancer. As I nodded my head in agreement, I thought of the cumbersome lead gowns that had done little to protect me from the cancer cells that had ganged up on me. If byssinosis, asbestosis and silicosis were occupational hazards of cotton workers and miners, radiation cancer could well be a hazard for orthopaedic surgeons.

  The horse had well and truly bolted, so I did not dwell on the cause of my cancer for too long. Lying under the radiation machine, I received my first tattoo marks when my chest was marked to target a dose of radiation that would destroy any runaway cancer cells that had escaped the surgery and chemotherapy. It was ironic that Dr Joseph was attempting to heal me with the same radiation that he believed may have brought on the disease. I placed my trust in the machine that unleashed the rays.

  Sitting outside the radiation suite one day, wearing a stylish olive-green scarf and eye makeup to compensate for my bald eyelids, I was amused when a woman expressed surprise that I was also a patient like her. ‘I thought your scarf was a fashion statement.’

  I made the most of my new look. With new hair and glowing skin, I was the picture of health. The chance of the cancer returning loomed over me, but when I looked in the mirror I felt hope and gratitude for the journey I was on.

  When the doors to orthopaedic training closed, I had felt a sense of helplessness and deep despair. Was it stress that suppressed my immune system and allowed the cancer cells to run amok, or was it radiation exposure in the theatres? The pursuit of orthopaedics was not without its dangers but I loved orthopaedics too much to let this break me.

  Life is beautiful and I had a lot more of it still to savour. As I looked at the beautiful faces of my son and daughter, the sun shone brighter for me. Francis gently stroked my left hand every night, pushing the lymphatic fluid towards my heart, and I nodded off enveloped in warm love. Daily calls from my brother, now working in the hotter climes of tropical Cairns, ensured that blood tests, scans and appointments were not forgotten. Emotional outbursts, when reason and logic were sacrificed to fear and uncertainty, were followed by remorse and disappointment at my lack of perspective. I was cherished, loved and protected by family and friends. I had been carried through the treatment. Yet I knew the task of healing my spirit and finding the courage to march on was a personal one.

  And so I turned inwards.

  I was grateful for the short time between the initial diagnosis to finding myself on the operating table. As I lay under warm blankets in the pre-operative room, the kind faces of the anaesthetist and assisting surgeon allayed my twinges of apprehension. Lying on the narrow table under the circular white theatre lights, I surrendered to the moment. The surgeon – my colleague and friend – asked the nurses to send their positive energy to me, and I thought of the healing power of shamanic practices around the world. The anaesthetic fluid coursed through my veins and I quickly drifted off to a land of oblivion. In what felt like no time, I heard my own unattractive grunts and groans as my consciousness returned. The familiar faces of nurses flitted across my vision as they kept me reassured and pain-free.

  When the bandages came off a few days later, I saw neat scars with invisible sutures. I remembered the pictures in surgical textbooks of Halsted’s radical mastectomy – a surgery in which the breast and muscle below it was completely removed in hope of eradicating the cancer, leaving a large gaping hole where the object of femininity once sat. What I saw was far less revolting than those images.

  The rest of the treatment was as seamless as the wound on my chest. I couldn’t help contrasting the treatment I was receiving with the treatment my cousin in India received for his lymphoma. He travelled long distances along crowded and bumpy roads on public transport to receive his chemotherapy. I was driven to comfortable chemotherapy suites along well-designed freeways, in a matter of minutes. As the harsh chemicals entered my system, I was given enough medication to keep the nausea at bay. I didn’t once vomit during my six cycles of chemotherapy. My cousin puked all the way home from his overcrowded hospital.

  Unable to opt out of the disease, I had to embrace the treatment. I did so in the full knowledge that I was receiving world-class treatment. The Australian government’s Medicare system ensures excellent treatment is available to all its citizens. The country’s rich natural resources allow for a flourishing medical system where no expenses are spared. I was a beneficiary of the system, and thankful for it.

  Despite that, I still found myself staring with regret at the reflection of my bald head and reptilian-looking eyes that were denuded of lashes. Again, there was help. The ‘Look good, feel good’ program, supported by cosmetic companies, came to the rescue. With chemicals already coursing through my veins, I consoled myself that a few more on my skin would do no harm. I slowly filled in nature’s gaps, like an artist let loose with a colour palette. I liked the reflection that looked back at me at the end of a face-colouring session. Slowly, a thick curly mop replaced my straight pre-treatment hair. The scientific mystery behind the emergence of that curly hair still eludes me.

