‘Life Interrupted’: Lessons learned on the importance of oral cancer screening, early detection and treatment
When I finished my oral and maxillofacial surgery residency, I started out as an associate in a multi-doctor group practice. I was full of hopes and dreams: I tried to become a better dentist and surgeon by regularly attending seminars, courses and dental conventions. I was planning on getting married and starting a family and the possibility of becoming a practice owner. I wanted to pass my board exam. I wanted to learn more about how insurance companies work. I wanted to help my patients to do better. I had so many goals to help create an uprising career in years to come.
All kinds of thoughts went through my mind as I envisioned my future life. I constantly felt a mix of excitement and nervousness. I was looking forward to a potentially long and fulfilling career with the foundation that I laid down with years of hard work.
My story is not unique. In fact, it is a common story shared by many.
As new dentists step out from dental schools into practice, there are moments that could be overwhelming which defaults our focus to tunnel-vision on teeth. It is of utmost importance that as dentists, we must treat patients as a whole: to perform the dental exam and a comprehensive head and neck examination. Check the buccal mucosa, palate, tongue, the floor of mouth, the oropharynx, and check the neck for asymmetry or induration of lymph nodes. Ask about your patient’s social history and medical history. Perform a biopsy and refer to an oral and maxillofacial surgeon early. Two pairs of eyes are better than one. Many early oral cancers cannot be detected by naked eye, and some benign lesions have transformational potentials to malignant lesions. Therefore, visible lesions should be biopsied and monitored closely. Malignant lesions require staging and a multidisciplinary approach by specialists: oncological surgeons, medical oncologist-radiologists, and other medical specialists. Early detection and referral are prudent.
The last thing that would come to my mind as a new dentist would be: what if all that is ahead of me is stripped away? What if my very presence no longer existed? What if all schooling and hard work just evaporated?
All the unimaginable turned out to be what happened to a new dentist, the late Dr. Manu Dua. Dr. Dua was born in the United Arab Emirates and migrated to Calgary, Canada, with his parents at the age of 13.
He was diagnosed with squamous carcinoma of the tongue at 33 and unfortunately passed at 34 in March 2021. He was not given the chance to further contribute to humankind and left many loved ones heartbroken. Before he left this world, writing became an outlet. He wrote essays on life, illness and death during the period of his illness with wisdom beyond his age to make us rethink our priorities. After his death, his essays were compiled by his sister, Dr. Parul Dua Makkar, into a book “Life Interrupted: Dr. Dua’s Survival Guide.”
Recently, I had the opportunity to interview my friend Dr. Parul Dua Makkar, a general dentist practicing in Long Island, New York, to discuss her brother’s short but incredible life journey, philosophies of human life and its fragility. I would like to share these life lessons with you.
Dr. Manu Dua, as a new dentist and an entrepreneur with a business background, created an impressive award-winning dental clinic in Calgary within a short time after graduating from University of British Columbia in Vancouver. One day, he discovered an ulcer on the left side of his tongue. He and his oral surgeon discussed the lesion, and he was placed on steroids.
He did not have the biopsy done until months later because he did not belong to the high-risk group. Steroids did not give him relief. Biopsy was finally performed when the lesion became symptomatic and had grown ominous. The biopsy result brought Dr. Dua the diagnosis of a stage 2 squamous cell carinoma of tongue, in an individual who had no risk factors. He did not drink alcohol and was not a tobacco user of any kind. He was young and otherwise healthy at the time of diagnosis.
He subsequently underwent hemiglossectomy. Within a span of eight months, in April 2020, the cancer recurred. He then had another surgery and received a total of 33 treatments of radiation and chemotherapy. This is when he made the decision to sell his clinic in the midst of the COVID-19 pandemic in hope to heal and recover. Recurrences found in the lymph nodes in turn spread to the lung. The metastatic lung tumor enlarged four times more within a period of eight months, rendering it inoperable. PET scans showed lesions down to pelvic bone. In December 2020, he had pulmonary pleurosis and had a chest port placed to drain fluid. The fluid buildup made it hard for him to breathe, to talk and to move. He passed away in March 2021 due to metastasis.
