Despite metastatic breast cancer, this woman continues to work... from her bed

Despite her multiple challenges and eligibility to be medically boarded out, Vali continues to work from her bed to make herself useful. — ZHAFARAN NASIB/The Star

Lumps and bumps are commonly found in the body and not always a cause for concern.

That’s what Manickavali Nalliah, 54, assumed.

She first noticed a lump in her breast when she was sitting for her SPM exam back in 1986.

Vali, as she is popularly called, had it removed and was assured that it was a benign growth as breast cancer was rare in teenagers.

Subsequently, similar small lumps kept recurring and she repeatedly went for ultrasound scans and mammograms over the next few decades.

The results always came back negative and the gynaecologist told her not to worry.

Life went on and she ignored these lumps, which would appear, and sometimes disappear, on their own.

Then in 2016, a boil that had developed at the side of her left breast burst and started to bleed.

Tired of seeing doctors, Vali paid no attention to it, thinking it would heal by itself.

By this time, she had been diagnosed with type 2 diabetes.

“The bleeding didn’t stop for a few days.

“My mother insisted I see a doctor because I was constantly dizzy.

“Eventually, I had to go for a blood transfusion as I became severely anaemic.

“One doctor even asked me to remove the breast because of the excessive bleeding, but I said no, I wanted a second opinion.

“Still, the breast cancer was not picked up,” relates Vali, who lives in Sungai Petani, Kedah.

At the same time, her younger brother N. Ananthagopi was getting married and the family was busy with wedding preparations.

As a junior executive at a local bank in Penang, Vali would commute an hour to work daily.

She recalls vividly over a recent online interview: “After the wedding in 2018, I was driving to work around 5.30am and my eyes suddenly blurred.

“I hit the divider – the car was badly damaged, but I came out unscathed.

“Two weeks later, my feet started to swell on and off, and my back hurt.

“I chose to see an Ayurvedic doctor and after seeing my wound from the boil that had burst, he said I had advanced breast cancer.

“He treated the wound, but I was numb with shock.”

Within two months, Vali was struggling to walk due to severe back pain.

Climbing 27 steps daily to get to her workstation on the second floor (the bank is located in an old building with no lifts) proved to be torturous and she applied for prolonged medical leave.

Diagnosis confirmed

It was then that a friend took her to a private hospital, saying traditional treatment alone won’t help back pain.

The side effects of chemotherapy resulted in Vali (right) losing 40kg in six months at one point. It was also hard for her mother (left) to accept that another daughter of hers also had cancer. — Photos: MANICKAVALI NALLIAH

Like most people, Vali was scared to face the inevitable.

“The tests confirmed I had breast cancer, which had metastasised to the spine.

“The orthopaedist didn’t want to start any treatment until the visiting oncologist came.

“Instead, he told my mother, ‘She only has six months to live, take her home, keep her comfortable and send her off peacefully’,” shares the eldest among three siblings.

Engulfed in emotion, her mother T. Vasunthra, and her brother, immediately broke down.

After all, they had already lost Vali’s younger sister to a rare form of cancer that began as a lump in her forearm in 2005.

“She had the lump removed, and just before she was supposed to start on chemotherapy, she suffered breathing difficulties and died in her sleep a day before Deepavali.

“She was 34.

“In the eight months after being diagnosed, she never once complained and continued to go to work as a school teacher,” says Vali, turning pensive.

The family, especially Vali’s parents, was devastated over their middle child’s demise as they were preparing to celebrate the auspicious festival.

This flashback and the orthopaedic surgeon’s words were too much to handle.

Vali says: “I didn’t cry, but thought to myself, dear god, please take me peacefully or guide me in whatever time I have left.

“I had to be brave for the sake of my family.”

When the visiting oncologist came, he confirmed that she had stage 4 HER2-positive breast cancer with spinal and bone metastasis.

“Since I could move my limbs, he said chemotherapy and radiotherapy would help.

“I was transferred to Universiti Sains Malaysia’s Advanced Medical and Dental Institute (IPPT USM) where I was warded for a month.

“The lump shrank and the pain reduced with the treatment, but the doctor said my spine needed repair as they found two fractures and some spinal cord compression, so they transferred me back to the private hospital.”

Alas, none of the surgeons were willing to perform the surgery as they deemed it too risky, but her oncologist eventually found someone in another private hospital who agreed to do it.

Vali was once again transferred and operated on in 2019; she had eight screws inserted into the thoracic and lumbar areas.

Thankfully, she has unlimited medical insurance coverage from her employer.

She says: “Thereafter, I could walk slowly using a walking frame, but there was some paralysis on my feet.

“The physiotherapist also taught me some exercises.

“Once I returned home, I continued going for chemotherapy at IPPT USM and the side effects caused me diarrhoea for a year.

“I had to hire a nurse to take care of me as I was frail.”

From a hefty 80kg, the singleton dropped to 40kg over the next six months.

