Below Krista shares, in her own words, her incredible journey through an osteosarcoma diagnosis.
My name is Krista Bose and I am 26 years old, in 2018 I was diagnosed with osteosarcoma.
I am Canadian and also a medical student, training to be a doctor, and before beginning my training, I majored first in Biology in my undergrad, and then in English Language and Literature. In the past eight years, I’ve lived in five different countries. Canada, Singapore, USA, China, and now, the UK. Now I’m not just saying this, but the UK is definitely my favourite. I used to live in Oxfordshire when I was a little girl in primary school, and then my family moved away to the States. Later in life, I returned at 22 years old, four years ago. As all great stories start, I had impulsively bought a one-way ticket to London, with no place to live, no job or school prospects, a stuffed suitcase and a ripped backpack, and a small stash of savings. I ended up meeting two guys in a pub that had a spare room going in Seven Sisters. Please imagine how well that phone call went with my parents.
I’d come to England at 22 because, obviously, I’d fallen in love with an English boy, I’d met in Shanghai the previous summer. His name is Oliver. He is now my partner of five years. I was also in love with medicine, and I’d wanted to become a doctor. I now have one year left until I qualify. And most importantly, I was in love with life! I was an avid traveller, explorer, athlete, primary school teacher… The list goes on. I wanted to share this part of myself with you guys today, as a backdrop, so that you could all paint a picture of Krista- BC.
BC, as in, Before Cancer.
Two summers ago, in June 2018, I was on a surgical elective in Prague. The vast majority of surgeons at the hospital I was training in, didn’t speak English, only Czech. So, as it was, it was very difficult to communicate.
I had expressed to my English-speaking advisor that my left leg had been getting quite sore while standing in the operating theatre for long periods of time. I also had a huge swelling emerging out of the top of my thigh, and it had been diagnosed in the UK as a haematoma.
Now, as a lacrosse-playing, half-marathon running, boxing, hockey coach, yogi, the world of sports injuries was not new to me.
Sore legs, bumps, and bruises… it was usually not worth fussing about. Ice, ice, baby, and suck it up buttercup were two of my most-used mantras.
One of the general surgeons in Prague decided that I should probably get an MRI scan of my leg, just in case. I’d already had an ultrasound in Prague that had confirmed internal bruising, but this Czech-speaking consultant thought we should look again. Luckily, he was willing to speed up the process, and order the MRI himself, but only if I was willing to get him Wimbledon Tennis tickets. This to me, was bizarre and hilarious. Of course, I’ll try and get you tickets! Why not? I’ve been living in Wimbledon for three years, I’m sure I could enter the ballot. So off he goes to order my MRI for Friday, in two days’ time.
The night before the scan, I had gone out dancing with several other international medical students on the same program as me. We ended up crawling into bed at around 4:30 in the morning! My leg had been aching while I was out, but I figured it was all because of the high heels. I nearly skipped the MRI which was scheduled for the following morning, as I was feeling hungover and exhausted. But I showed up in my hospital uniform, ready to go straight into my placement afterwards.
You’d have thought that as a medical student, I would have seen it coming. A huge lump sticking out of my leg. I hadn’t been feeling well for ages, and I’d lost a lot of weight, which I’d attributed to all the exercise.
The scan showed a very, very large malignancy devouring what was supposed to be my left leg. You do not need to be medical whatsoever to understand the scan. It’s plainly, clearly, unequivocally, bad. My very kind surgical advisor emerged from the room where the team had seen the MRI scan, and he asked me to sit down with a face so white, I already knew it was bad news. Instead of crying or freaking out, I did what all Canadians do best, and I politely thanked him (several times) and apologised that he’d had to give me such terrible news.
The team in Prague told me to go home to London and to get a biopsy of my leg done as soon as possible. It took me a few weeks to be passed along through my GP, to the soft-tissue sarcoma team at the Royal Marsden, to the hard-tissue sarcoma team at UCLH, including several trips to the Royal National Orthopaedic Hospital for more scans and finally, for my bone biopsy, and then, eventually, to the Macmillan Cancer Centre at UCLH in London.
After my bone biopsy results came out, I walked into an appointment at the RNOH with the orthopaedic consultant. You guys know those commercials about a person hearing they have cancer and then all of the rest of the words become static? It really is true.
I only remember him saying one thing.
Krista, I will attempt to save your leg, but only chemo can save your life.