Dr. Dua’s death may be attributed to the delay in diagnosis and treatment, as the last thing for a new dentist to come to mind would be to be diagnosed with oral cancer: when you think of oral cancer, the imagery of an older person who smokes and drinks comes to mind. He did not fit the stereotype. He once helped a female patient to diagnose her oral cancer and she ended up surviving.
Since I was the primary caretaker of my late father who passed away from prostate cancer, I was immediately taken by the book “Life Interrupted.” I did not know Dr. Manu Dua when he was alive. However, as I read through the passages, I felt that he was sitting in front of me, giving me life lessons in the most earnest manner, to open my mind to perspectives new to me, and to remind me of what I knew but have forgotten. As his life was peeled away layer by layer, he came into total peace with the situation and himself.
When you realize that there is a finite time immediately in front of you, you gain new perspectives on life. The hardest thing for Dr. Parul Dua Makkar, Dr. Manu Dua’s sister, was the travel restrictions due to COVID-19. She was waiting for the PCR testing to come through before she could travel to Canada when she learned that her brother went into organ failure and subsequently passed. Dr. Parul Dua Makkar would never have her brother picking her up from the airport again. Their parents will never have their son coming home asking “What’s for dinner?” As someone who lost a parent to cancer, and as a mother of two, I sobbed solemnly. The pain was immense.
From our phone interview, I would like to share the excerpts of the interview quoting Dr. Parul Dua Makkar, as her messages to all the dentists:
- Grief is very isolating sometimes. People who haven’t been through it don’t get it. Sometimes grief hits like a tsunami that takes my breath away. At times in silent tears and at times in happy memories.
- I want to remind people, especially our youth, that oral cancer is on the rise. Cancers have no boundaries of age, gender, education, etc. Pay attention to the signs and symptoms, advocate for ourselves and for our patients and the doctors to work together.
- As a young dentist, we are all going to make mistakes. That’s why it’s called the practice of dentistry, even though we all don’t know everything, we’re constantly learning. Getting that license comes with a lot of privilege, a lot of trust. So when you are in that chair treating that patient, your primary focus should be that patient and the well-being of that patient. Listen to your patient, talk to your patient. Take that extra couple of minutes to feel around. Don’t just focus on the tooth, really focus on the overall care.
- Be loyal to the job, be true to the job and be true to your patients. At the end of the day, they are going to go home, they have a family to go back to.
- You don’t know everything. You can’t know everything. You are learning. It’s the practice of dentistry. So, if you make an error, own up, learn and improve yourself.
- Don’t treat insurance. Treat people.
Life is beautiful and life is hard. To be interrupted is to say the least unfair. However, Dr. Manu Dua’s contributions and life lessons are tremendous to me on a personal level, and I would like to share his last message from “Life Interrupted” to all of you as self-affirmations.
“One of the most important things that I have learned during these turbulent and difficult times is to accept the loss of control, and continue to ride the wave day by day … I understand that every day is a new journey, and I focus on getting through the days enjoying little victories and having complete faith that the future will unfold as it should, and my worries and anxieties are normal but fruitless, and will not help me define a new path in life. What is imperative is inner peace, strength, and truly believing that there will be a better life in this world or the next.”
Dr. Cathy Hung is an AAOMS Fellow with a solo practice in New Jersey. She is an alumna of ADA Institute for Diversity in Leadership program and an author, speaker and coach on cultural competency and women leadership. Her first book “Pulling Wisdom: filling the gaps in cross-cultural communication” is currently available in the ADA bookstore as a practice management tool. She recently published her second book, “Behind Her Scalpel: a practical guide in oral and maxillofacial surgery and stories by female surgeons”, an IDL project in hope to close the gender gap. She is a certified professional life coach of Pulling Wisdom Coaching and Workshops, LLC to help women and/or minorities professionals with struggles to gain confidence and excel in the professional world. She was recognized by Benco Dental as one of the Lucy Hobb’s Project’s “Women who inspire” in 2020.