April 17, 2024 • 52 mins
Life Interrupted: Finding Purpose Through Grief
In a deeply moving episode of "The Broken Pack™", Dentist Dr. Parul Dua Makkar shares her sibling loss story of losing her younger brother, Dentist Dr. Manu Dua, to oral cancer. With Dr. Dean, she explores her special sibling special bond, the harrowing experience of Manu's illness, and how this profound loss has transformed her life.
Dr. Makkar describes how the writing of her brother's previously unfinished book, Life Interrupted: A Young Dentist's Journey with Cancer, Legacy, and the Lessons Left Behind, became a powerful act of processing her grief and connecting to Manu. Her dedication to finishing his story led her down the path of advocacy, raising awareness about not only sibling loss but also the importance of early detection and treatment of oral cancer.
About Dr. Makkar & Links Mentioned in the Show:
Instagram: www.instagram.com/duagoodjob
Linked in: Dr. Parul Dua Makkar
Website (including information on the Dua Good Job Symposium): https://www.duagoodjob.com/
Book: Life Interrupted: Dr. Dua’s Survival Guide
An additional Oral Cancer Awareness / resource:
The Oral Cancer foundation: https://oralcancerfoundation.org/
Young Adult Cancer Resource: https://yasurvivors.org/about/
If you would like more information or to share your own adult sibling loss story, please contact me, Dr. Angela Dean, at contact@thebrokenpack.com or go to our website, thebrokenpack.com.
Please like, subscribe, and share!
Please follow us on social media:
Facebook: @BrokenPack
Instagram: @thebrokenpack
TikTok: @the_broken_pack
YouTube: @thebrokenpack
Sign-up for Wild Grief™, our newsletter: https://thebrokenpack.com/newsletter
Thank you!
Angela M. Dean, PsyD, FT
Credits:
The Broken Pack™ Podcast is produced by 27 Elephants Media
"If Tomorrow Starts Without Me" © ℗ 2023, 2024
Written by Joe Mylward and Brian Dean
Performed by Fuji Sounds (feat. MYLWD.)
Licensed for use by The Broken Pack™
Now available on all streaming platforms including Apple Music & Spotify: https://tinyurl.com/3vx3kk46
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Dean (00:12):
/Hello and welcome to The Broken Pack™, a podcast
focused on giving adultsurvivors of sibling loss, a
platform to share their storiesand to be heard.
Something that many sibling losssurvivors state that they never
have had.
Sibling Loss is Misunderstood™.
The Broken Pack™exists to changethat and to support survivors.
(00:32):
I'm your host, Dr.
Angela Dean.
Today's episode features Dr.
Parul Dua Makkar talking aboutlosing her brother, Dr.
Manu Dua, to oral cancer.
Both of them were dentists.
This role that they playedimpacted their grief, his
illness, and how she's changedher work and her life to be both
(00:54):
a self advocate for her griefand herself in other ways, and
as it's played a role inchanging her work and how she's
making an impact in leaving alegacy.
She's an author and her brotherwas an author as well.
Take a listen All right.
(01:21):
So welcome to the show.
What would you like to tell usabout yourself?
Dr. Dua Makkar (01:25):
Hi, thank you for having me.
First of all, it's a
Dr. Dean (01:27):
You're welcome.
Dr. Dua Makkar (01:28):
here to share this journey.
I'm Parul.
I am a dentist based in New Yorkand, I lost my younger and only
sibling.
It's been three years now,March.
to cancer, and the irony of thewhole thing is that, he died of
oral cancer, and both he and Iare dentists, or were dentists.
Dr. Dean (01:50):
Yeah.
Thank you for sharing that.
I just reread, the book and so Iknow that'll be part of our
conversation as well, but I waswondering how you would describe
your brother and what you wantus to know about him?
Dr. Dua Makkar (02:04):
Manu was carefree.
He was very honest.
He didn't have any grays zone.
It was black or white.
It was right or wrong, He lovedlife.
He really did.
He enjoyed, every minute that helived and he lived it to the
fullest.
He did things that he wanted todo, not what peer pressure
society expected of him.
(02:26):
So he really lived life to hisown terms and fully.
He wanted to live more.
He really had so many plans and,arrived to the different term.
Dr. Dean (02:37):
And the age difference was about seven years, you said?
Dr. Dua Makkar (02:41):
Yeah.
Seven and a half.
Exactly.
He was June.
I was Jan.
That's exactly seven and a half.
Dr. Dean (02:49):
How was your relationship with him?
Dr. Dua Makkar (02:50):
I think I was more of a second mother to him.
and we were raised verydifferently.
I grew up, my formative years.
I was six when we moved fromIndia to Abu Dhabi and that's
where he was born.
So he grew up, I grew up in anIndian predominant culture.
I went to an Indian school inAbu Dhabi, Manu went to a
British school.
He didn't know Hindi, which isour, native tongue.
(03:12):
He learned it later on in life.
And then, I always say we grewup with two different parents.
My parents were, earlier on themarriage, they were struggling
and he was born almost a decadeafter them being married, and he
was born when my parents were alittle bit more financially
stable and were able to offerhim more, And then I left for
college, half across the worldin, the late nineties, to the
(03:36):
States and he was 10, I was 17.
And so there was a big gap.
It wasn't like I was coming homeevery weekend.
I was coming home every fewmonths for holiday break and
Manu and my parents were stillin Abu Dhabi at that time.
And then they moved to Canada.
Again, it wasn't like Toronto orNew York.
It was, I was still in Oklahomaand he was in Calgary and it
(03:59):
was, a full day flight.
So we grew up, pretty much likeonly children and we would meet.
So what really united us was,dentistry.
Because when I graduated dentalschool, he graduated high
school.
And then we lived together inthe same house and he followed
my footsteps.
He watched me and my career andhe decided to follow my
(04:20):
footsteps.
And then I got married when hegot Dental school.
So when I would go back homeafter marriage, he was in dental
school and he would come back.
so yeah, we were very, we werenever together for long.
And, And so he always looked upto me.
And then I think at some pointour roles reversed where I
started listening to him and hewas very much more read and
(04:41):
worldly and he would offer meadvice on my career and my
practice.
He even helped me lay out theplans for my new practice
because he had already startedhis prior to me opening my own
from scratch, because I waitedfor my kids to be older.
So somewhere along the lines,the roles reversed And, We
taught, we took coursestogether.
We went to DR, we took animplant course together.
(05:03):
We would talk about cases andyeah, dentistry united us.
Dr. Dean (05:08):
So that's interesting.
I wonder what it was like.
I know that you're doing a lotof advocacy for oral cancer
awareness for dentists and otherprofessionals.
And I'm wondering how that wasto learn that he had oral cancer
while you were both dentists?
Dr. Dua Makkar (05:22):
Manu had a lesion and he showed me, he's
like, this has been botheringme.
And I looked at it, He was inCalgary.
I'm in New York and this is2019.
And I said, dude, this doesn'tlook good.
you need to get this biopsied.
And he's like, no, I've got myoral surgeon friend.
I'm on this medication and wehaven't done the biopsy yet
because it's something notserious.
(05:43):
And I go every summer and, thiswas June.
He was just shy of his 33rdbirthday and I go in July.
So we celebrate his birthdaytogether.
He's bought a new house.
And, I said, show me yourtongue.
And this lesion that he showedme a month ago is is really
ulcerated and he's havingtrouble eating, like we went out
(06:03):
for sushi.
He's no, the wasabi hurts me,trouble talking.
And I looked at the lesion andI'm like, are you kidding me
right now?
Why haven't we biopsied this?
And so when the cancerdiagnosis, I think there was
part denial.
like I said, he was 33.
He had a startup scratchpractice in 2016.
You just bought a new house.
(06:24):
He, did all the special build.
He picked all his, finishings.
He bought custom furniture.
He was high on life.
uhhmm His practice to everylittle thing he built, he was
featured on a Dental Town, whichis a dental magazine.
And he was on the cover of thatmagazine in 2019.
and he had the cancer diagnosisat the same time.
(06:46):
And so I think there was a lotof, denial did not want to get
the earlier biopsy because hefeared if it would be true what
he had.
My dad lost his mom, ourgrandmother to cancer, a
different form.
For my dad, it was always cancerassociated death.
Dr. Dean (07:03):
mmhmm
Dr. Dua Makkar (07:04):
And then, I remember my dad asking me that
question, is Manu going to die?
And I said, No, Papa, he's notgoing to die.
He's young.
He's healthy.
He's active.
He plays all the sports and he'sgot no other core morbidities.
This is not your mother who is60 some years old.
This is a young 33 year old.
three year old, they're justgoing to take out the lesion and
(07:26):
they're just going to remove allthe bad stuff and radiation.
He's going to be fine because weknow cases of people who have
had cancer and have survived andhave lived full lives or had
more time on their hands.
So there was no doubt in any ofour minds that he would do it.
I'm like, no, I know this.
I know people who've had cancerin their mouths and it's fine.
(07:47):
It'll be okay.
And that's what we reallybelieved to be.
Unfortunately, it was veryaggressive and it returned after
his first surgery where half histongue was removed and graft
from his arms.
All of that was an eight hoursurgery,
Dr. Dean (08:02):
hmm.
Dr. Dua Makkar (08:03):
and he went back to practice.
He actually came to New York tosee me and then went back to
practice.
Within two months of hissurgery, the cancer returned
Dr. Dean (08:12):
mm
Dr. Dua Makkar (08:13):
and that's just when COVID hit.
COVID hit, we got shut down inMarch, as dentists and Manu's
cancer returned on April 1st,that same year, 2020.
Dr. Dean (08:24):
mm hmm.
I was trying to think back.
