There are just three of them now. The man, woman and child, who wrestled with fate to stay together as a family and are happy with a simple Sunday in the park. Just like any other millennial couple, Deepika Gopnarayan and husband Sugat had their life neatly packaged for them. Both engineering graduates, they got the jobs they wanted, travelled around and decided to have a baby five years after they got married and settled down in Pune. She was 28 then, he was 32, a perfectly healthy age to become parents. And then midway through her pregnancy, she was diagnosed with a rare cancer.
The rest of her story reads like a believe-it-or-not newsreel: Sixteen cycles of chemotherapy, one surgery, radiation, a bout of COVID, a year of struggling to keep the body alive. Yet in between she delivered a healthy baby boy, the dew of life that nursed her back to health and has made her the mother she is today.
Surviving all of this, she tells us how she took each day at a time, determined to give birth to her child and live for her husband, who took half of her worries and anxieties. “Once I was diagnosed, Sugat read up and kept himself well-informed about my condition, the complexities involved and the delicate nature of the healing journey. He took on all the chores at the house and asked me to focus only on my recovery. Frankly, I didn’t overcrowd myself with information and focussed only on what had to be done one day at a time. His effort to pull me out of the trough made me stronger and I willed that I had to be there for him. And as my son grew big inside, I told myself that I could not leave him in the lurch.”
Dr Pranjali Gadgil, Breast Surgeon at Pune’s Jupiter hospital, who has become Deepika’s go-to person since her diagnosis in 2020, says that Deepika was suffering from Pregnancy Associated Breast Cancer (PABC), a special variant of cancer that can complicate 1 in 3,000 pregnancies. “Given the complexity of the case, where addressing one concern could grossly impact the other and where we risked working at cross purposes, we set up a multi-disciplinary team of oncologists, obstetricians and gynaecologists. Individually each of us knew what needed to be done but the way we all came together is what makes Deepika’s journey miraculous,” says Dr Gadgil. Of course, she was taken in by the persistence, patience and long-haul tenacity of both Deepika and Sugat. “Not only did they have a scientific temperament, they were far more mature than their years and made us fight for them as a team,” she adds.
THE SHOCK OF DIAGNOSIS
Deepika got pregnant in the middle of 2020, just when the pandemic was peaking. Six months into her pregnancy, a lump appeared in her breast. Since she had had a fibroid in the same area before, which was found to be benign, she didn’t pay heed to it, thinking it to be a tissue knot that many pregnant women preparing for lactation complain about. But when the pain turned unbearable, Sugat rushed her to hospital.
“She had no family history of cancer. However, when the lump grew from 1 cm to over 5 cm over a few weeks, Dr Gadgil immediately did a core needle biopsy,” says Sugat. PABC is a rare cancer, affecting one among 3,000 pregnancies, and often tends to be aggressive. It can grow rapidly under influence of hormones and growth factors that abound in pregnancy. Says Dr Gadgil, “The average age of women who have PABC is 32-38 years. Deepika was only 28. There are also some constraints in treating breast cancer when a patient is pregnant. Radiation cannot be given during pregnancy. Chemotherapy cannot be administered during the first trimester, during crucial phases of development. We avoid general anaesthesia and surgery very early in pregnancy. Although Deepika was in her second trimester and surgery could have been performed, a 5.5 cm tumour would have necessitated complete removal of the breast called mastectomy. That meant reconstructive surgery would have had to be performed immediately to replace the removed breast. We wanted to minimise the exposure of the foetus to anaesthesia and hence deferred reconstruction to a later time.”
HOW THE CHEMO SAVED DEEPIKA AND HER SON
Deepika was put under neoadjuvant chemotherapy during her pregnancy to shrink her tumour. “Contrary to common belief, modern-day chemotherapy for breast cancer can safely be administered during the second and third trimesters. Deepika handled chemotherapy without major complications. Her husband Sugat was very supportive and the couple had a very positive approach throughout treatments,” says Dr Gadgil. As the gynaecologists monitored the development of the foetus, adjusting medication, dietitians drew up a diet plan while psychological counsellors hand-held Deepika through the pain and mental lows. Meanwhile, Dr Gadgil monitored the response of the tumour to chemotherapy. “The tumour, which was almost 5.6 cm when we started the chemotherapy, was downsized to less than 2 cm. We also did genetic testing for future risks but they came out normal,” says she.
