It's often been said that doctors make the worst patients.
They often neglect their own health, citing busy work schedules trying to help and save others.
This was partially true in Datuk Dr Ryan Ponnudurai’s case.
“Yes, I didn’t really do many medical check-ups as I was in my ‘immortal’ mode,” he says, chuckling.
So, when he had a mild cough and a bit of throat irritation, he brushed it aside, self-medicated with some cough syrup and went about his business.
As a consultant gastroenterologist at a private hospital, much of his work involved giving workshops and talks around the world before the Covid-19 pandemic hit.
At the end of 2018, Dr Ryan was giving a talk in Hong Kong when he suddenly felt unwell on stage.
He recalls: “I proceeded to finish the talk before my Malaysian counterparts came up to me and commented, ‘Ryan, you’re not your usual self’, and I said yes, I haven’t been feeling great.
“They felt my pulse and it was 145 – way too high.
“They asked if I wanted to get admitted, and I said no, I just wanted to go home, so I cut short my trip and flew back.
“My wife didn’t know what was going on and asked why I had returned early, and I told her I’d completed my talks.”
He headed to the hospital (his workplace) the next morning and wondered what he should do next.
“I had a bit of chest pain, so I thought maybe I should get a chest X-ray, and I did – it revealed a huge pneumonia.
“I was admitted and given a course of antibiotics, and monitored for the next two months.
“The spot didn’t go away, but I was actively carrying on doing my procedures and scopes,” relates the 55-year-old.
It’s cancer
Dr Ryan’s story is very similar to Dr Paul Kalanithi’s, the late American neurosurgeon-cum-author of the bestseller When Breath Becomes Air, an autobiographical book about his life and illness, battling metastatic lung cancer.
“I read it a few months before I got sick and thought, what a horrible way to die.
“Fear is an incredible thing – people underestimate the power of it. If you can conquer fear, half the battle is won.
“One of my biggest fears was falling sick on stage and it happened,” he says.
His team of doctors – all his colleagues – then scheduled him for a computed tomography (CT) scan.
He shares: “I sat next to the radiologist and we’re both looking at the scan and he was keeping quiet, and I asked ‘what’s happening’?
“He doesn’t say anything but pulls out these calipers to measure something, and I know (as a doctor) we don’t do that unless there is something to measure.
“There was an 8cm lesion above my heart, which was compressing my lung, but the area wasn’t picked up by the X-ray – that’s why I was having pneumonia.”
The next day, he underwent a CT-guided biopsy.
He adds: “I deal with cancer cases every day and I work with pathologists who read these biopsies.
“Usually, I’ll call the pathologist to ask what the biopsy shows and then I explain to my patients.
“But here is my biopsy and the pathologist felt it was okay to call and tell me while I was in the bathroom one morning, getting ready for work.
“He said I had lung cancer.
“I came out of the bathroom and told my wife and she was like, what?!”
The lung physician then called and told Dr Ryan that the lesion was big and he probably had three months to live.
“I wasn’t feeling sick, I had not lost weight, and I thought okay, I need to figure out what to do next.
“I remember very clearly I was doing a scope that day and when I was looking through the results, this patient comes up to me and repeatedly asks, ‘Doctor, do I have cancer?’
“I told him, ‘No, you don’t have cancer’, but my mind was racing at 100km/hour as I was trying to decide how to deal with my cancer while seeing patients – it was a crazy time,” he shares.
It’s not cancer?
Thinking his life expectancy was short, he drove over to his parents’ place to break the news.
“They were in their 80s and quite stoic, telling me I would be fine,” he says.
That night, Dr Ryan’s mum suffered a heart attack and a stroke, and was admitted to the intensive care unit (ICU) at the hospital where he works, but the family kept the news from him.
“And I was a few beds away reading a patient’s biopsy results!”
Three days later, he gets another call from the lung physician to say his lesion wasn’t cancerous.
Dr Ryan says: “Twenty minutes later, as I’m celebrating the news, the pathologist calls me again and I thought, ah, I bet he’s calling to apologise for the wrong diagnosis.
“Instead, he informs me that it’s not lung cancer, but after consulting other experts, it was confirmed to be lymphoma.”
That was how Dr Ryan’s diagnosis was changed to stage two primary mediastinal B-cell lymphoma, a rare cancer that forms in white blood cells and usually affects younger people.
News travelled fast, and that night, Dr Ryan’s fellow gastroenterologists and their wives came over to visit him.
“I turned to them and said: ‘I’m really stuck, would you be able to look after my kids when I’m gone?’