So if you were shut down, washis treatment delayed?
Dr. Dua Makkar (08:31):
So his initial treatment wasn't delayed in 2019
where half his tongue wasremoved in the surgery and all
that.
But after his second diagnosis,he got his surgery immediately,
He was diagnosed, April 1st andApril 17th.
Two weeks later, he had a secondsurgery where he had lymph nodes
removed more, went back in forthe neck dissection.
(08:53):
And they saw a lesion on hischest.
And hindsight's always 20 20.
Dr. Dean (09:00):
Mm hmm.
Dr. Dua Makkar (09:00):
And, they ignored it.
It was too small to do a biopsy.
And it was on the same side ashis initial tongue lesion.
Dr. Dean (09:07):
Mm
Dr. Dua Makkar (09:07):
They wrote it off and they gave him chemo
radiation anyway.
Dr. Dean (09:11):
hmm.
Dr. Dua Makkar (09:11):
he finished that in the summer and that's when he
quit dentistry.
He sold his practice.
Dr. Dean (09:17):
mm hmm
Dr. Dua Makkar (09:17):
I guess between COVID uncertainty, I couldn't
travel, borders were shut down.
He decided he's just going toquit dentistry and focus on his
health.
And he started writing the book,the blogs.
Dr. Dean (09:28):
mm hmm
Dr. Dua Makkar (09:29):
That was his outlet because there was no
contact with friends, withfamily.
He was single, it was just hisparents, so he needed something
to share the grief with.
Writing was his outlet.
He found his calling in it, Ithink.
And I think after the radiationand chemo, there wasn't enough
follow up because of COVID.
(09:52):
It did play a role.
He was supposed to have a sixmonth follow up.
It got delayed.
The chest lesion had grown.
They were to do a biopsy.
That got pushed another month.
Before he could even get thatbiopsy, he was in the hospital
with failure to breathe becausethe cancer was in his lungs.
which was shown on the CT scans,which they didn't biopsy, but he
(10:15):
had fluid in his lungs andthat's why he couldn't breathe.
And that fluid was drained andit was positive for squamous
cell carcinoma.
and then it was just a downwardspiral from then on.
That was December of 2020.
And, at that time, even then wewere still hopeful that he would
(10:36):
pull through.
but yeah, definitely, I think alot.
With what COVID played a rolewas Manu was in isolation during
all the treatments
Dr. Dean (10:48):
Mm hmm.
Dr. Dua Makkar (10:48):
radiation.
My parents would drop him, pickhim up.
There was nobody holding hishand during the
Dr. Dean (10:53):
Yeah.
Dr. Dua Makkar (10:54):
There was nobody with him when the consults were
done with the doctor.
So when you're in your thirtiesand you're getting this,"Oh,
we're going to do experimental.
We're going to do immunotherapy.
We're going to do chemo.
These are your after effects.
This is what you need to do.
We're doing wills.
We're doing end of life plans.
We're processing all thisinformation and it's a treatment
(11:15):
protocol, all of that, sideeffects, loss of hair, the burns
from radiation, disfigurement,and he did it alone.
Dr. Dean (11:26):
Mm hmm.
Dr. Dua Makkar (11:27):
and I think that's how COVID plays a role in
Dr. Dean (11:30):
Yeah.
Dr. Dua Makkar (11:30):
his mental status, and maybe not processing
the treatment protocol and weweren't there.
We didn't have a choice.
Dr. Dean (11:39):
Yea that sounds so very isolating and awful.
I worked in a cancer center atthe time.
And I do recall just how aloneand isolated the patients
reported feeling.
So I wonder if that's also addedto your grief.
Dr. Dua Makkar (11:55):
like, when my dad lost his mom to cancer.
It was in India, and we were inthe Middle East, and they would
take turns, my parents.
That was 30 years ago.
Here we are in the western sideof the world, there's so many
advances made, and here we areat the same outcome.
Dr. Dean (12:15):
Mm-Hmm.
Dr. Dua Makkar (12:16):
I remember when my grandmother passed, my
parents used to take turns.
And I want to share this becausehow compounded grief was at this
time.
My dad's the only child.
He lost his dad early on inlife.
So he never knew his dad.
He knew his only parent livingwas his mom.
And I was 14, Manu was seven.
(12:39):
My mom was visiting with mybrother in India, and she called
my dad and said, you need tocome home now.
And I was left with friendscause of middle school and it
was April.
I still remember that.
My dad flew for the final riteswith Manu.
Now, fast forward almost 30years later In a different part
(13:01):
of the world same parents.
My dad watched his only parentdie of this horrible disease Now
he's watching only son mm hmmdie in front of his eyes.
My mother lost her mother April4th.
April 1st Manu was rediagnosed
Dr. Dean (13:21):
mmm
Dr. Dua Makkar (13:21):
So now she's lost a parent for who she can't
grieve because she was in India.
And then in February of 21, mydad asked me that same question.
He asked me, is Manu going todie in February of 21?
And this time I told him, yes,
Dr. Dean (13:40):
mmm
Dr. Dua Makkar (13:40):
you have to be prepared and you have to let him
do what he wants, let him eatthe foods that he wants,
whatever his heart desires.
You have to be ready.
Dr. Dean (13:50):
Mm-Hmm.
Dr. Dua Makkar (13:52):
I knew the diagnosis.
I had been reading the reports.
I knew the outcome.
They knew the outcome.
Manu knew the outcome, but wenever talked about it.
And in March, it was a Fridaywhere Manu was taken to the
hospital for failure to breatheand he had some edema.
(14:14):
And it was a normal occurrenceat this point, him going back
and forth to hospitals.
And my dad's like, Manu's goingin.
Don't call him.
He's going to be admitted.
Call him tomorrow, and I happento be working that Saturday.
So in between my patients, Icalled and my dad's like, we're
meeting with the palliativeteam.
Call us later in the night.
We have to deal with stuff.
(14:36):
So I knew it was coming and thatevening, my mom, I finally got a
hold of her and she told me thesame thing that she told my dad.
30 years ago, I was scheduled tofly.
at this point you neededcompassion, release papers and
all of that, because borderswere shut down and there's a
whole protocol to make it acrossthe border.
(14:58):
And I had my paperwork.
I was coming anyways, a weeklater.
So she says,"Come as soon as youcan.
He's not going to make it." Thatsame phone call she made 30
years ago.
I remember as a 14 year old andmy child is now 14
Dr. Dean (15:17):
Mm
Dr. Dua Makkar (15:17):
And I'm like, okay, I will do anything in my
power to come and I'm expeditingPCR results on a Sunday and then
the following day.
And, I booked my flight.
I get the result within 3 hours.
I say goodbye to Manu like thisand I told him you need to let
go.
It's okay.
I'll make it as fast as I can,but you have my permission.
(15:39):
Don't wait for me.
He was sedated, and he's gotmorphine drip on, and his organs
are shutting down.
And then, I think that allowedhim to let go, because that
evening, he passed and myparents called me and showed me
his deceased body and they'rekissing him and they're loving
him and they're like, he wasjust here.
(16:01):
I was sitting right next to him.
When did he leave?
We didn't even know.
And then three months later, mymother loses her dad.
Dr. Dean (16:12):
mm
Dr. Dua Makkar (16:13):
So my mom lost both her parents and her son
within a year.
And my dad lost both hisparents, watched his only
surviving parent die of cancer,watched his youngest son die of
cancer.
So the grief has evercompounded.
Dr. Dean (16:29):
Yeah.
And that's a lot of loss for youas well.
Dr. Dua Makkar (16:33):
With no one.
Dr. Dean (16:35):
Yeah.
Dr. Dua Makkar (16:35):
Because I'm in the States without, I grew up in
different parts of the world, soI didn't have the village that I
grew up with.
It's all disappeared.
Dr. Dean (16:42):
Mm-Hmm.
Dr. Dua Makkar (16:43):
with people who didn't know my brother very
well, and who, nobody else'slives get affected.
just yours.
Dr. Dean (16:51):
Yeah Did you end up making it there the next day?
Dr. Dua Makkar (16:55):
I did.
Dr. Dean (16:57):
What was that like for you?
Dr. Dua Makkar (17:00):
I knew I was planning a funeral, and I, I
think my mind didn't know what Iwas doing.
I was an autopilot.
I wrote the eulogy on the plane.
I was wearing a mask and I'mcrying.
I'm alone.
And then I go, and my dad'slike, you have to go to the
funeral home.
I can't pick the casket.
You have to do it.
(17:21):
My mom's like, I can't pick outhis clothes, you go into his
closet because it smells of him.
Now his house was, this is wherethe book's title comes from,
because when I entered hishouse, there was a magazine
where he, the same magazine thathe had first talked about his
cancer journey, he had writtenan article about leaving
dentistry.
And that got published the samemonth, at the time of his death.
(17:43):
So it hit hard and everythingis, his clothes are on the
floor, unmade bed, medication,food in the sink.
It's his life interrupted.
And it was just so unrealbecause I had never faced death
of a loved one.
All my grandparents passed in adifferent country.
I knew they're gone.
it's like, They're supposed toleave and they've gone and it's
(18:07):
done, that's just the circle oflife, but this brother of mine
whose diapers I've changed.
I remember him taking his firststeps.
I remember him as a baby, He'dcolor my books and I would get
so mad at him and, he'd crayonall my notebooks and, and I have
my own kids.
(18:28):
I'm like, as a mother having toknow, go through this and as a
sibling having to go throughthis and who do I share this
with?
I had no one.
My parents are doing their owngrief.
They have each other.