  The surgical scars settled and the tattoo dot was all that remained to remind me of the beams that had irradiated my chest. Positive appointments with the cancer specialist continued and as the hallowed five-year mark approached, I rejoiced. When I was finally discharged, with a warm hug from my oncologist, I stepped out into sunshine that shimmered over the lake across from the hospital. Black swans strutted majestically on the sidewalks, ducks floated serenely on the water, and slate-grey coots dived and emerged with green algae dripping from their white beaks.

  Life on the lake paddled on while a song inside me hummed a new tune. I had crossed another cancer milestone. Though this was not a complete ‘Get out of jail free’ card, I savoured the moment. I had survived both the disease and the treatment.

  THE SCENT OF JASMINE

  One Sunday morning I woke up to find fresh white jasmine on my bedside table. Later that evening, I lay on the yoga mat in a public hall and breathed in deeply. The fragrance of jasmine wafted past me again. Devi had brought me a handful of flowers from her carefully tended jasmine creeper and placed them beside my mat. While Devi’s figure did not evoke the image of a yogini, her spirit was buoyant and flexible. Her ready smile and delightful chatter broke the sombre air of the yoga hall and its students. As I inhaled and exhaled deeply to the instructions and tried to bring my body into union with my higher self, I found the scent of Devi’s jasmine taking me from the community hall in Perth to the streets of Coimbatore in India.

  Coimbatore was once called the Manchester of India – more for its cotton textile industry than for its weather, whose salubrious warmth would find no echo in the cold north.

  Today, when I return to India on holidays and enter the now-congested city, I see the changes that have occurred over the last twenty years. People jostle in crowded places. Fast cars crawl through the clogged roads. I spot the occasional old Ambassador – once the king of the road but now deposed by Toyotas, Mercedes Benzes and Volkswagens. As I notice the homogenisation of the world slowly creeping into the expanding city of Coimbatore, I search for the old and familiar and find them not far below the surface of modernisation.

  Street vendors spruik their rare vendibles, jungle berries, jamuns, that have been carefully harves
ted from tall trees. The tart flavour leaves a purple stain on my tongue. Carts are loaded with large guavas on beds of green leaves. Jackfruit pods, with their sickly-sweet smell, attract flies that have to be constantly shooed away. Women haggle over the prices of okra and onions. The sound of a gentle bell draws me to peanuts being freshly roasted over a coal fire. These delights are all around me as people thread their way along crowded streets and pavements.

  Amidst the hustle and bustle and tantalising smells floats the fragrance of jasmine. I trace it to a wicker basket where the flowers sit curled, artfully threaded on a long string. Sitting cross-legged behind the basket is a formidable woman, a flower-seller who, after some negotiation, measures the garland from her fingertips to the point of her elbow before snipping off a length and placing it gently on my palm. Every evening, innumerable lengths of these perfumed garlands adorn the black, neatly oiled and braided hair of women across Coimbatore. I think heaven must smell of freshly picked jasmine.

  Smells have always been all around me. Evocative, provocative, disguised, blatant, familiar, not. They followed me into my medical training and became a tool that supplemented my other senses.

  The white coats we donned through our formalin-filled anatomy days become a permanent part of our attire. Over the years, they bore witness to our struggles. The smell of hydrogen sulphide mingled with acetic acid from our days spent in the pharmacology labs. The odour of cultures on petri dishes that made us cover our noses. Later, when I entered the forensic department, the smell of a decaying corpse reinforced my decision to work with the living.

  When I was an intern, my white coat was loaded with smells from bloody wounds and abscesses that gushed pus when I lanced them. I never knew what smells would have to be washed away at the end of each day. The pungent smells of ether in operating theatre and the putrid smells of fungating cancers were all part of the day’s work. Revolting though it was, I loved this feast of odours. They added colour and challenge to my medical adventure. Walking through the old arched corridors of the hospital with a whiff of Savlon and bleach from the freshly scrubbed floors greeting me, I experienced the deep satisfaction of knowing I was where I wanted to be.