A bird takes flight

In a country where friends and neighbors automatically become "aunts" and "uncles", one can find family outside the bloodline—and be as essential to how one learns to fly through life's ups and downs.

“But Auntie Aves, I want to watch Rosalinda!”

My whiny seven-year-old self stomps her feet as Auntie Aves, my unofficial tutor, turns the TV off.

“Absolutely not. You have to review. You have an exam tomorrow. You think I’d let you throw away your future over a telenovela?”

She had her way, in the end. I missed that day’s episode of Rosalinda, a popular Mexican telenovela dubbed to Filipino in the ‘90s. The titular character, played by Thalia, sells flowers and falls in love with the charismatic Fernando José, played by Fernando Carillo. Why I was so engrossed in this eighty-episode series of romance, family secrets, and amnesia arcs—well, your guess is as good as mine.

This was in 1999, two decades before Netflix and other streaming platforms allowed us complete control of starting, pausing, and repeating your favorite shows. Back then, we only had television, and we needed to know episode schedules to the minute, else run the risk of missing a show. That’s why my generation knows that Ang TV starts at 4:30 in the afternoon (“4:30 na, Ang TV na!”), or that TV Patrol is on by 6:00pm, just in time for dinner. What a marvel that, before Philippine Standard Time was even established, we were glued to our seats just in time for an episode. Some households—ours not included—were lucky enough to have the option to record shows and save them for watching on the weekend, but that still meant remembering exactly when to hit the record button. When you miss a show, you miss a show.

Alas, that night, I missed Rosalinda. I was confined to my room memorizing the regions and provinces of the Philippines. There would be more nights like this, with Auntie Aves insisting that I read my notes, and afterwards taking them in her hands to quiz me for the exam. When I was much younger, she would read storybooks to me, feeding what would soon be a lifelong love of books and reading.

Auntie Aves is not her real name. Her name is Maria Teresa Salabas, or Tess to her friends and family. As a toddler, I could not articulate her one-syllable nickname, opting to invent one instead. As the obstinate little girl and young influencer that I was, I eventually had my way, and all her friends followed suit.

Aves, as I would learn in grade school zoology, is a taxonomic class of vertebrates that has feathers, beaked jaws, and lays eggs, more commonly known to us as birds. I’m not sure why this rolled off my infantile tongue. I certainly knew nothing about birds. I didn’t know their scientific names, and I definitely did not associate Auntie Aves with birds. There goes another locked mystery from my childhood. But Auntie Aves she became.

Interestingly, Auntie Aves is not my aunt, either. As with many Filipino families, friends and neighbors all become aunts and uncles, “titas” and “titos”. Auntie Aves is a dear friend and co-worker to my parents, but she might as well have been family, to be honest. She stayed in the same company staffhouse in Binondo, Manila, so I saw a lot of her growing up, even more than some of my blood relatives. She was the brilliant one in their group of friends, which is probably why Mom designated her the role of my tutor. She tutored me through my early years of primary school. Eventually, I could study on my own, proceeding to earn top spots in class and graduating valedictorian in grade school and high school. I say this not with pride, but with gratitude. If I had anyone to thank for whatever study habits and excellence standards I have in my system, that would be Auntie Aves.

It wasn’t just in studying where she had to put up with me. Whenever we had a gathering or birthday or Christmas celebration at home, Auntie Aves would be host, with the added burden of making sure I won in all the games. Despite my resistance to studying, I was fiercely competitive, and sadly a sore loser. Whenever I lost a parlor game, I would explode into hysterics and run to my room, slamming the door behind me. I imagine they were at a loss at what to do, but whenever I calmed down and was ready to come out, she always welcomed me with a bright smile.

Our family has always been a recipient of her generosity. When my dad died in 1997, my mom was an absolute wreck. She could not eat, drink, or think, much less handle the thought of becoming a widow. It was Auntie Aves who took the reins my mother couldn’t handle. She arranged for the funeral services, the casket, the transfer of the body to Bohol, and all the pesky paperwork, fixing everything so that all Mommy needed to do was to sign what she needed to sign. It was Auntie Aves who kept the lights on, when all we could handle was darkness.

I remember Auntie Aves for her boisterous laughter, a resounding melody that was uniquely hers. She spoke in animated breaths with her curly hair and bright eyes. In spite of her intelligence, she was incredibly modest, refusing to shine the spotlight on herself. Case in point: when my parents unfortunately couldn’t attend my high school graduation, I told her she could share the stage with my brother. “Ayaw na. Maulaw ko, ‘day,” she told me. She refused, saying she was terribly shy. Not because she wasn’t proud of me, because she was—she flew all the way to Manila for the ceremony—but because she believed the glory was mine to bask in.

Auntie Aves and a giddy Ella.