Deepika went through 12 cycles of chemotherapy, worried about early labour pains that it could induce. But there was pain of another kind. “As side effects of my chemo, I would get shooting and bone-splitting pains and aches. Then as my baby grew bigger, there was another kind of pain. But I was single-minded in my purpose of birthing my child. The doctors wanted to prioritise me but I prioritised my baby. So I would ask my doctors to tell me what I needed to do to get through the pain that day, what medicines I needed to keep my baby safe. I never focussed on risks or complications. In fact, I shut myself out and concentrated on a singular goal, to form a family with my son and husband. My heart would jump every time my baby was checked after a chemotherapy session and I would breathe a sigh of relief after the all-clear,” she says. There were bad days when she broke down but Deepika had a mantra to steel herself. “Everything comes from your mind and heart, meds just help you along the way,” she says.
Chemotherapy also meant that she couldn’t eat much as she would suffer daily bouts of nausea. And the lockdown meant that the young couple had to pretty much fend for themselves. “I ate mechanically just to stay alive. And I hardly had the strength to cook. I had done a dietitian’s course, so I had an idea about disease diets. I relied on fruits and dal chawal a lot. Pregnancy meant I had mood swings and I would suddenly have a craving for ice creams. Sugat improvised by putting toppings on curd. He even prepared cupcakes, pancakes and sang songs to divert my mind. His support firmed up my decision to live for him too,” says Deepika.
Yet as her trimesters progressed, the weight of a growing baby challenged her body that had just about learnt to take chemotherapy in its stride. “I would get so exhausted and unmotivated that I would wonder if the baby should be taken out before full term. Then I would calm myself by reading books and listening to inspirational songs, particularly from the film Mary Kom,” adds the new mother, keeping a watchful eye on her son.
THE BABY WAS BORN BUT HER ORDEAL WAS NOT OVER
As the baby came closer to term, newer challenges came up. “One day she had acute chest pain and fell unconscious. We had to rush her to hospital fearing cardiac arrest, she was so immunocompromised. But it wasn’t a heart attack, she had just collapsed due to pain,” says Sugat. He still cannot forget the day when Deepika was in labour and pre-delivery checks at her hospital revealed that she had COVID-19. “In the middle of the lockdown, we ran from pillar to post at midnight to find a facility which would allow a Covid-positive woman to deliver a child,” he adds.
“The birth was equally dramatic. Deepika tolerated a 40-hour labour pain as she chose a normal delivery. She didn’t want a C-section surgery, knowing very well that she would anyway need another surgery to remove the residual growth in her body and she wanted to be strong enough for it,” says Sugat, who is now writing a book on their three-year roller coaster ride through life to inspire other cancer survivors to never give up.
In January 2021, Deepika delivered her child, a bonny boy of 3.35 kg. “The chemotherapy saved my baby because the cancer could not grow. Since I had taken so much medication, which might have gone to the baby’s bloodstream, the doctors ran all tests on him and handed him over to us only when they were satisfied,” says Deepika.
But since she could not be declared cancer-free, she couldn’t feed her son, who was given formula food. She had four more chemotherapy sessions. And in April 2021, she had a six-hour surgery to remove the residual lump and lymph nodes, the reason that cancer spreads and recurs, as a precaution for the rest of her life. She also had reconstructive surgery where her breast was recast to retain the look and feel. The last step was radiation, 20 sessions to be precise. “This was a preventive protocol, the idea being to kill any bit of tissue or cell that could have escaped surgery,” says Deepika. She had to follow a special technique called a breath-hold technique (gating), due to which doctors were able to reduce the radiation dose and side effects to the heart significantly.
Despite such microscopic attention to detail, Deepika’s body had taken so much in the course of a year that rehabilitation was a long process of six months, knocking her down and sapping her out completely. And though she celebrated the first birthday of her child early this year, she could reclaim her role as a mother after six more months. “I couldn’t take my baby and he would cry a lot. As I didn’t go for surgery immediately, he got used to my touch. Whenever I regained some strength, I would try to bathe and massage him on my own despite my pain. In a way, I forgot my pain attending to him. Over the last few months, I have rebonded with my son. Now I do everything for him. I ate healthy, so he was born healthy but I watch his food with a dietitian’s rigour. I have gained weight because of cancer therapies. So now I have got into a regular exercise regime to lose weight. My one-year-eight-month-old son reminds me about my fitness regime,” says Deepika, tears streaming down her cheeks.
She is 31 now, Sugat is 35. The long treatment means that they have exhausted their insurance and whatever savings they managed in their short careers. “We’ve endured so much that now the unexpected cannot scare us. And if we could do it, others can too,” says Deepika. For life is worth every bit the fight. “And awareness that the earlier we screen for breast cancer, the better shot we would have at life. Deepika busted many myths,” says Dr Gadgil.