I’d walked into that appointment, and I was wheeled out. I was sanctioned non-weight-bearing, meaning I could not put any weight whatsoever on my left leg, because if I were to fracture it, they would have to amputate my leg. That was the last day of my life in which I walk on my two birth-legs. I ran almost every day of my adult life, and now, supposedly, I will never run again. That day, I was diagnosed with stage 2b, out of three, osteoblastic osteosarcoma.
Getting cancer sucks. Losing all mobility and personal independence on the same day? That was really rough.
I had a few days off before chemo started, so I decided to Brave the Shave. All of the proceeds, went to CNS nurses at Macmillan. I donated all of my hair to Little Princess Trust, a company that makes wigs for cancer patients. I had been donating my hair every other year since I was 11 years old. Little did I know.
I was started on MAP chemotherapy in July 2018. MAP is a set of three chemo drugs. For the first week of the cycle, I would be given two drugs for five days. During these five days, Oliver and I would stay at the Cotton Rooms overnight, which is the chemo-hotel across the street from the Macmillan Cancer Centre. Then Oliver would wheel me in my wheelchair over at nine am for treatment. I would start my side-effects pills, get plugged in to fluids and chemo, and he’d give me a hug and head to work, which was fortunately only a few blocks away. He’d pop over on his lunch break to try to get me to eat, and then he’s be back around 6:00 to take me back to the hotel. Although for Oliver, the days probably felt quick and stressful, those five days for me were torture. The amount of resilience it takes to watch the chemo drugs drip, drip, drip into your bloodstream, and knowing that every drop will make you that much sicker. The fight is trying not to rip your PICC line out of your arm. I’ve actually seen someone try this, so please don’t think I’m over exaggerating.
After the five days of Doxorubicin and Cisplatin, I would effectively become a zombie. Everyone experiences chemo side effects differently, and everyone has a different haul of complications, but I could’ve been the poster child for what-can-go-wrong. If it was on the list, I got it. Constant, never ending nausea, gagging from water that’s too warm, vomiting, horrendous constipation that could last for a week, pain in my leg, pain in my stomach, pain in my subconscious, extreme muscle weakness so that sitting up in bed was too much, and remember- don’t even think about walking, mucosal ulcers anywhere along the GI tract from top to bottom, sweats, fatigue, nosebleeds, hair loss everywhere that hair once grew including arms, legs, and nose hairs, neuropathy in my fingers and toes… the list goes on. Then apart from my first cycle of chemo, every single other cycle, I would be hospitalized around four- or five-days post chemotherapy treatment for neutropenic sepsis. Meaning that my immune cells were so low, that I couldn’t fight infections off, leaving me septic with various bacterial infections. I’d be hospitalized for around a week. They’d give me several flavours of antibiotics, blood transfusions, platelet transfusions, fluids, and lots of morphine. Then I’d get out of hospital, have one or two days off, and then I’d be back in for two weeks of Methotrexate, the third chemo drug in MAP. Queue ulcers and side effects.
This went on from July to October. I’d had another scan of my leg, and found that after all that chemotherapy, my tumour had grown, significantly.
I was called in to see the orthopaedic surgeon, again. He asked me to look at the scans, and he gently asked me, how much do you like your knee.
I barely looked at the scans.
Take it. I am not going to be coming back here in a year to do this again because you couldn’t get clear margins for a knee. Take it.
So, on October 1, 2018, I had my femur, knee, and top of my tibia resected. On opening me up, the surgeon discovered that the cancer had spread outside of my bones, where it began, and into my beloved quadriceps. So, he took those too. All four.
I spent five days in HDU at the RNOH after surgery. Then another week on the orthopaedic ward afterwards.
I had a failed epidural, two drains than ran the entire length of my prosthetic ripped out, this was my first 10/10 pain, ketamine-induced hallucinations, a catheter, over seven failed peripheral cannulas, and I’ve had the very degrading experience of a bed-pan on a crowded ward with a bum leg. I was told this week, that due to the findings in theatre, I may never walk unaided, and that I may never lift my left leg again.
I am aware that sometimes in medicine, there really are limitations to what we can do. But I also know that there’s always new research emerging, new treatments on trial, and new people that will surprise you. So, it’s the job of the health-carers, the physios, the doctors, the researchers, and everyone involved to, when you can and if it’s appropriate, offer hope. Offer a challenge instead of an impossibility. At the end of the day, optimism tastes a lot better than the meds I’ve taken, that’s for sure.