She continues: “The doctor gave me the green light to start working just before the first Covid-19 lockdown.

“My brother would drive me to work daily, and considerate colleagues would sometimes carry me up and put me in a wheelchair.

“My bosses even tried to get me a transfer to the Sungai Petani branch, but there was no vacancy.”

Due to the diarrhoea, Vali had to wear adult diapers to work and ask the cleaner ladies to help out when nature called – they willingly obliged.

When the movement control order was imposed in 2020, she was asked to work from home.

One challenge after another

Slowly, she got stronger, but towards the end of 2020, another small pimple appeared on her breast and the oncologist suggested she do a mastectomy.

Vali, seen here with a colleague, when she was still somewhat independent and able to work in the office.

After speaking to the surgeon, Vali decided to remove both breasts.

Always positive, she recovered well and resumed working at the office when she was dealt with yet another blow in 2021.

She says: “I was climbing the stairs at work and pus started oozing out from my spine where I was operated on.

“The diabetes probably caused my wound not to heal well and it became infected.

“They did another scan and found the chemotherapy was not working as the cancer cells had spread to the abdomen, liver and bone.

“But the hospital didn’t have any further drugs so they transferred my case to yet another private hospital in Penang where I’m currently receiving treatment.”

The cancer had also affected her nerves, and subsequently, partial paralysis set in on her right hand and foot.

Vali cannot walk any more and needs two persons to help her stand.

“The doctor says I might need surgery for my spine, but I don’t think my body can withstand it.

“So they opened up my wound, cleaned it and stitched it back.

“There is a hole as the skin is not growing back.

“My brother has learnt how to clean it and the doctor is impressed with his skills – he changes the dressing daily and does a better job than the professionals!” she says proudly.

Despite the multiple challenges, the once fiercely independent woman continues to battle on.

Her understanding bosses have allowed Vali to continue working – she does it from her bed using a laptop and two mobile phones.

“If I don’t work, what am I going to do at home?

“Who is going to pay my loans and bills?” she asks.

On most days, she only wears adult diapers as the medications make her hot and sweaty.

If there are online meetings, she puts on some clothes.

For someone who loves dressing up, her current “attire” took some time to adjust to.

“I’m one person who likes to look good and feel young at all times – my clothes must match with my jewellery and shoes.

“I haven’t been able to wear new Deepavali clothes for the past two years,” she says, sighing.

These days, due to the wound on her lower back, she is unable to sit for long and has to go to the hospital by ambulance (in a stretcher) for her targeted chemotherapy sessions every three weeks.

She shares: “It’s expensive, a return day trip costs RM500 on the ambulance.

“Among other expenses, I also have to pay for the helper, who comes during the weekdays, and if she doesn’t show up, Ananthagopi will work from home and take over her duties.

“He also takes care of me at night when I need to change diapers.

“I feel bad as he has two young kids and a wife, but what else can I do?

“My mum is old and is using a walker, so she also needs help.”

Sometimes, Vali wishes she had an ambulance sponsor.

Just last week, she was admitted to the hospital again for radiotherapy as her routine scans picked up another two cancer spots – in her brain and pelvis.

“I’m okay, just the food is lousy,” she chirps.

A great mindset

Family support is extremely important and Vali (left) considers her brother Ananthagopi (right) her rock as he doubles up as her main caregiver. Seen here with them are their mother who is seated with her granddaugher, and Ananthagopi’s wife (standing).

Dr Ang Soo Fan, her consultant medical oncologist, is in awe of his patient.

“What impresses me most about Vali is that she never lets anything get her down – she accepts everything with an open mind – I have never seen her in tears.

“Many cancer patients give up when they have to depend on others, thinking they are useless, but Vali remains motivated and wants to excel in her work.

“I asked her why she doesn’t get medically boarded out as she is eligible for Socso, but she insists on making herself useful,” he says.

Vali is currently experiencing oligoprogressive metastatic cancer, where only one or two cancer spots are progressing, while the other spots remain stable.

Dr Ang explains: “So, we have to change her treatment again as the old drugs are no longer working well and we need to tackle the cancer that is growing in a particular spot.

“There are a lot of new drugs now to treat HER2-positive breast cancer.

“One of them is a drug that belongs to a class of targeted therapies called antibody drug conjugates.

“It is not available in most developing countries, including Malaysia, due to supply shortage, but we will get approval to import it from Singapore for selected patients who need it and can afford it.

“The results are very good to control the cancer; unfortunately, it is very costly, so it’s a challenge for those without good medical insurance.”

The drug is administered intravenously once every three weeks and the price is an astronomical RM40,000 per cycle.

Ten years ago, the oncologist says HER2-positive metastatic breast cancer patients would have only lived two or three years, but advances in medicine have extended the survival rates.

He says: “Vali has excellent support from her family; she’s blessed to have a caring brother who always accompanies her to hospital.

“She’s also mentally strong and that helps a lot.

“She does her exercises and has no bed sores.

“You don’t see many patients like her.”