The sibling loss is so unique,
Dr. Dean (18:45):
mm hmm
Dr. Dua Makkar (18:46):
and when I sat on that table with the funeral
director across from him, and Ihad all this paperwork and
things that need to be signedoff, and do you need a casket,
do you want his fingerprint, doyou want to see his body, do you
want this, do you want that, themakeup, and what idol do you
want, and what prayers do youwant said, and all these things
(19:08):
that you need to go through,you're like, it's just, it's
You're just deciding, picturesand I'm like, crap I have to do
this two more times for myparents.
Who's going to sit with me?
No one.
And
Dr. Dean (19:24):
and he was supposed to be there for you,
Dr. Dua Makkar (19:27):
I'm like, this is, I don't understand what's
going on because I'm supposed tobe picking out stuff for his
wedding or write, his weddingspeech to emcee his.
dance, my kids didn't get todance at their uncle's wedding.
They performed songs at hiscelebration of life, right?
(19:48):
It's just unrealistic.
Sometimes I want to wake up andbe like, this is all just a bad
dream.
And I feel like, yeah, myparents have each other and
they've had their shared griefand they both understand what
they're going through, butthere's a sense of loneliness.
that I feel that, my parentswill age and they're aging
(20:11):
faster because of, what they'vegone through.
I'm going to lose everybody ofmy blood.
I've lost all my grandparentsand now my parents, my cousins
live far apart.
I don't have that kind of arelationship with them that I'm
close to them because ofcircumstances.
And, it's just me.
Dr. Dean (20:30):
mm hmm yeah I think that's such a unique part of
this too because you have apartner and you have your kids,
but it's that family of origin,
Dr. Dua Makkar (20:39):
Exactly.
Dr. Dean (20:40):
that whole shared history,
Dr. Dua Makkar (20:42):
history.
Dr. Dean (20:42):
a secondary loss.
Yeah.
Dr. Dua Makkar (20:45):
yeah.
and it's reminded Every singleoccasion, every single
celebration, every singleholiday, the what ifs, the what
could have beens, the whatshould have beens.
And there's nobody to blame.
It is what it is.
And you have to come to termswith it.
(21:07):
When you grew up alone as anonly child.
That's all, you know.
When you have siblings, you'relike, yeah, remember when dad
did this or mom did this or,silly history.
Remember when you had guestsover and you locked the oven and
we, all the food got burnt, likeall these little stories.
And I don't have them.
(21:27):
And so there's a lot of angersometimes.
Like I get so mad at him somedays.
I'm like, damn it.
You let me do everything.
I have to take care of theparents.
You left all your writing.
I have to put the book togetherand I have to take care of my
kids and you're not there totake that responsibility to take
them, You left everything on me.
(21:49):
I'm like, you had a great timeand you left.
Dr. Dean (21:53):
I have that same conversation with my brother all
the time.
Dr. Dua Makkar (21:58):
Yeah,
Dr. Dean (21:59):
So that was 2021
Dr. Dua Makkar (22:01):
correct.
Dr. Dean (22:02):
when you passed.
Okay.
And I believe the Canadianborder was still closed for some
time.
Dr. Dua Makkar (22:09):
Oh, yeah, it was still closed then.
The day of his funeral, becauseyou have to have limited
release, which places you haveto go to.
So I was there for two weeks.
My husband flew for my husbandto fly.
he needed to prove he's comingfor a Canadian citizenship.
So he had all the paperwork.
There's a, there's an eight pagecleared by the government.
(22:30):
Then he had to prove with ourmarriage license, he came
separate.
So he had to prove the marriagelicense, my Canadian passport
copy that he's coming that yes,I'm married to this woman.
Yes.
She's a Canadian citizen.
And, this is why we're coming inthe funeral paper director and
signed off on the funeral stuff.
So it was a nightmare.
(22:50):
The Canadian, have an app youhad to check in every single
day, that we would get calls.
How are you isolating?
Where are you isolating?
You're only allowed to stay inplaces where you've written on
the limited release, which is myparents and my parents have to
sign that off that.
Yes, we take responsibility ofher isolation.
I would get calls.
Where are you getting your foodfrom?
(23:11):
Where are you staying?
Which part of the house are youstaying?
How are you getting fresh air?
I'm like, okay, I have a walkoutbasement and my food is brought
downstairs.
All of these.
So for me to go to the funeralhome, the day of the funeral
home, only 20 people wereallowed.
That was another thing wecouldn't share grief with
others.
We only 20 people allowed.
And we had 300 people on zoomacross the world.
Dr. Dean (23:33):
Mm hmm.
Dr. Dua Makkar (23:35):
That's why we did a celebration of life.
at the end of the year after thecovid restrictions were lifted,
but it was just this constant.
So the day of the funeral, I amactually on the phone with the
Canadian consulate because thefuneral director had to sign off
a limited release to allow me tobe at the funeral home for my
(23:56):
husband and I.
So I'm calling there, I'm like,I need this paperwork faxed and
sent over.
The government had to know thatI'm going to be at this place on
limited release for thispurpose.
Like it, it's just the wholeprocess was just a nightmare.
I don't even know how Iprocessed everything.
So instead of grieving for mybrother and planning that, I'm
(24:17):
doing this dumb paperwork.
Dr. Dean (24:19):
Yeah.
I almost wonder if that feltlike a distraction in any,
positive way, but also delayingyour grief.
Dr. Dua Makkar (24:28):
I've never thought of it that way.
That's a very interesting way toput it.
Was it a distraction?
Yeah.
Now that I think about it, Idon't think the grief hit me
until months later and that'swhen I had my first panic attack
Dr. Dean (24:45):
Oh.
Dr. Dua Makkar (24:45):
This was in June and I was at an event and what
had happened was I was on thephone some stuff from my parents
who were dealing with their owndepression and stuff.
I was at work and I couldn'ttake so much time off work.
I'm a private practice owner.
I took three weeks off.
Um, but then I was back toworking and that's when I heard
(25:06):
the music that he loves to danceto.
And I'm like, Oh, how much hewould have loved this.
That broke me.
And since then I've gone to alot more funerals and I've I've
broken down.
Because it's déjà vu, or I'veattended a few young deaths, in
(25:26):
the 30s, 40s, and I watch theparents, and I think of my
parents, and this reliving thiswhole thing.
So it's a constant reminder.
But my grief, I don't think Iinitially processed it until
three months later, when Ibroke.
Dr. Dean (25:43):
So that's an interesting aspect too of you
being the private practiceowner.
And I fully get that as aprivate practice owner myself,
that you don't work, you don'tget paid kind of approach.
Dr. Dua Makkar (25:54):
But you
Dr. Dean (25:54):
also you can take more time off than if you had worked
for a corporation, right?
So it's both a blessing and acurse, I guess.
But what was it like to go backto work, especially because you
shared the same profession?
Dr. Dua Makkar (26:10):
It was good because I, it gave me something
to do.
and then what I missed was Iwould share cases with him, or I
would be doing a procedure thathe loved and I would want to
show him my x rays and I can't.
But because it was oral cancerand because he was a dentist, I
(26:32):
was a dentist and because hisdoctor, his, oral surgeon didn't
biopsy and prescribed himmedication, a prednisone, which
is an immunosuppressant, andmaybe that, we don't know.
I'm just, guessing.
Did that contribute to hiscancer being more aggressive and
spreading faster?
(26:53):
I don't know.
But my point is that, of selfadvocation.
you see something, it doesn'tseem right.
Get a biopsied.
His friends told me like, Manuwasn't quite, we met him at a
conference and he wasn't, didn'thave the energy, he wasn't
feeling like himself.
And that was in March and Junewas when he showed me the
(27:13):
lesion.
So the lesions been there for awhile.
This is when it'd be
Dr. Dean (27:17):
Mm hmm.
Dr. Dua Makkar (27:19):
why he didn't, and this is what I push for and
for doctors not to prescribeunless you know what you're
prescribing for in the firstplace.
I have seen it.
How hard is it?
He had his wisdom.
So they thought it was eitherlichen pinus, which is an
autoimmune thing, or it was, hehad his wisdom teeth taken out.
They're like, Oh, it's fromrubbing against the wisdom
(27:39):
tooth.
This is why you have an ulcer inyour mouth.
you took out your wisdom teeth.
How hard is it to just take asmall part of your tongue and
get a sample?
Dr. Dean (27:46):
Yeah.
Dr. Dua Makkar (27:46):
Right?
Dr. Dean (27:47):
a little bit of the anger coming out as you're
talking about that.
Dr. Dua Makkar (27:49):
Yeah.
I'm like, and I don't want theserepeated mistakes.
Dr. Dean (27:53):
Mm hmm.
Dr. Dua Makkar (27:54):
I couldn't save him.
Maybe I can save someone else.
Dr. Dean (27:58):
Is that how you shifted into the advocacy work?
Do you want to say more aboutthat for our listeners?
Sure.
Dr. Dua Makkar (28:04):
So this is what I advocate on, talk on oral
cancer, what it is.
And in my path of when Manu wasgoing through treatment and
doing the CT scans, whattreatment protocols are, like, I
didn't know, I'm not a surgeon,that's not my field, right?
I just know how to diagnose it.
And my realm of diagnosis,because I'm a general dentist,
(28:27):
is, okay, I see a lesion, yeah,that looks suspicious.
Off you go to the oral surgeonand hats off, right?
that's my.
Dr. Dean (28:33):
Mm hmm.
Dr. Dua Makkar (28:34):
And I'm like, you know what?
I learned after Manu, I learnedto do my own biopsies.
if I can do surgical extractionsand place implants, I can do it.
I learned my own biopsies.
Why delay the time?
Why wait for the patient to gosomewhere else and then they
don't do the follow up, or theydon't go to the, they delay it
on their own.
They're like, you're in mychair, I'm just gonna take it
(28:56):
off and send it on.
