To Resume or Not to Resume (Mom Part II)

“Should we resume the monoclonal antibodies that help her heal or preserve the fragile calm we’ve found in their absence?”

The question looms, heavy and unrelenting.

My mother, the matriarch, now stands at a delicate crossroads. These past two months without medication infusions have brought a surprising lightness to her days. She moves with more ease, takes joy in simple tasks—cooking, cleaning, even making those sugary desserts again.

One evening, as she kneads dough for chapatis, she pauses and looks me in the eye.

“Do you think I can get through this without more treatments?” She asks.

I don’t know how to answer—but in that moment, her strength reminds me that this is her battle, and I am only there to support her. It’s a reprieve that feels both precious and precarious, shadowed by the uncertainty of what lies ahead.

Another day, the warm aroma of cardamom wafts through the kitchen as she prepares our favorite halwa, her hands moving with a rhythm that feels both familiar and fragile. Watching her, I can't help but notice how the joy of these small acts now carries the weight of uncertainty.

“Can this calm endure, or does logic dictate resuming the treatment that helps her but also takes its toll?”

The question remains. 

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I struggle to reconcile this ambiguous moment of calm with the unabating logic of medicine.

The monoclonal antibodies Trastuzumab (Herceptin) and Pertuzumab (Perjeta) – or simply The Mabs - as I not so fondly call them—the very therapy that dissolved her dominant lump early in treatment—are cutting-edge and effective. But when they consort with the more traditional chemotherapy drugs, they do come at a cost - a cost she has already paid in months of additional side effects and emotional toll.

She looks to me for guidance, yet I hesitate, caught between two identities. As her son, I see her newfound energy and want to protect it. As a doctor, I weigh the evidence and wonder if resuming treatment is necessary.

In moments of quiet, she asks me questions that blur the line between roles.

One evening, we sit at her dining table, a pile of medical reports between us.

“If I were your patient, what would you tell me?” She looks up and asks. Her voice is steady, but her eyes betray a flicker of vulnerability. I hesitate, torn between the clinical certainty of restarting therapy and the human desire to preserve her renewed vitality.

“I just want to feel normal again. I don’t want the treatment to make me forget what that feels like.”

Her words echo in my mind, adding weight to every decision.

Should I remind her of the risks as a doctor, or reassure her as a son that this newfound calm is worth preserving?

Each answer feels incomplete, leaving me wrestling with the weight of both identities.

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I think back to a story I wrote about another mother, "Ma." She was not mine, but in helping her during a journey, a long-distance flight to be precise, I find myself imagining my own mother in her place. Would a stranger step forward for her as I had for Ma?

Now, my mother’s journey feels no less daunting. The discovery of her lump—unspoken by her for weeks—was an accidental finding for me. Thanks to her family physician’s alertness it led us to where we are now: a rollercoaster of scans, treatments, surgery, and decisions. Her response to the medical and surgical treatments has been fantastic, but the path has been anything but smooth.

My mom’s story is intertwined with mine. This shared history makes the present decision even more complex. The care she receives unfolds in the same hospital where I came of age as a medical student and where I now work as a professor of emergency medicine. These familiar halls, which once taught me the rigor of science, now bear witness to my struggle to reconcile knowledge with love.

Prior to hers, my dad’s medical journey is inextricably tied to this hospital as well. You see, this is the same hospital where my father was cared for after his massive stroke. I remember the weeks following that event—the unpredictability of his condition, the long hours of caregiving my mother undertook with a resilience that, while remarkable, was far from serene.

This shared connection to the hospital serves as a poignant reminder of how illness shapes family histories, weaving its way through generations. It also brings into focus the long shadow cast by our family’s battle with breast cancer. My mom’s cousins at very young ages, and now she, albeit older—this disease feels like a thread running through our lineage, binding us to its unpredictability—hence, the need for seeking answers in DNA, perhaps? This feels both urgent and elusive; a reminder of the complexities that science alone cannot unravel.

My mother has always been a presence—sometimes quiet, often not. In the years prior to the stroke, when my father’s memory faltered due to progressive dementia and his questions repeated endlessly, she was there. Her patience often gave way to frustration; her frustration sometimes became anger. But she never left his side. She faced the chaos and turmoil of caregiving head-on, embodying a que sera sera resilience. It was messy, it was human, and it was hers.

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Breast cancer has also brought an overwhelming array of voices into her life.

“Take this test,” “Try that scan,” “Stick with this chemo.”

Her friends, many of whom have walked this path before, each offer their own guidance.

I’ve tried to help her see that no two cases are the same, that her cancer is hers alone, demanding its own course of action. Some friends and family members who have never walked down the cancer path (breast or else) also have many suggestions for her; as do her favorite YouTube channels and TikTokers or other social media influencers. Convincing her to avoid ‘desi totkas’- hacks of quacks: those traditional remedies often touted as cures—is a challenge I’ve navigated more easily than expected.

The journey has not been without its shared pain multiple times. My eldest brother, oceans away in the US, grapples with the helplessness of distance, staying connected as best he can while I navigate the immediacy of her care here. The absence of his physical presence is a weight we all feel, an ache that lingers despite his unwavering support.

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Through all of this, gratitude remains a constant.

Gratitude for that other brother and his wife in Karachi, who stepped in when I could not.

Gratitude for the oncologist, the breast surgeon, the chemo nurses, and every member of the hospital staff—the coordinators, security guards, housekeeping staff, radiology, and lab techs, and more—who have treated her not just with professionalism but with genuine care. Their kindness transcends duty, reminding me that even in the most clinical of settings, compassion remains a powerful medicine in itself. They knew my father’s story, and now they carry hers with the same compassion.

Gratitude also extends to the support systems that make this journey possible in a setting where parental health insurance is often lacking. The financial burden of her treatment has been immense, with monoclonal antibodies like Herceptin and Perjeta each costing upwards of three lac rupees (more than $1000) per dose; then add to that a treatment regimen of a year – this rapidly becomes an unimaginable strain for many families. Yet, we and other families are blessed to have access to a national program under the aegis of the pharmaceutical company that provides these lifesaving Mabs at subsidized rates. This program has been a lifeline, turning what could have been a major financial challenge into a more manageable, though still daunting, reality.

Gratitude, above all, to my Creator, for giving me time: time to reflect, to hope, to cherish.

To resume or not to resume?

Although the question lingers unresolved, the decision is hers to make.

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This experience profoundly shapes my understanding of the delicate balance between patient autonomy and medical guidance.

I shall embrace uncertainty, honor patient’s voices even when they diverge from clinical recommendations and prioritize quality of life over rigid adherence to protocols.

I shall carry forward a renewed commitment to see each patient not just as a case, but as a person navigating a deeply personal journey.

And I shall stand beside my mom—not as her doctor nor her son, but as someone who loves her, one uncertain step at a time.

Dedicated to breast cancer patients and their fantastic healthcare teams

References: 

1. Ma (Mom Part I) by Asad Mian

2. https://tribune.com.pk/article/61374/dear-yoda-would-dad-approve-my-decision-to-sign-his-code-status-as-do-not-resuscitate

3. https://tribune.com.pk/article/41038/he-cant-say-what-its-called-because-hes-already-forgotten 

from Narrative Medicine