Auntie Aves eventually relocated to her hometown, to Ozamiz, Misamis Occidental. Since then, our interactions were minimized to Facebook likes and personal messages on Messenger. She was always quick to comment on my posts, from awards, to blog entries, to life updates, even the occasional meme I would share. She never skipped a chance to tell me how proud she was of me. She always greeted me on my birthday, with sweet messages to the tune of “you’re the most wonderful girl I have ever known!” and “wishing that life will always be kind to you.” If I ever needed a confidence boost on a bad day, I only had to open our chatbox, and the encouragement would be more than enough.

When I got my medical license, she would consult me now and then about lower back pains and high blood sugar. Last month, we learned from Ninang Badette—another of my parents’ co-workers—that Auntie Aves fell ill, requiring admission for pneumonia. When Mommy and I video-called her, I was horrified to find her at half her previous weight, so much thinner than when I last saw her. She said she had fluid in her lungs, and the doctors used a tube to take them out and have it analyzed in the lab. But the fluid kept coming back, like a loose pipe that continued spilling water where it shouldn’t.

Lungs should have air, not fluid. When fluid fills our lungs, there’s less space to breathe, hence Auntie Aves needed oxygen support. Still, it was clear that she was overjoyed to see us. She was as lively as I remembered from grade school. In that call, we were hopeful, still looking forward to a quick recovery and a catch-up soon.

When the call ended, she sent me a message. “Thanks much. It was enlightening to talk with you and your mom!” I hate myself now, knowing those video calls and personal messages were few and far between.

What I couldn’t tell her was how much her weight loss had worried me. Weight loss is one of the most generic, most ominous symptoms in medicine. It could be anything. Auntie Aves claimed hers was intentional, saying she was cutting back when her blood sugar spiked. But it could be a red flag for infection, with bacteria or parasites stealing calories to feed themselves. In the Philippines, the most common infectious cause would be tuberculosis. It’s a daunting diagnosis wrapped in social stigma. Patients with tuberculosis are still met with avoidance and disgust, with patients euphemizing their diagnosis as “mahina ang baga” (weak lungs) or their treatment as “vitamins sa baga” (vitamins for the lungs). It’s a Filipino Voldemort, known but never named.

But the more worrisome weight loss culprit is more sinister than TB, and arguably a more formidable Voldemort. Cancer often makes itself known through weight loss, with cancer cells taking over our nutrient stores the same way microorganisms do. Cancer, however, is not something we can flood with antibiotics or eradicate in six months. Next to cancer, TB becomes a much friendlier diagnosis, because it can be cured with supremely more certainty.

I could not tell Auntie Aves that I suspected cancer. Her family history was not in her favor. Both her parents died from different cancers: her father, of the skin; her mother, of the pancreas. Her younger sister endured her own battle with breast cancer, thankfully emerging victorious after years of surgery, chemotherapy, and radiotherapy. Cancer is not always and not absolutely heredofamilial, but the more it visits your family, the more likely it is to come back.

Ella, now a doctor, visits her Auntie Aves in a hospital in Cebu.

We visited Auntie Aves a few weeks back in Cebu, when she was transferred for further diagnostics and management. I’m always jarred when I enter a new hospital. The parts are similar, but the format is always confusing, like Lego dollhouses with a million different permutations. My mom and I asked a security guard, who told us that visiting hours were over and we’d best come back the next day. Mommy, not one to give up without a fight, white-lied her way to getting us in. We walked in like we owned the place, while also trying to find the elevator. It took two more people to ask before we found our way to room 402, to Auntie Aves’ room.

It took a while for her to register that it was us, but as soon as she did, her eyes lit up. Her siblings and nieces were there, in full support. She looked the same as she did on video call, this time with the IV line on her right hand. She was still on oxygen support.

My doctor brain looked at her oxygen level. Three liters per minute: one of the lower tiers of oxygen we give. Good sign, I told myself.

She was also speaking in full sentences. That’s another way we assess difficulty in breathing, by how easily someone can speak. When it gets harder to breathe, a patient would speak in shorter, more clipped sentences, then phrases, then words, until they’re unable to speak at all, choosing to prioritize breathing over the tedious task of talking.

But Auntie Aves was talking. She asked me how I was and what I was doing in Cebu. We were attending a wedding, I told her. She repeated how happy she was to see me. We discussed her symptoms, how she was feeling, what she was told so far. She was feeling better, she said. Better appetite. Better sleep, too. She had tubes in both of her lungs by now, to allow the whitish-yellow fluid to drain out instead of taking up space in her lungs. I encouraged her to eat, to not worry about her blood sugar, to prioritize gaining back her strength.