I changed the way I practice.
and I'm more vocal about sharingmy journey with my patients, and
other people because it reallyopens up.
Patients feel that empathy and Ihave a very different
relationship with my patientsnow.
What happens after you'rediagnosed, the psychological
impact, the treatment, thefluoride trays, the radiation
(29:17):
trays, the, dry mouth syndrome,the, you know, your mucus is
thickened, what do you do?
And these patients are going tobe in your chair.
And how do you help them?
I didn't know these thingsbecause I just.
I didn't deal with it and nowI'm sharing that and this is why
(29:38):
I created the Dua Good Job.
It's a pun off my maiden Manu'slast name..
Dr. Dean (29:44):
Yeah.
Dr. Dua Makkar (29:44):
I'll give Manu the credit he came up with it.
He used to call his website usedto be Dua Good Job where he used
to share his blogs.
And and the whole symposium ison this to that cancer is not
just an isolating thing thatit's a multi dimensional
approach.
There is an oral systemic linkthat it can metastasize to
(30:06):
people who have other forms ofcancer like breast and stuff.
They can have oral lesionspresent.
You need to be knowledgeable.
and that's my motive is bringingthis awareness throughout and
have an open conversationsbetween medical professionals
and dental professionals andtruly understand how you can
practice empathy as a doctor,
Dr. Dean (30:27):
Mm hmm.
Dr. Dua Makkar (30:28):
empathy to the family, because your patient is
so overwhelmed with how muchinformation they're being given.
And the person who's watching onthe sidelines is so overwhelmed
with having to take care of thissick person that you need to.
their support also in theprocess.
Dr. Dean (30:47):
absolutely.
My background as a psychologistin, oncology settings, I
actually worked in the head andneck survivorship clinic here at
UPMC before I left.
And, that's a verymultidisciplinary, clinic there.
And the reason I, as apsychologist, was there was to
support both the patients.
and the caregivers because it'ssuch an adjustment and that
(31:09):
coordination of care between adentist and the oncology team is
difficult at best, given ourhealth system here.
So I'm glad that you're doingthat.
Dr. Dua Makkar (31:19):
yeah, and I have I have cancer surgeons in there,
I have oral surgeons, who aretalking about oral systemic
links.
I have a psychologist talkingabout anger in the dental chair.
And I'm sure you've experiencedthat, right?
Your anger, sometimes you'reangry at the doctor who's
diagnosing you, because youdon't know where to shift your
anger to.
Dr. Dean (31:38):
Mm
Dr. Dua Makkar (31:39):
but yeah, so I have such a diverse group of
speakers.
we're talking about this and andthis is open to all health care
professionals.
whether you're a resident,you're a student, or you are,
any field of medicine,practicing or any field of
dentistry.
Dr. Dean (31:55):
Do you plan to do it annually?
Dr. Dua Makkar (31:56):
This is my 1st year, so I can see what kind of
response I get, but I think it'sbeen pretty good.
Dr. Dean (32:01):
I'll put the link in the show notes.
Okay.
Dr. Dua Makkar (32:03):
Yeah, this is virtually, but it's aired on
the, on Manu's birthday, hewould have been 38, but you can
watch the recordings throughoutbecause it's on a Thursday and a
lot of work and everybody's timeis important.
we have it set up so that peoplecan watch it later on, and it'll
be available for the next sixmonths
Dr. Dean (32:22):
What would you like to say about the book?
And I'm also curious as to howthat has played a role in your
grief process.
Dr. Dua Makkar (32:29):
Yes.
Dr. Dean (32:30):
Yes.
Life interrupted.
Dr. Dua Makkar (32:32):
This is the most tangible thing I have of him.
I don't have his kids.
There's no other legacy.
I don't have him and to sharehim with the world.
This is it.
Manu had expressed that hewanted to be published.
I flew down in December of 2020when he had fluid in his lungs
(32:54):
and he got a chessboard placedin.
And that's when I knew this was,my, I had other medical friends
who were like, you need to geton a flight.
And I was not vaccinated at thattime.
The world was a very scary andNew York was the epicenter and
my parents are like, no, youcan't fly.
We're all losing one child.
We cannot have you.
What if you get COVID?
(33:14):
You've got young kids.
What?
My dad was not listening to me.
So I wrote my dad an email and Isaid, Manu is my only brother.
And at that time, I didn't tellhim he was going to die, but I
just said you need to let mecome see him.
I have not seen him, since hisdiagnosis, he had flown in
(33:34):
September, but I'm like, I havenot seen him since his second
surgery, all the chemo,everything.
I've not been there foranything.
Let me just come.
And I put on a mask and I flew.
My husband was scared.
Everybody was scared.
But that's when he told me, he'sI've been writing, I really want
to be published.
And then I said, okay.
I found a publisher and I toldhim in February,"I found a
(33:55):
publisher, let's get you, I needyour manuscripts" he's like, no,
I've got time, I really want towrite more.
And then I said, okay, you'vegot nothing else going on.
Go ahead.
there was, he was barelywalking, he had lost so much
weight struggling to breathe,drink twice a day sometimes.
And, so when I found all hiswritings, the unfinished pieces,
(34:19):
I put it in the samechronological order as he had
put in them, and it was my wayof doing something for him
because I felt a failure as adentist, as a sister, as a
daughter in so many aspects.
I couldn't be there.
I couldn't save him.
I couldn't push him.
there's always, there's a guilt.
There's a survivor's guilt.
(34:40):
I have the same gene pool ashim, why him, not me.
I've been reading this bookcalled Worthy and in that, I
read there's a special reasonwhy you've been picked and, your
purpose is different than, andyou have to live to your
purpose.
And there's a lot of healing andthis book was part of that
healing.
yeah, I couldn't be there, but Idid something else for him that
(35:02):
he wanted.
I still got to do something forhim.
And.
I helped finish it.
I wrote the epilogue, TheAftermath of Cancer, that it's a
joint project and it's tangible.
And when I read it, it's infirst person.
So if I ever feel like talkingto him, I read him.
Dr. Dean (35:26):
hmm.
Dr. Dua Makkar (35:26):
You're still talking to me in first person.
Dr. Dean (35:29):
It struck me because I reread it and it felt like what
a gift to be able to have hiswords on paper.
And so many of the entries feltvery much about how he perceived
the world and engaged in theworld.
And so it, it felt like inreading it I was like, Oh, I
have a little bit of a sense ofwho he was.
And as his sister, that must be,like you said, the thing that
(35:49):
you can hold on to, because youdon't have a lot of other
things.
Dr. Dua Makkar (35:52):
I don't.
His house is sold and his carsare gone and there's nothing
tangible.
Dr. Dean (35:59):
Mm Hmm.
Dr. Dua Makkar (36:01):
And and I knew when he had given up, He never
gave up.
I don't think he ever stoppedfighting.
Dr. Dean (36:08):
Mm
Dr. Dua Makkar (36:09):
But in Jan of 2021, he was admitted for two
weeks in isolation.
Complete isolation because itwas still COVID.
He had a lot of fluid buildup.
He had a demand.
They were draining him and hehad high white blood cell
counts.
And so silly, he would shy awayfrom telling us the full details
(36:31):
of what he was going through, hewas protecting us, He was
admitted one time for highcalcium levels.
I'm like, Manu, why do you havehigh calcium levels?
And he's like, no, don't worryabout it, Didi, it's because I
had too much calcium pills.
Not because your cancer is downto your pelvic bone and you're
slowly degrading.
(36:52):
Manu, why do you have a highwhite blood cell count?
Not because you have a cellnecrosis.
he's no, it's just someinfection.
They're just going to fight itoff.
I'm in two weeks at thehospital.
And when he was in thathospital, he had written, the
chapter, the last blog, NewBeginnings.
last chapter, that lastparagraph, and he always shared
(37:14):
his writings with me, right?
He's okay, Dee, this is what Iwrote.
and when I read it, even then Iknew.
It was any day now,
Dr. Dean (37:23):
Mm Hmm.
Mm
Dr. Dua Makkar (37:24):
and then he stopped writing after that
because he just got really sick.
And then February, and he wasgetting immunotherapy.
And it's again, I don't know ifhe knew and was eminent because
in Feb, I told him, I'm like,kids are off.
I'm going to come.
He's don't come now.
I'm getting more radiation.
I have another lesion and that'spositive for cancer.
(37:45):
Also, the chest port was movedand the initial chest port side
had fluid retention, and thatwas cancer.
And he's I'm going to get moreradiation on my abdomen.
I'm going to be done by Marchsomething.
And so why don't you come thatweekend, March 21st?
So I was to fly.
But I already had my tickets.
I had, and that's why I got thecompassion release because it's
(38:05):
only valid for a month.
So I had it applied in Decemberand then I applied it for March.
And I said, okay, so February isgoing to take me time.
I'm vaccinated now.
Okay.
And my husband's going to cometo, we planned this all,
unfortunately passed before allof it, but had he not told me I
Dr. Dean (38:24):
You would have been there.
Dr. Dua Makkar (38:25):
I would have not been able to make it.
I would not have my paperwork.
I would not have, been ready tofly.
and the day I was supposed tofly was his actual cremation.
So in some ways he knew and.
He just told us as much as hefelt he needed to tell us.
and and that was his sense ofcontrol, He couldn't control the
(38:47):
other aspects of life.
So this is what it was, he didthings his own way.
He never came to anything, Hefought to the end as much as he
could, and he did it on histerms.
Dr. Dean (39:01):
How are you doing now?
Dr. Dua Makkar (39:03):
MMM.
I've come a long way.
I've definitely become moreempathetic.
when somebody passes, it's sorobotic to say, I'm so sorry for
your loss,
Dr. Dean (39:16):
Mm hmm.