“They just stared at me.
“I was hoping someone would say it’s going to be all right and I’d beat the cancer, but nobody said anything – it was that moment of helplessness,” he says.
His children were five and 10 then; his wife Datin Caroline Law had to be strong for their sake.
Fight to live
Then began Dr Ryan’s journey of chemotherapy in his workplace, in the same ward he used to do rounds with his nurses.
He had to take off the doctor mantle and become a patient with patience.
“Just a week before, I was doing rounds, and here I was in my patient scrubs trying to figure out how to use a commode and preserving whatever dignity I had left!
“I was able to hold myself on a world stage once, and now I’m shaving my head for my children so they don’t have to see my hair dropping,” he shares.
Prior to being ill, he would always tell people that he had led an incredible life with plenty of blessings and if he were to die that day, it wouldn’t matter.
He reflects: “That changed. All these thoughts about I’m okay to die tonight went away.
“When I was faced with my own mortality, I wanted to live.
“It gave me an insight into the human mindset – it’s all about preservation of life.
“When you talk to people, nine out of 10 will say they’d rather die than be on a breathing machine because they don’t want to be a burden to others.
“But in my decades of medical practice, I can count with one hand when that has actually happened.
“Faced with an illness, they will fight as much as possible and I discovered that firsthand.”
The treatment was brutal and he spent six months in and out of hospital.
“I call it the mother of all chemos as it blasts your bone marrow,” he says.
“It was a cocktail of all these drugs I used to read about in medical school – I couldn’t even pronounce the names, and here, nurses in ‘space suits’ were giving them to me intravenously.
“If the drug falls to the floor, the room has to be disinfected and they were putting this radioactive material into my blood – it was surreal what I was going through.”
But one thing his friends noticed was that he started talking more than normal!
“My colleagues were comfortable with me calling them at 6am to talk – ‘til this day they laugh about the multiple conversations I had with them,” he says.
Sharing his story
The drugs caused severe side effects, and in the first month, Dr Ryan had to be rushed into the ICU.
As he was being wheeled in, passing him on the other stretcher was a former patient he had performed a procedure on.
“I was bald, but he recognised me and I could hear him asking my colleague if I was the doctor who treated him.
“I was too sick to say hi!” he says.
Dr Ryan started writing memoirs of his daily activities to understand what he was going through, and for his children – he called it The Other Side of the Bed.
“I’ve developed a cynical, quirky view on life and am open to people asking me what my cancer was like.
“Many patients have said, ‘But you are a doctor, how could you have developed cancer?’
“People think doctors are invulnerable and shouldn’t get sick.
“I don’t smoke, don’t drink much, but I never wondered ‘why me?’; it was all about being patient and doing what was right to get better.
“When I celebrated my 50th birthday, a friend told me if I could survive 50 to 60 without an illness, I’d live to be 80 or 90 because that’s when everything catches up with you.
"True enough, a year later, I fell ill,” he says.
Immediately after completing his treatment, Dr Ryan got back to work – bald, skinnier and without eyebrows.
He says: “I don’t know if my patients got scared seeing me!
“And how bizarre that the first patient I saw was someone with B-cell lymphoma?
“I’m always giving patients the death sentence when I tell them they have liver or pancreatic cancer.
“Their minds are in turmoil when those words are uttered – their life changes, but I know chemotherapy actually works and I share my journey with them. I’m more empathetic.”
Fear of recurrence
Dr Ryan hasn’t reached his five-year remission date yet, but his life has definitely changed – home and family take precedence these days.
A few months ago, his daughter told him she thought he would be under the “rip rock”.
Stumped, Dr Ryan asked her what that was.
“There was a cemetery near her school and she was referring to the RIP on the tombstone and the rock underneath.
“She said, ‘Papa, I don’t want to be around if you die.’
“The kids seem resilient, but my cancer has undoubtedly affected them.
“The journey of cancer is a journey of a family – my immediate family and wife have been incredibly supportive, although she (his wife) developed high blood pressure.
“And my inner circle of doctor friends has been wonderful in guiding and guarding me in every step.
“My life will never be the same again, and I’d be lying if I said everything is well.
“I do have an element of post-traumatic stress and get scared when some of the symptoms recur – my mortality is always in my face,” he admits.
A doctor always analyses symptoms to see if they correlate to a problem.
“I don’t want to know any more,” he concedes.
“I’ve surrendered my medical thoughts with regards to my cancer and become a patient.
“Just tell me what to do and I’ll do it.”
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