At some point, a nurse came in to check in on her. A few minutes later, a doctor came in, too, whom I assumed was the resident-on-duty. She started interviewing Auntie Aves for her medical history. I found my chance to be helpful, so I chimed in when I could. She took montelukast + levocetirizine before she got admitted, I said. She was on seven days of antibiotics, I said. She has no maintenance medications, except for the replacement hormones she’s been taking since her thyroid surgery. She had an episode of elevated blood sugar, but nothing severe enough to explain her body wasting away. I mentioned that we were waiting for some labs, including a chest CT scan done that morning. I brought up the strong family history of cancer. If Auntie Aves understood that this was a bad sign for her, she didn’t let on.

Still, I could see she was scared. She was smiling and talkative, but her eyes gave her away. I could not tell her that I thought of cancer. I instead told her that it was too early to tell, that we had to wait for the lab results, that it could be anything. Like something potentially curable. Something completely unknown. Something that wasn’t cancer.

This last bit I only told myself, mostly because it was I who needed convincing. I have had hundreds of patients with cancer, in different organs, in different stages, with different complications. This was not something I had not done, but admittedly, it was a conversation that never got easier, least of all because now it involved someone I loved dearly. There’s a delicacy to being the doctor in the family. On one hand, it’s a blessing, that invigorating satisfaction of being needed and knowing the right answers. But at times like this, it’s also a curse, this burden of knowledge and this presumed wisdom to know when to dispense it.

I’ve been told many times that medicine is an art as it is a science, and conversations like this certainly fall into the former category. It’s an art not for its beauty, as medicine can be grisly and horrifying, nor for its poetry, as medicine is often not defined by rhyme or rhythm. It is an art because it demands a command of nuance, of timing, of vulnerability. Unlike the science of medicine, the art is not easily taught, often left to the wisdom gained from experience and error. No one receives awards for mastering this art, but I argue that it’s a skill that no award can properly represent.

To my dismay, when the lab results came out, it was clear: breast cancer, stage IV. With metastasis to the lungs, explaining the fluid that kept refilling itself. Possibly even the bones, explaining her on-and-off joint pain. For all my clinical suspicion, it felt horrible to be right. Even more to learn how severe it already was.

Her siblings told us that she had an oncologist on board, whose goal was to build her up to prepare for chemotherapy. The fluid in her lungs refused to abate. She was short of breath more often, so much so that her doctors put her on morphine, one of the tail-end treatments we give for dyspnea, reserved for the kind of shortness of breath that feels like perpetual drowning. I can never imagine how that must feel, a drowning you can’t escape. Auntie Aves, whom I rebranded with a name meant for birds, creatures gifted with flight and unencumbered by the burden of gravity, is now drowning, despite all the air around her.

That short visit to Cebu was the last time I ever got to see Auntie Aves. She passed away a few days ago, bad news I received a week ago through Facebook Messenger from Mommy. It was the end of a regular Monday, the sunset obscured by dark clouds and drizzling rain. At that moment, a number of other messages reached me through other platforms. A friend continued a conversation about matcha drinks. A colleague updated me on a job opportunity I might be interested in. My bank sent me an email saying my fund transfer was successful. Testaments to how the world continues despite whatever heartbreak is tearing us to pieces.

A week has passed. I’m still grappling with the fact that she’s gone. Death walks away with a shroud of disbelief in its wake. A few weeks ago, I could not even accept her diagnosis, let alone face the inevitability of her death. Now, we’re left to figure out how to live life without her. Her absence leaves a void that time cannot fill.

But what a blessing it is to have known Auntie Aves in this lifetime. To be loved so sincerely, to find family in someone who would otherwise have been a stranger. My regret today is that she never got to hear these words, and that I failed to tell her how much I loved her.

In her birthday messages to me, she always told me to soar, and that she was but an instrument of God in my life, a part she gleefully played all her years. I call her by a name synonymous to birds, but in truth, it was always Auntie Aves who kept me flying. She was my wind, my compass, and my sun. My only solace in her death is that now, she can fly too, free from the pain of disease and the worries of this world. She lived 59 short years, a life that will always feel too short, but a life lived so full that the love naturally spreads.

Fly free, Auntie Aves. I will miss you terribly, but I’ll keep flying, remembering that it was you who taught me how.

---

About the author—Ella Mae Masamayor is an internist, blogger and podcaster. With her best friend JB Besa, she co-hosts Kwentong Callroom Podcast, a weekly program where they talk about life in and around the medical profession. Her pieces have appeared on the Philippine Daily Inquirer’s Youngblood column, the literary magazine Santelmo, and in the anthologies PGH Human Spirit Project and Rx Narratives, as well as on her own Substack publication, Ella Thinks Aloud.

---

The illustrations accompanying this essay were taken from the book Bird-land Echoes (1896), written by Charles Conrad Abbott and illustrated by William Everett Cram. This was contributed by the Smithsonian Libraries and Archives and made available by the Biodiversity Heritage Library.