Dr. Dua Makkar (39:17):
I
Dr. Dean (39:17):
Mm hmm.
Mm
Dr. Dua Makkar (39:18):
can't imagine what you're feeling unless you
have gone through that process,unless you have watched a loved
one die and been there throughthe aftermath, you don't, I, and
like I said, I lost mygrandparents and I was like,
okay,
Dr. Dean (39:36):
mm hmm
Dr. Dua Makkar (39:37):
That's life, but to watch somebody die in front
of you, Is very, it's adifferent road and few travel
it.
so now when people pass, peopledon't need support as much when
somebody has gone, hasexperienced loss.
(39:59):
the few days after people come,they call, they do the phone
calls.
And you don't need that anymore.
You need it when the nextholiday comes or you need it a
few months later.
And you feel alone and nobody'scalling and ringing and checking
up on you.
(40:19):
And it's made me realize howimportant that is.
And I do it.
Those death anniversaries, thebirthdays, that's when it
matters.
I've become stronger, and I'verealized how much strength I
possess.
That what I have had to gothrough endure.
(40:41):
In my loneliness in ways.
Yes, my husband's there forsupport, but that's not his
brother.
His life didn't alter.
My kids are too young toremember.
They didn't make an impact.
and so you learn to stand up foryourself because no one else
will.
so, when you ask me, like, isthere any question off topic?
(41:03):
There isn't because I want thisto be candid and I've shared
this even with my family, likemy in laws and everybody that
like we celebrated my father inlaw's 80th birthday and my
husband saw my face.
It's not that I'm not happy.
Yes, I'm happy we'recelebrating, my father in law's
(41:26):
there with his grandkids and thewhole family and all his
friends.
I'm like, I'll never have that.
My dad will never have that.
We planned to go away in Marchof 21 as a family to Hawaii.
To celebrate my dad's 70th, andthat trip never happened because
of COVID.
And then a month later, Manu wasdiagnosed for the second time.
(41:47):
We were going to celebrate Manubeat cancer.
We're going to celebrate hisfamily.
My dad's turning 70.
Mom's turning 65.
to do this whole thing as afamily trip.
That trip never happened.
My parents don't want tocelebrate birthdays anymore.
And it was that realizationthat.
And that's when grief hits you.
And I took a walk and myhusband's do you want to come?
(42:09):
I'm like, no, you need to bewith your family and enjoy your
dad's birthday.
I'll be fine.
I just need to take time out formyself to process what I'm going
through.
I'll be back.
And it's realizing when to stepaway and be present when you're
ready.
And it's okay to say no tothings that I just genuinely was
(42:32):
like, I can't be there.
especially right after thedeath.
even if time has passed, itdoesn't just affect you that few
months, a year later, the griefhits you at any time and you
just have to be ready for it andlearn how to cope.
And that's what this process hastaught me that, and I need to
take care of myself.
(42:53):
No one else is going to.
I need to step away and comeback.
Dr. Dean (42:58):
I think that's a nice parallel to your self advocacy
statement from before about selfadvocacy for health, but I think
also in grief we have toadvocate for ourselves There's
different people in your familygrieving, your parents are
obviously grieving differently,so I wonder if your boundaries
and your needing to take breaksfeels different than theirs and
(43:20):
how you've navigated that.
Dr. Dua Makkar (43:23):
Yeah, I think they're more isolated because
they don't have me around.
and they are invited to events.
And they say no to a lot ofthings.
You're like, we're not ready.
We're not in the happy zone andlife doesn't stop
Dr. Dean (43:36):
Right.
Dr. Dua Makkar (43:37):
and they have their own healing to do and they
are going to have to do it ontheir own time.
And I cannot force it on them.
life does go on, I can't forgetManu, but I can keep him as long
as I can with me.
But do something good andpositive in a way, try to let go
of the anger and shift it tosomething else because
Dr. Dean (43:58):
hmm.
Dr. Dua Makkar (43:59):
otherwise it's going to eat me away.
Dr. Dean (44:01):
It sounds like through this work that you're doing, the
speaking engagements and thesymposium, And the book, that
you're carrying him with you.
Dr. Dua Makkar (44:11):
Yeah.
And that's what I wrote in thebook, my last
Dr. Dean (44:16):
page.
I probably read that, I read itbefore bed, maybe.
Dr. Dua Makkar (44:21):
It's the last page, it was my note to him.
Dr. Dean (44:25):
Oh.
That'right Have you been en ableto share with your kids about
him?
Dr. Dua Makkar (44:29):
They weren't there for the funeral.
but when we did the dispersionof the ashes, they were with us,
we did it together.
And it was so overwhelming.
I'm like, okay, this is youruncle in a jar.
And because they didn't see thefuneral.
So they didn't see the actualprocess.
I had to explain it to them,this is circle of life, it's
(44:50):
just, you had to learn thelesson a little early.
Usually it's your parents orgrandparents that you experience
this with, not your uncle.
Not so early on.
And, and we still talk abouthim.
And, my older, who's 14 now, heasks me questions.
He's like, if they called himmamu, which mama in our language
(45:13):
means mother's brother.
So in Deerling, they called himmamu and they said, would we
hang out?
Would we do stuff together?
Dr. Dean (45:24):
hmm.
I
Dr. Dua Makkar (45:25):
would he like me?
you know, stuff like that.
And I said, yeah, you guys wouldplay Legos together.
he loved cars.
You would do this.
and my son wears his oldclothes.
Is there about the same heightnow?
Manu shopped, When Manu's cancerhad stopped.
He came to New York and he wentshopping.
(45:48):
He came with an empty suitcaseand he goes to the outlets and
he shopped so much.
And he never got to wear thoseclothes because he got sick
right after.
And so my son has all thesebrand new clothes and, shoes and
everything.
So he feels so much closer tohim.
It's cool.
Mamu left me this and Mamu, hegets all excited.
So yeah, Manu is still a part oftheir lives in a way we talk
(46:11):
about him.
We celebrate his birthday.
We'll take a cake.
We'll put a balloon out.
We do Rakhi, which is acelebration of a brother, sister
bond.
And.
Dr. Dean (46:21):
was going to ask you about that.
Yeah.
Dr. Dua Makkar (46:22):
Yeah.
so I still carry that tradition.
I have a tree in front of myhouse that was gifted and we
have a plaque that was alsogifted.
And, that tree represents Manuto me.
It's living, it's alive.
And so I tie it to that and mykids watch it.
So yeah, Manu is still a partand we talk about it.
We, and if you feel sad, it'sokay to feel sad and, they've
(46:45):
seen me break down and I said,I'll, I just need a few minutes
and mommy still loves you.
I'll be right back.
Dr. Dean (46:53):
So even being able to take those breaks with your kids
is a healthy process.
Yeah.
Dr. Dua Makkar (46:58):
And I want them to know that life is not always
all about ups.
It's downs and you need tolearn.
To pick yourself after if youhave a down,
Dr. Dean (47:07):
Which it sounds like you've really learned to do.
Are there other things aboutgrief or sibling loss that you
wish you had known then?
Dr. Dua Makkar (47:22):
I wish I'd never known.
Dr. Dean (47:24):
Yes, of course.
Same.
Dr. Dua Makkar (47:26):
I don't think I ever in my wildest dreams wish
I'd known any of this.
I don't wish it upon anyone.
In fact, I think I thought abouthaving a third child.
I'm like, God forbid, somethinghas to happen.
At least they'll have anothersibling, cause it's so
isolating.
So lonely.
Dr. Dean (47:43):
That's funny.
My aunt always said that becausemy dad had three siblings and
she always said she was havingmore than two kids in case they
lost one another because theyknew that experience.
Dr. Dua Makkar (47:55):
no.
And I think, it's you alwaysthink things for granted.
I always took, I took a lot ofstuff for granted.
Like I'm a far away from myparents.
and I, because I thought Manuwould always be there.
It was almost a decade youngerthan me.
I'm like, I'm gonna always takecare of them.
He'll be around.
He had lived always closer.
He went to college, in Calgarywhere my parents lived.
(48:17):
He went to school in Vancouver.
It's only a flight away.
He worked in the same city asthem.
so it was always thispredisposed condition that
they'll always be there.
I left my house at 17.
I was only with my parents for17 years of my life.
And then I went to college.
I went to dental school and Ilived with them for a few years.
Then I got married.
So I joke around.
I'm like, okay, I have them forthe first 17 years of my life
(48:38):
and I will have them for thelast 17 years that they've got
left, they're aging now.
but it's cherish those moments,be there for your family.
I, it's just, take more picturesand videos.
I wish I had more of that.
Dr. Dean (48:53):
Yeah,
Dr. Dua Makkar (48:53):
Even though you may think you're promised
things, it's not necessarilythat they will actually happen.
Dr. Dean (48:59):
exactly.
Do you have any favoritememories that you want to share?
Dr. Dua Makkar (49:10):
I think the most fun I've had with him was when
we lived in the same house asadults, when he had finished
high school, he started college.
And then now he wasn't thislittle annoying brother who
would like to try to eavesdropand I'm talking with my
girlfriends and now he was like.
(49:31):
he became a peer and somewhere,he became the older sibling.
I don't know.
but those are like, those threeyears of sharing the same house,
fighting over the bathroom.
And he's like, all your contactsare all over the place.
I'm like, your toothbrush andyour shaving stuff, like we
would fight over.
(49:52):
We never had that opportunity aswe were growing up.
So it's these little thingsthat.
we could actually go hang outtogether and those three years
are great
Dr. Dean (50:09):
Oh wow, so three years as adults you were living in the
same
Dr. Dua Makkar (50:12):
until I got married and then I moved, you
Dr. Dean (50:15):
and you're now in the states.