I finally left the RNOH. Oliver and his amazing mom, Barbara, brought me home.
A week or so later, I came back to my Macmillan home, and met with my Professor, who was the best I’ve ever known. He and I decide that MAP wasn’t working for me. So, he switched me to a second line of chemo.
Ifosfamide and Etopicide. I would take these two drugs for four days, along with a slew of side-effect preventing medications. I still had every single side effect in the book, and I was once again, hospitalized for infection after every single round. I was also started on immunotherapy, which was given twice a week for three months and then once a week for six months. It gave me the rigours, and it made me weak and fragile, but it wasn’t as bad as chemo. This new regime went on from October to January.
It was here, in this chapter of my story, that things got bad for us.
I now weighed just under 100 pounds, about 45 kilos, about 7 ¼ stones. I didn’t usually eat unless a friend came over to encourage me, or Oliver forced me to swallow scrambled eggs. I laid in bed, usually in a hospital, hallucinating, vomiting, and sleeping. I listened to Harry Potter audiobooks on repeat. My dreams were vivid nightmares.
I was visited in hospital by the palliative care team, and they inserted subcutaneous morphine drivers, to constantly release morphine into my system, to try and make me feel more comfortable.
Every single day though, when Oliver went to work or my friends were away, I was never alone. My team of nurses, physios, and volunteers always had my back.
At St George’s, where I’m training to be a doctor, and also where I was treated, I think nine time for neutropenic sepsis, I had CNS named Claire. She was phenomenal. Claire never looked at me with pity. She came to see me, brought me tea, or small favours, she listened, patiently and kindly, she made me laugh at stories, and most importantly, she advocated for me. Every time.
I had a very naughty habit on the wards, of using my medical knowledge to try and convince the medical teams to discharge me. I would present my own case on ward rounds, frequently memorising my own counts, and stats so I could convince the consultants that I was on an upward trend, and that I was ready to go home. Claire would go and look up counts on the computer for me, to back me up.
My Macmillan team at UCLH went above and beyond for me. Pedro would discuss pop culture and game of thrones with me every time I came in, often re-enacting scenes for me as he drew blood. Oliver and I spent our New Year’s Eve with Raj, as she plugged me in for my final round of chemo. Rachel and Emma would both call out my name when I crutched or wheeled onto the ward, Rachel with her glowing smile, and Emma with her mischievous grin. She was always up to trouble. But anytime I was too sick to take my mesna tablets (which are the most revolting tablets in the world), she’d helpfully infuse them for me. All of my nurses were there for me. They all did so much for me.
Then there was the TYA Youth support worker, Manju. Manju could look into your soul. She had an unparalleled graciousness and warmth about her. She also could kick up a storm of banter, like I’ve never seen before. She brought everyone together and introduced me to some incredible people.
My physiotherapists are the reason I walk today. Becca created JOGLE, which I hope is still going strong on the wards. If you haven’t heard of JOGLE, me and my fellow sarcoma patients biked through chemo/immunotherapy/limb-sparing surgery, on the adapted stationary bike, the entire distance from JOG to LE. 874 miles. It took us about six months.
I also have met with dieticians, doctors, psychologists, pharmacists, surgeons, alternative therapies teams, support workers. Everyone. Since finishing treatment, I have also gotten involved with countless charities.
The Bone Cancer Research Trust have decided to spend days devoted to researching better treatments for bone cancer. I’d like to thank you in advance, for all the people that will one day wish to thank you, that are receiving better treatment than I did. They won’t know how to reach you, and they won’t know your name, but believe me, they will think of you. They will directly benefit from your influence, your research, your support, and your optimism. Thank you in advance for all lives you will change, by being here today.
To finish off my cancer timeline, I started back at medical school on June 24, 2019, and I finally finished immunotherapy treatment on July 23, 2019, one year ago. I am cancer-free.
In summary, I would like to say thank you to everyone who is reading this. You are all such honourable human beings for becoming a part of this bone cancer family and for helping people get through what might be the most difficult time of their lives. It may not always be easy, but I do hope you recognize, the gift you are giving.
Someone incredible, another osteosarcoma patient in fact, said to me during me very early on in my cancer journey,
Welcome to the club you never wanted to be a part of.