One of my friends from school studied with me in 9th grade. She was exceptionally pretty, the kind of beauty that stood out. She was the only daughter and had a younger brother. She got married at a relatively young age and had one son. After her marriage, she moved to another city. She lived in a joint family and had many responsibilities, managing a lot of issues on her own. Her parents lived in Islamabad.

Her father was a deeply religious man who taught several students at various mosques and madrassas. He often engaged in Chillas, which are periods of meditation and solitude lasting forty days, commonly practiced by Islamic mystics and other spiritual seekers. His absences were so frequent that he was home for only a few days. Her mother was a strong woman who worked as a beautician and earned a good income. Her husband did not provide much financial or emotional support for the family, so she raised their children responsibly and eventually helped them get married. After their marriages, she let out a sigh of relief. However, it seemed that fate was not on her side.

One day, my friend reached out to me to share that her mother had been diagnosed with breast cancer. Her treatment was to be initiated in the oncology department at our hospital. Since my friend couldn’t visit Islamabad frequently due to her responsibilities at home and with her in-laws, she entrusted me with the care of her mother. I understood her situation and promised to keep an eye on her mother.

The day she came to visit us, I was the first to meet her. I had been waiting because my friend had texted me to say that she would be arriving soon. She was very young, extremely pretty, and it was clear that my friend had inherited her beautiful looks. I wanted to familiarize myself with her case, so I took her medical history. She was quite anxious about the diagnosis, but she felt relieved when she realized that her daughter’s friend was there for support. We exchanged phone numbers and began talking frequently.

She began treatment for her stage 3 breast cancer, and the type of breast cancer she had is considered to have a somewhat better prognosis compared to other types. Initially, she underwent neoadjuvant chemotherapy, followed by surgery and then radiation therapy. Throughout her treatment, she experienced significant anxiety but placed a lot of trust in me. My reassurance often comforted her, and I admit that at times I even told her small lies just to ease her worries.

After returning home each day, I would listen to her audio messages and then reassure her about various side effects and provide explanations regarding her treatment. To be honest, I often felt irritated by her frequent messages. However, I reminded myself that she was the mother of my friend, that her daughter was not there, and that she had no one else to support her.

I never felt that she was just the mother of my friend; she was more like a mother figure to me. Perhaps she found a friend in me as well. Whenever she came during her chemotherapy and radiation treatments, she never left without meeting me. She usually waited to be examined by me, expressing that she trusted my opinion and felt relieved only after I had seen her. Although she was under the care of a very capable oncologist and I had no doubts about him, she was so anxious that she sought my opinion every single time.

She was always appreciative of my care. After her radiation treatment ended, one day she left a gift for me with the PA, as I couldn’t meet her that day. The PA handed me the bag, and I opened the gift when I got home. Inside, I found a lovely perfume, lipstick, metallic bangles, and an unstitched dress (shalwar kameez). My sister immediately snatched the perfume, the lipstick, and the bangles were given to someone else, and I was left with the dress. I had it stitched and wore it often. I enjoy using gifts given to me by others, and many of those gifts stay with me for years.

After her radiation therapy, she began hormonal treatment with oral pills. This treatment was much easier for her compared to the earlier chemotherapy and surgery she had undergone, which helped lessen her anxiety. Although I had to provide reassurance on some days, I was relieved that she felt a little better overall.

During one visit, she was sulking like a child and complained to me that her oncologist was being “cruel.” I found it amusing, and upon probing, I learned that she was upset because, after enduring so much, he still refused to say that her cancer was cured. She couldn’t understand how he could afford using that terminology while she was still undergoing treatment. Although the treatment was milder, it was still ongoing. Nonetheless, she insisted that she wanted to hear the words “you are cured.”

To make her feel better, I reassured her by saying she was cured, as she had requested. She seemed so relieved when she left that day. I felt guilty for saying it, but I believed I had no other option.

Over time, she improved. Her hair grew back, and she started dyeing it, wearing makeup, and looking like the beautiful lady I had known before her treatment. She frequently sent me pictures of herself. I suggested she return to work so she could stay busy and not think too much about her illness. To be honest, I also wanted her to be occupied so she would bother me a little less often — I know I was being selfish. The truth is, due to reassuring her multiple times on many days, on a subconscious level, I might have perceived she was cured, and her disease won’t relapse ever. How foolish I was.

Within a year of starting hormone therapy, she came to the hospital in the evening one day, coincidentally on a day when I was on call. The OPD was closed by then. She came to me and told me that she was experiencing headaches, balance problems, and memory issues that had persisted for a few days. I remembered that she had mentioned the slight memory issues before, but I hadn’t taken her too seriously because I thought they were minor. In fact, during those days, I was facing more significant memory challenges myself due to the immense stress I was under. My long working hours, coupled with a heavy workload, endless exams, and the expectations of those around me were overwhelming. On top of that, I had to handle the non-stop text and audio messages each evening from friends, family, and cancer patients, along with ongoing problems at home.