Dr. Dua Makkar (50:18):
know, New York back into the States, you know,
Dr. Dean (50:23):
thank you for all of that.
Is there anything else that youwanted to share or say?
Dr. Dua Makkar (50:28):
no, that's been great.
Finding your own people whenlike you said, you've got this
Broken Pack, it's finding yourpath
Dr. Dean (50:35):
Yeah.
Dr. Dua Makkar (50:36):
because we're all broken in all sorts of ways.
And you can never be whole, youcan try to find those pieces and
maybe make it whole.
Dr. Dean (50:44):
Yeah, I like that interpretation.
In fact, That's not why it'snamed the Broken Pack, but I
actually had a couple peoplereach out when I first named it
and the people that I knew andthey're like, I'm not broken.
I'm grieving.
And I was like, I get that.
it's actually called the BrokenPack because the wolves grieve
and their pack is broken as thefamily structure.
(51:04):
And so that's what the brokenrefers to, but it's obviously
open to interpretation.
um, yeah,
Dr. Dua Makkar (51:11):
I know the wolf reference, but I perceive it as
finding your pack.
Dr. Dean (51:16):
yeah.
I like that too, because part ofwhat I'm doing here is building
community.
And I know that you and I havemessaged about this, but also
other things.
And it's been nice to connectwith people.
And so I do plan to build thatpart of The Broken Pack up
slowly because we're smallorganization right now.
But, yeah.
Thank you.
And thank you for chatting withme today and sharing a little
(51:37):
bit about Manu.
Dr. Dua Makkar (51:39):
Thank you.
Thank you for having me.
Dr. Dean (51:42):
you're welcome.
/Thank you so much forlistening.
Our theme song was written byJoe Mylward and Brian Dean and
was performed by Fuji Sounds(feat.
MYLWD.).
If you would like moreinformation on The Broken Pack™,
go to our website,thebrokenpack.
com.
Be sure to sign up for ournewsletter, Wild Grief™, and to
learn about opportunities andreceive exclusive information
and content, as well as grievingtips for subscribers.
(52:05):
Information on that, our socialmedia and on our guest can be
found in the show notes whereveryou get your podcasts.
Please like, follow, rate,subscribe, and share.
Thanks again.
/Hello and welcome to The Broken Pack™, a podcast
focused on giving adultsurvivors of sibling loss, a
platform to share their storiesand to be heard.
Something that many sibling losssurvivors state that they never
have had.
Sibling Loss is Misunderstood™.
The Broken Pack™exists to changethat and to support survivors.
(00:32):
I'm your host, Dr.
Angela Dean.
Today's episode features Dr.
Parul Dua Makkar talking aboutlosing her brother, Dr.
Manu Dua, to oral cancer.
Both of them were dentists.
This role that they playedimpacted their grief, his
illness, and how she's changedher work and her life to be both
(00:54):
a self advocate for her griefand herself in other ways, and
as it's played a role inchanging her work and how she's
making an impact in leaving alegacy.
She's an author and her brotherwas an author as well.
Take a listen All right.
(01:21):
So welcome to the show.
What would you like to tell usabout yourself?
Dr. Dua Makkar (01:25):
Hi, thank you for having me.
First of all, it's a
Dr. Dean (01:27):
You're welcome.
Dr. Dua Makkar (01:28):
here to share this journey.
I'm Parul.
I am a dentist based in New Yorkand, I lost my younger and only
sibling.
It's been three years now,March.
to cancer, and the irony of thewhole thing is that, he died of
oral cancer, and both he and Iare dentists, or were dentists.
Dr. Dean (01:50):
Yeah.
Thank you for sharing that.
I just reread, the book and so Iknow that'll be part of our
conversation as well, but I waswondering how you would describe
your brother and what you wantus to know about him?
Dr. Dua Makkar (02:04):
Manu was carefree.
He was very honest.
He didn't have any grays zone.
It was black or white.
It was right or wrong, He lovedlife.
He really did.
He enjoyed, every minute that helived and he lived it to the
fullest.
He did things that he wanted todo, not what peer pressure
society expected of him.
(02:26):
So he really lived life to hisown terms and fully.
He wanted to live more.
He really had so many plans and,arrived to the different term.
Dr. Dean (02:37):
And the age difference was about seven years, you said?
Dr. Dua Makkar (02:41):
Yeah.
Seven and a half.
Exactly.
He was June.
I was Jan.
That's exactly seven and a half.
Dr. Dean (02:49):
How was your relationship with him?
Dr. Dua Makkar (02:50):
I think I was more of a second mother to him.
and we were raised verydifferently.
I grew up, my formative years.
I was six when we moved fromIndia to Abu Dhabi and that's
where he was born.
So he grew up, I grew up in anIndian predominant culture.
I went to an Indian school inAbu Dhabi, Manu went to a
British school.
He didn't know Hindi, which isour, native tongue.
(03:12):
He learned it later on in life.
And then, I always say we grewup with two different parents.
My parents were, earlier on themarriage, they were struggling
and he was born almost a decadeafter them being married, and he
was born when my parents were alittle bit more financially
stable and were able to offerhim more, And then I left for
college, half across the worldin, the late nineties, to the
(03:36):
States and he was 10, I was 17.
And so there was a big gap.
It wasn't like I was coming homeevery weekend.
I was coming home every fewmonths for holiday break and
Manu and my parents were stillin Abu Dhabi at that time.
And then they moved to Canada.
Again, it wasn't like Toronto orNew York.
It was, I was still in Oklahomaand he was in Calgary and it
(03:59):
was, a full day flight.
So we grew up, pretty much likeonly children and we would meet.
So what really united us was,dentistry.
Because when I graduated dentalschool, he graduated high
school.
And then we lived together inthe same house and he followed
my footsteps.
He watched me and my career andhe decided to follow my
(04:20):
footsteps.
And then I got married when hegot Dental school.
So when I would go back homeafter marriage, he was in dental
school and he would come back.
so yeah, we were very, we werenever together for long.
And, And so he always looked upto me.
And then I think at some pointour roles reversed where I
started listening to him and hewas very much more read and
(04:41):
worldly and he would offer meadvice on my career and my
practice.
He even helped me lay out theplans for my new practice
because he had already startedhis prior to me opening my own
from scratch, because I waitedfor my kids to be older.
So somewhere along the lines,the roles reversed And, We
taught, we took coursestogether.
We went to DR, we took animplant course together.
(05:03):
We would talk about cases andyeah, dentistry united us.
Dr. Dean (05:08):
So that's interesting.
I wonder what it was like.
I know that you're doing a lotof advocacy for oral cancer
awareness for dentists and otherprofessionals.
And I'm wondering how that wasto learn that he had oral cancer
while you were both dentists?
Dr. Dua Makkar (05:22):
Manu had a lesion and he showed me, he's
like, this has been botheringme.
And I looked at it, He was inCalgary.
I'm in New York and this is2019.
And I said, dude, this doesn'tlook good.
you need to get this biopsied.
And he's like, no, I've got myoral surgeon friend.
I'm on this medication and wehaven't done the biopsy yet
because it's something notserious.
(05:43):
And I go every summer and, thiswas June.
He was just shy of his 33rdbirthday and I go in July.
So we celebrate his birthdaytogether.
He's bought a new house.
And, I said, show me yourtongue.
And this lesion that he showedme a month ago is is really
ulcerated and he's havingtrouble eating, like we went out
(06:03):
for sushi.
He's no, the wasabi hurts me,trouble talking.
And I looked at the lesion andI'm like, are you kidding me
right now?
Why haven't we biopsied this?
And so when the cancerdiagnosis, I think there was
part denial.
like I said, he was 33.
He had a startup scratchpractice in 2016.
You just bought a new house.
(06:24):
He, did all the special build.
He picked all his, finishings.
He bought custom furniture.
He was high on life.
uhhmm His practice to everylittle thing he built, he was
featured on a Dental Town, whichis a dental magazine.
And he was on the cover of thatmagazine in 2019.
and he had the cancer diagnosisat the same time.
(06:46):
And so I think there was a lotof, denial did not want to get
the earlier biopsy because hefeared if it would be true what
he had.
My dad lost his mom, ourgrandmother to cancer, a
different form.
For my dad, it was always cancerassociated death.
Dr. Dean (07:03):
mmhmm
Dr. Dua Makkar (07:04):
And then, I remember my dad asking me that
question, is Manu going to die?
And I said, No, Papa, he's notgoing to die.
He's young.
He's healthy.
He's active.
He plays all the sports and he'sgot no other core morbidities.
This is not your mother who is60 some years old.
This is a young 33 year old.
three year old, they're justgoing to take out the lesion and
(07:26):
they're just going to remove allthe bad stuff and radiation.
He's going to be fine because weknow cases of people who have
had cancer and have survived andhave lived full lives or had
more time on their hands.
So there was no doubt in any ofour minds that he would do it.
I'm like, no, I know this.
I know people who've had cancerin their mouths and it's fine.
(07:47):
It'll be okay.
And that's what we reallybelieved to be.
Unfortunately, it was veryaggressive and it returned after
his first surgery where half histongue was removed and graft
from his arms.
All of that was an eight hoursurgery,
Dr. Dean (08:02):
hmm.
Dr. Dua Makkar (08:03):
and he went back to practice.
He actually came to New York tosee me and then went back to
practice.
Within two months of hissurgery, the cancer returned
Dr. Dean (08:12):
mm
Dr. Dua Makkar (08:13):
and that's just when COVID hit.
COVID hit, we got shut down inMarch, as dentists and Manu's
cancer returned on April 1st,that same year, 2020.
