“My best friend’s mother arrived at our oncology outpatient department. She had recently been diagnosed with locally advanced breast cancer and was understandably apprehensive, filled with numerous questions. I took her medical history and performed an examination. She didn’t have any relatives with cancer, so all the treatments and terminology were completely unfamiliar to her. Her medical workup was completed, and she began neoadjuvant chemotherapy, with surgery planned for a later date. Throughout her treatment, I closely observed her experiences: hair loss, nausea, vomiting, body aches, reduced blood counts, sporadic crying spells, uncertainty, fear, and more. She needed counseling and reassurance frequently. As her daughter (my friend) lived out of town, she relied heavily on me for support and became quite close to me. After finishing chemotherapy, she underwent surgery, followed by radiation therapy, and was later prescribed hormonal treatment and bisphosphonates. During radiation, she experienced skin tanning, reactions, and required her seroma to be aspirated multiple times. However, she eventually completed her treatment and returned home. A few months went by, and she stayed in contact with me. One day, she sent me videos and photos of her regrown (albeit short) hair, which she had dyed. She had removed her bandana for the first time in months, applied beautiful lipstick and eyeliner, and looked absolutely stunning. I felt immensely happy for her.”

The above passage comes from my diary as an oncology resident.

However, three months later, she was admitted to the emergency room on my call day, presenting with ataxia and slurred speech. Scans revealed multiple brain metastases without any disease elsewhere. She had many questions again, but this time, I was left with tears in my eyes and no answers. We administered whole-brain radiotherapy and started her on medication.

I couldn’t bring myself to write in my diary after that day.

Now, one year later, she is doing well, and I have accepted the reality that no matter how much we do, fate is not within our control. I have begun writing again.

Damane Zehra is a radiation oncology resident in Pakistan.