I arranged for her CT scan immediately. Our department has its separate CT machine that we use for radiation planning. This time, her husband was with her, even though he had been absent throughout her treatment. While she was in the CT room for a brain scan, I stood behind the glass door, watching the monitor screen. I silently prayed that she hadn’t developed brain metastasis. My heart raced erratically during those two minutes as she underwent the scan. I tried to calm myself by reciting Quranic verses, but, as I feared, the scan showed brain metastases and significant edema. I felt weak in the knees.

When she emerged from the CT room, I could see the concern on her face, and I knew she must have sensed something was wrong. She kept asking me repeatedly what had happened. I was searching for her husband so I could explain the situation and discuss the next steps in her treatment.

I had her sit in the waiting room while I took her husband aside to explain what had happened. I admitted her to the ward and started her on steroids. I then called my senior, who was her attending physician, to discuss her medications. He advised me on the treatment plan and informed me that he would see her first thing in the morning.

She repeatedly asked me what had happened, clearly extremely anxious. I explained that we had noticed some spots on the brain scan that might be causing her symptoms, and that she might need a different type of treatment. She was not satisfied with my explanation and kept asking the same questions. I called my friend to explain everything, and she became very worried. She planned to come to Islamabad as soon as possible.

The next morning, when I went to see her, with my senior (her attending physician) I was filled with worry that day, wearing a face mask so she wouldn’t see how pale I had become.

She seemed more alert and noticeably better, although she had quickly returned to her questioning and interrogation mode. When she got to know that the cancer had relapsed in the brain, she was not willing to accept that. She began by remarkably challenging her oncologist, demanding to know why her cancer had relapsed, especially since she had a type of cancer that is more hormone-sensitive compared to others. My senior was taken aback; she even confronted him, asking how this could happen when I had assured her multiple times that her prognosis was good and she was cured. The oncologist did his best to counsel her and explain the further treatment plan.

I tried to hide behind my senior, knowing he would later scold me for giving her false hope in the first place. To be honest, I was completely silent, with tears constantly falling into my mask. Thankfully, she couldn’t see them because of my spectacles.

When he came out of the room, he noticed my eyes and scolded me for crying. He questioned what kind of doctor I was, suggesting that I shouldn’t be affected emotionally in such situations as a cancer doctor. He urged me to control my emotions and not to be a loser. I tried to compose myself; what other option did I have?

She began radiation therapy and started on the next line of treatment. This time, she was fortunate; further brain scans showed that the progression of the disease had stopped, and she began to improve slightly. However, she was still anxious and frequently sought reassurance that she would get better. Her daughter began visiting more often, and her husband stopped going on his meditation trips to take care of her.

This time, I was mentally prepared for the reality that she had stage four cancer, and I didn’t have to lie to myself anymore. Her treatment continued, and for two years, she seemed to be doing well. Subsequent brain scans did not indicate any progression of the disease. Throughout this time, I continued to talk to her, but the communication became less frequent. As months went by, I felt a bit relieved knowing that there were people to take care of her now.

After a few months, I started to experience some medical issues and became very sick. I took a leave of absence from work for three months and was quite unwell during that time. Gradually, I began to forget many things about my life, which made it difficult to remember the people around me. She didn’t contact me for months, and eventually, I forgot about her as well.

When I returned to work, I had forgotten about her completely. I don’t blame myself for this now, as I had forgotten many things during that time. A few months later, I saw a WhatsApp status from my friend asking for prayers because her mother had passed away. My heart sank.

I reached out to her to inquire about her mother. She explained that her brain metastasis had progressed significantly in the past few months. Her mother was placed on palliative care and became bedridden. She experienced altered consciousness and had forgotten most things. However, I still don’t understand how she managed to survive in that condition for so long.

My friend told me that she had taken her mother with her to her in-laws’ home, where her mother passed away peacefully, pain-free, one day by her daughter’s side. I was a little relieved to hear that she was apparently pain-free and her loved ones were by her side, but still I asked my friend if her mother had ever mentioned me. How could she have forgotten about her loyal friend?

I also wanted to know why she never informed me about her mother’s decline. My friend explained that her mother had asked about me a few times during her altered state of consciousness, but she didn’t contact me as she did not want to bother me because she heard from the OPD staff that I was very sick and not in a condition to talk to anyone.

I don’t blame anyone for what happened. I don’t blame my friend for not telling me, and I don’t blame myself for forgetting her because I had been extremely unwell. Even if I had known, there was nothing I could have done to save her. Many days, I open my gallery to look at the beautiful pictures and videos she shared with me from the times when she was happy and felt better. Those were the days when she wore makeup, had dyed her hair, and looked like a princess.

I know I could never have changed the course of events. But on some days, when I wear that dress, I wonder, if the dress is still here, where she is. Why did I often feel irritated by her messages? Why did she leave this world so soon? Why was I never able to see her or meet her during her last days? Why did I never get a chance to say goodbye to her? When she considered me her friend, why did she make me cry so much? It has been more than two years, but on some days, I feel angry at God for not granting me closure.

“Like time suspended,
a wound unmended —
you and I.
We had no ending,
no said goodbye;
For all my life,
I’ll wonder why.”
—Lang Leav, Love & Misadventure

I can do nothing for her except pray; I ask you all, wherever you are and whatever you’re doing, to please say a little prayer for her.

I would be grateful.

Damane Zehra is a radiation oncology resident in Pakistan.