Dr. Dean (08:24):
mm hmm.
I was trying to think back.
So if you were shut down, washis treatment delayed?
Dr. Dua Makkar (08:31):
So his initial treatment wasn't delayed in 2019
where half his tongue wasremoved in the surgery and all
that.
But after his second diagnosis,he got his surgery immediately,
He was diagnosed, April 1st andApril 17th.
Two weeks later, he had a secondsurgery where he had lymph nodes
removed more, went back in forthe neck dissection.
(08:53):
And they saw a lesion on hischest.
And hindsight's always 20 20.
Dr. Dean (09:00):
Mm hmm.
Dr. Dua Makkar (09:00):
And, they ignored it.
It was too small to do a biopsy.
And it was on the same side ashis initial tongue lesion.
Dr. Dean (09:07):
Mm
Dr. Dua Makkar (09:07):
They wrote it off and they gave him chemo
radiation anyway.
Dr. Dean (09:11):
hmm.
Dr. Dua Makkar (09:11):
he finished that in the summer and that's when he
quit dentistry.
He sold his practice.
Dr. Dean (09:17):
mm hmm
Dr. Dua Makkar (09:17):
I guess between COVID uncertainty, I couldn't
travel, borders were shut down.
He decided he's just going toquit dentistry and focus on his
health.
And he started writing the book,the blogs.
Dr. Dean (09:28):
mm hmm
Dr. Dua Makkar (09:29):
That was his outlet because there was no
contact with friends, withfamily.
He was single, it was just hisparents, so he needed something
to share the grief with.
Writing was his outlet.
He found his calling in it, Ithink.
And I think after the radiationand chemo, there wasn't enough
follow up because of COVID.
(09:52):
It did play a role.
He was supposed to have a sixmonth follow up.
It got delayed.
The chest lesion had grown.
They were to do a biopsy.
That got pushed another month.
Before he could even get thatbiopsy, he was in the hospital
with failure to breathe becausethe cancer was in his lungs.
which was shown on the CT scans,which they didn't biopsy, but he
(10:15):
had fluid in his lungs andthat's why he couldn't breathe.
And that fluid was drained andit was positive for squamous
cell carcinoma.
and then it was just a downwardspiral from then on.
That was December of 2020.
And, at that time, even then wewere still hopeful that he would
(10:36):
pull through.
but yeah, definitely, I think alot.
With what COVID played a rolewas Manu was in isolation during
all the treatments
Dr. Dean (10:48):
Mm hmm.
Dr. Dua Makkar (10:48):
radiation.
My parents would drop him, pickhim up.
There was nobody holding hishand during the
Dr. Dean (10:53):
Yeah.
Dr. Dua Makkar (10:54):
There was nobody with him when the consults were
done with the doctor.
So when you're in your thirtiesand you're getting this,"Oh,
we're going to do experimental.
We're going to do immunotherapy.
We're going to do chemo.
These are your after effects.
This is what you need to do.
We're doing wills.
We're doing end of life plans.
We're processing all thisinformation and it's a treatment
(11:15):
protocol, all of that, sideeffects, loss of hair, the burns
from radiation, disfigurement,and he did it alone.
Dr. Dean (11:26):
Mm hmm.
Dr. Dua Makkar (11:27):
and I think that's how COVID plays a role in
Dr. Dean (11:30):
Yeah.
Dr. Dua Makkar (11:30):
his mental status, and maybe not processing
the treatment protocol and weweren't there.
We didn't have a choice.
Dr. Dean (11:39):
Yea that sounds so very isolating and awful.
I worked in a cancer center atthe time.
And I do recall just how aloneand isolated the patients
reported feeling.
So I wonder if that's also addedto your grief.
Dr. Dua Makkar (11:55):
like, when my dad lost his mom to cancer.
It was in India, and we were inthe Middle East, and they would
take turns, my parents.
That was 30 years ago.
Here we are in the western sideof the world, there's so many
advances made, and here we areat the same outcome.
Dr. Dean (12:15):
Mm-Hmm.
Dr. Dua Makkar (12:16):
I remember when my grandmother passed, my
parents used to take turns.
And I want to share this becausehow compounded grief was at this
time.
My dad's the only child.
He lost his dad early on inlife.
So he never knew his dad.
He knew his only parent livingwas his mom.
And I was 14, Manu was seven.
(12:39):
My mom was visiting with mybrother in India, and she called
my dad and said, you need tocome home now.
And I was left with friendscause of middle school and it
was April.
I still remember that.
My dad flew for the final riteswith Manu.
Now, fast forward almost 30years later In a different part
(13:01):
of the world same parents.
My dad watched his only parentdie of this horrible disease Now
he's watching only son mm hmmdie in front of his eyes.
My mother lost her mother April4th.
April 1st Manu was rediagnosed
Dr. Dean (13:21):
mmm
Dr. Dua Makkar (13:21):
So now she's lost a parent for who she can't
grieve because she was in India.
And then in February of 21, mydad asked me that same question.
He asked me, is Manu going todie in February of 21?
And this time I told him, yes,
Dr. Dean (13:40):
mmm
Dr. Dua Makkar (13:40):
you have to be prepared and you have to let him
do what he wants, let him eatthe foods that he wants,
whatever his heart desires.
You have to be ready.
Dr. Dean (13:50):
Mm-Hmm.
Dr. Dua Makkar (13:52):
I knew the diagnosis.
I had been reading the reports.
I knew the outcome.
They knew the outcome.
Manu knew the outcome, but wenever talked about it.
And in March, it was a Fridaywhere Manu was taken to the
hospital for failure to breatheand he had some edema.
(14:14):
And it was a normal occurrenceat this point, him going back
and forth to hospitals.
And my dad's like, Manu's goingin.
Don't call him.
He's going to be admitted.
Call him tomorrow, and I happento be working that Saturday.
So in between my patients, Icalled and my dad's like, we're
meeting with the palliativeteam.
Call us later in the night.
We have to deal with stuff.
(14:36):
So I knew it was coming and thatevening, my mom, I finally got a
hold of her and she told me thesame thing that she told my dad.
30 years ago, I was scheduled tofly.
at this point you neededcompassion, release papers and
all of that, because borderswere shut down and there's a
whole protocol to make it acrossthe border.
(14:58):
And I had my paperwork.
I was coming anyways, a weeklater.
So she says,"Come as soon as youcan.
He's not going to make it." Thatsame phone call she made 30
years ago.
I remember as a 14 year old andmy child is now 14
Dr. Dean (15:17):
Mm
Dr. Dua Makkar (15:17):
And I'm like, okay, I will do anything in my
power to come and I'm expeditingPCR results on a Sunday and then
the following day.
And, I booked my flight.
I get the result within 3 hours.
I say goodbye to Manu like thisand I told him you need to let
go.
It's okay.
I'll make it as fast as I can,but you have my permission.
(15:39):
Don't wait for me.
He was sedated, and he's gotmorphine drip on, and his organs
are shutting down.
And then, I think that allowedhim to let go, because that
evening, he passed and myparents called me and showed me
his deceased body and they'rekissing him and they're loving
him and they're like, he wasjust here.
(16:01):
I was sitting right next to him.
When did he leave?
We didn't even know.
And then three months later, mymother loses her dad.
Dr. Dean (16:12):
mm
Dr. Dua Makkar (16:13):
So my mom lost both her parents and her son
within a year.
And my dad lost both hisparents, watched his only
surviving parent die of cancer,watched his youngest son die of
cancer.
So the grief has evercompounded.
Dr. Dean (16:29):
Yeah.
And that's a lot of loss for youas well.
Dr. Dua Makkar (16:33):
With no one.
Dr. Dean (16:35):
Yeah.
Dr. Dua Makkar (16:35):
Because I'm in the States without, I grew up in
different parts of the world, soI didn't have the village that I
grew up with.
It's all disappeared.
Dr. Dean (16:42):
Mm-Hmm.
Dr. Dua Makkar (16:43):
with people who didn't know my brother very
well, and who, nobody else'slives get affected.
just yours.
Dr. Dean (16:51):
Yeah Did you end up making it there the next day?
Dr. Dua Makkar (16:55):
I did.
Dr. Dean (16:57):
What was that like for you?
Dr. Dua Makkar (17:00):
I knew I was planning a funeral, and I, I
think my mind didn't know what Iwas doing.
I was an autopilot.
I wrote the eulogy on the plane.
I was wearing a mask and I'mcrying.
I'm alone.
And then I go, and my dad'slike, you have to go to the
funeral home.
I can't pick the casket.
You have to do it.
(17:21):
My mom's like, I can't pick outhis clothes, you go into his
closet because it smells of him.
Now his house was, this is wherethe book's title comes from,
because when I entered hishouse, there was a magazine
where he, the same magazine thathe had first talked about his
cancer journey, he had writtenan article about leaving
dentistry.
And that got published the samemonth, at the time of his death.
(17:43):
So it hit hard and everythingis, his clothes are on the
floor, unmade bed, medication,food in the sink.
It's his life interrupted.
And it was just so unrealbecause I had never faced death
of a loved one.
All my grandparents passed in adifferent country.
I knew they're gone.
it's like, They're supposed toleave and they've gone and it's
(18:07):
done, that's just the circle oflife, but this brother of mine
whose diapers I've changed.
I remember him taking his firststeps.
I remember him as a baby, He'dcolor my books and I would get
so mad at him and, he'd crayonall my notebooks and, and I have
my own kids.
(18:28):
I'm like, as a mother having toknow, go through this and as a
sibling having to go throughthis and who do I share this
with?
I had no one.
My parents are doing their owngrief.
They have each other.
