When my grandmother was diagnosed with peritoneal mesothelioma

My grandmother, in her white coat, with my father in Japan

When my grandmother was diagnosed with a very rare form of cancer, peritoneal mesothelioma, I felt far away and helpless in my ability to help. My grandmother was in Japan, where she had just recently retired after more than 55 years in practice as an ob-gyn. I was in America, completing my first year at Stanford University, where I was just embarking on my own journey towards becoming a doctor. Despite the generational, cultural and linguistic gaps, I had always felt a special tie to my grandmother, who - like myself - had grown up between worlds (she, between China and Japan; myself, between Japan and America). She was a trailblazer and an inspiration, and it was a shock for anyone who knew her to learn that she had cancer.

After her initial diagnosis, my father (also a doctor) and I delved into the literature surrounding mesothelioma. The incidence of peritoneal (affecting the abdomen) as opposed to pleural (the lungs) is quite low - even today, only 10-15% of the ~3300 cases in the U.S. each year are peritoneal (source). In Japan, where my grandmother lived, those figures are even lower. There hadn't been much research into this type of cancer, as it's pleural form is more common; however, its only known cause is through exposure to asbestos, a microscopic natural fiber that was heavily used in industry before being banned in the late eighties (in the US). As I poured through the articles, I started to realize her prognosis may not be good.

When I finally made it back to Japan to visit my grandmother, however, I could no longer hide behind my facts and research - I had to face the emotional truth that my grandmother was passing. Over her CT scans and test results, I suppressed the growing sensation that she might not get better. Looking frail sitting up in her bed, I wanted to urge her to not give up. At the same time, I wanted to let her know she could relax. So, I sat by her bedside, playing the role of cheerful granddaughter, reciting recently acquired Mandarin phrases. I remember that there was a lot of silence those days, and yet that the air was thick - full of unspoken thoughts, memories and, always, hope that maybe this would not be the end. As time passed, my grandmother laid out careful instructions for my father regarding a funeral, her house and my grandparent's finances (my grandmother took care of everything, it seemed). Watching her choreograph her own funeral, I let my mind wander to images of her at a more vibrant period in life: my grandmother, rushing to the hospital in the middle of the night. Her furrowed brow as she poured over her patient's paperwork. Her gentle smile and rolling laughter as she taught my brother and I the art of making gyoza (dumplings). She had worked so hard her entire life - she had been one of the only women in her medical school and had left her home country due to the war to establish life in a new country. And she had never once complained. Someone coughed, dissipating my little revery and I looked up at the much older-looking, less energetic woman sitting up in bed.

My grandmother passed away in the spring of 2008, less than one year after she received an initial diagnosis. I think about her often. I think about the conversations we would have as I study for the MCAT, when I am in medical school and when I finally become a doctor.

Losing my grandmother was difficult, but the impact she left will continue to inspire me for as long as I live. It is comforting to know that as long as we continue to remember and take joy in the memories of those who have passed, they continue on. I am honored to "carry the torch" so to speak, as my grandmother devoted her life towards improving the health and well-being of so many others. I can only hope to leave the same kind of legacy.