The sibling loss is so unique,
Dr. Dean (18:45):
mm hmm
Dr. Dua Makkar (18:46):
and when I sat on that table with the funeral
director across from him, and Ihad all this paperwork and
things that need to be signedoff, and do you need a casket,
do you want his fingerprint, doyou want to see his body, do you
want this, do you want that, themakeup, and what idol do you
want, and what prayers do youwant said, and all these things
(19:08):
that you need to go through,you're like, it's just, it's
You're just deciding, picturesand I'm like, crap I have to do
this two more times for myparents.
Who's going to sit with me?
No one.
And
Dr. Dean (19:24):
and he was supposed to be there for you,
Dr. Dua Makkar (19:27):
I'm like, this is, I don't understand what's
going on because I'm supposed tobe picking out stuff for his
wedding or write, his weddingspeech to emcee his.
dance, my kids didn't get todance at their uncle's wedding.
They performed songs at hiscelebration of life, right?
(19:48):
It's just unrealistic.
Sometimes I want to wake up andbe like, this is all just a bad
dream.
And I feel like, yeah, myparents have each other and
they've had their shared griefand they both understand what
they're going through, butthere's a sense of loneliness.
that I feel that, my parentswill age and they're aging
(20:11):
faster because of, what they'vegone through.
I'm going to lose everybody ofmy blood.
I've lost all my grandparentsand now my parents, my cousins
live far apart.
I don't have that kind of arelationship with them that I'm
close to them because ofcircumstances.
And, it's just me.
Dr. Dean (20:30):
mm hmm yeah I think that's such a unique part of
this too because you have apartner and you have your kids,
but it's that family of origin,
Dr. Dua Makkar (20:39):
Exactly.
Dr. Dean (20:40):
that whole shared history,
Dr. Dua Makkar (20:42):
history.
Dr. Dean (20:42):
a secondary loss.
Yeah.
Dr. Dua Makkar (20:45):
yeah.
and it's reminded Every singleoccasion, every single
celebration, every singleholiday, the what ifs, the what
could have beens, the whatshould have beens.
And there's nobody to blame.
It is what it is.
And you have to come to termswith it.
(21:07):
When you grew up alone as anonly child.
That's all, you know.
When you have siblings, you'relike, yeah, remember when dad
did this or mom did this or,silly history.
Remember when you had guestsover and you locked the oven and
we, all the food got burnt, likeall these little stories.
And I don't have them.
(21:27):
And so there's a lot of angersometimes.
Like I get so mad at him somedays.
I'm like, damn it.
You let me do everything.
I have to take care of theparents.
You left all your writing.
I have to put the book togetherand I have to take care of my
kids and you're not there totake that responsibility to take
them, You left everything on me.
(21:49):
I'm like, you had a great timeand you left.
Dr. Dean (21:53):
I have that same conversation with my brother all
the time.
Dr. Dua Makkar (21:58):
Yeah,
Dr. Dean (21:59):
So that was 2021
Dr. Dua Makkar (22:01):
correct.
Dr. Dean (22:02):
when you passed.
Okay.
And I believe the Canadianborder was still closed for some
time.
Dr. Dua Makkar (22:09):
Oh, yeah, it was still closed then.
The day of his funeral, becauseyou have to have limited
release, which places you haveto go to.
So I was there for two weeks.
My husband flew for my husbandto fly.
he needed to prove he's comingfor a Canadian citizenship.
So he had all the paperwork.
There's a, there's an eight pagecleared by the government.
(22:30):
Then he had to prove with ourmarriage license, he came
separate.
So he had to prove the marriagelicense, my Canadian passport
copy that he's coming that yes,I'm married to this woman.
Yes.
She's a Canadian citizen.
And, this is why we're coming inthe funeral paper director and
signed off on the funeral stuff.
So it was a nightmare.
(22:50):
The Canadian, have an app youhad to check in every single
day, that we would get calls.
How are you isolating?
Where are you isolating?
You're only allowed to stay inplaces where you've written on
the limited release, which is myparents and my parents have to
sign that off that.
Yes, we take responsibility ofher isolation.
I would get calls.
Where are you getting your foodfrom?
(23:11):
Where are you staying?
Which part of the house are youstaying?
How are you getting fresh air?
I'm like, okay, I have a walkoutbasement and my food is brought
downstairs.
All of these.
So for me to go to the funeralhome, the day of the funeral
home, only 20 people wereallowed.
That was another thing wecouldn't share grief with
others.
We only 20 people allowed.
And we had 300 people on zoomacross the world.
Dr. Dean (23:33):
Mm hmm.
Dr. Dua Makkar (23:35):
That's why we did a celebration of life.
at the end of the year after thecovid restrictions were lifted,
but it was just this constant.
So the day of the funeral, I amactually on the phone with the
Canadian consulate because thefuneral director had to sign off
a limited release to allow me tobe at the funeral home for my
(23:56):
husband and I.
So I'm calling there, I'm like,I need this paperwork faxed and
sent over.
The government had to know thatI'm going to be at this place on
limited release for thispurpose.
Like it, it's just the wholeprocess was just a nightmare.
I don't even know how Iprocessed everything.
So instead of grieving for mybrother and planning that, I'm
(24:17):
doing this dumb paperwork.
Dr. Dean (24:19):
Yeah.
I almost wonder if that feltlike a distraction in any,
positive way, but also delayingyour grief.
Dr. Dua Makkar (24:28):
I've never thought of it that way.
That's a very interesting way toput it.
Was it a distraction?
Yeah.
Now that I think about it, Idon't think the grief hit me
until months later and that'swhen I had my first panic attack
Dr. Dean (24:45):
Oh.
Dr. Dua Makkar (24:45):
This was in June and I was at an event and what
had happened was I was on thephone some stuff from my parents
who were dealing with their owndepression and stuff.
I was at work and I couldn'ttake so much time off work.
I'm a private practice owner.
I took three weeks off.
Um, but then I was back toworking and that's when I heard
(25:06):
the music that he loves to danceto.
And I'm like, Oh, how much hewould have loved this.
That broke me.
And since then I've gone to alot more funerals and I've I've
broken down.
Because it's déjà vu, or I'veattended a few young deaths, in
(25:26):
the 30s, 40s, and I watch theparents, and I think of my
parents, and this reliving thiswhole thing.
So it's a constant reminder.
But my grief, I don't think Iinitially processed it until
three months later, when Ibroke.
Dr. Dean (25:43):
So that's an interesting aspect too of you
being the private practiceowner.
And I fully get that as aprivate practice owner myself,
that you don't work, you don'tget paid kind of approach.
Dr. Dua Makkar (25:54):
But you
Dr. Dean (25:54):
also you can take more time off than if you had worked
for a corporation, right?
So it's both a blessing and acurse, I guess.
But what was it like to go backto work, especially because you
shared the same profession?
Dr. Dua Makkar (26:10):
It was good because I, it gave me something
to do.
and then what I missed was Iwould share cases with him, or I
would be doing a procedure thathe loved and I would want to
show him my x rays and I can't.
But because it was oral cancerand because he was a dentist, I
(26:32):
was a dentist and because hisdoctor, his, oral surgeon didn't
biopsy and prescribed himmedication, a prednisone, which
is an immunosuppressant, andmaybe that, we don't know.
I'm just, guessing.
Did that contribute to hiscancer being more aggressive and
spreading faster?
(26:53):
I don't know.
But my point is that, of selfadvocation.
you see something, it doesn'tseem right.
Get a biopsied.
His friends told me like, Manuwasn't quite, we met him at a
conference and he wasn't, didn'thave the energy, he wasn't
feeling like himself.
And that was in March and Junewas when he showed me the
(27:13):
lesion.
So the lesions been there for awhile.
This is when it'd be
Dr. Dean (27:17):
Mm hmm.
Dr. Dua Makkar (27:19):
why he didn't, and this is what I push for and
for doctors not to prescribeunless you know what you're
prescribing for in the firstplace.
I have seen it.
How hard is it?
He had his wisdom.
So they thought it was eitherlichen pinus, which is an
autoimmune thing, or it was, hehad his wisdom teeth taken out.
They're like, Oh, it's fromrubbing against the wisdom
(27:39):
tooth.
This is why you have an ulcer inyour mouth.
you took out your wisdom teeth.
How hard is it to just take asmall part of your tongue and
get a sample?
Dr. Dean (27:46):
Yeah.
Dr. Dua Makkar (27:46):
Right?
Dr. Dean (27:47):
a little bit of the anger coming out as you're
talking about that.
Dr. Dua Makkar (27:49):
Yeah.
I'm like, and I don't want theserepeated mistakes.
Dr. Dean (27:53):
Mm hmm.
Dr. Dua Makkar (27:54):
I couldn't save him.
Maybe I can save someone else.
Dr. Dean (27:58):
Is that how you shifted into the advocacy work?
Do you want to say more aboutthat for our listeners?
Sure.
Dr. Dua Makkar (28:04):
So this is what I advocate on, talk on oral
cancer, what it is.
And in my path of when Manu wasgoing through treatment and
doing the CT scans, whattreatment protocols are, like, I
didn't know, I'm not a surgeon,that's not my field, right?
I just know how to diagnose it.
And my realm of diagnosis,because I'm a general dentist,
(28:27):
is, okay, I see a lesion, yeah,that looks suspicious.
Off you go to the oral surgeonand hats off, right?
that's my.
Dr. Dean (28:33):
Mm hmm.
Dr. Dua Makkar (28:34):
And I'm like, you know what?
I learned after Manu, I learnedto do my own biopsies.
if I can do surgical extractionsand place implants, I can do it.
I learned my own biopsies.
Why delay the time?
Why wait for the patient to gosomewhere else and then they
don't do the follow up, or theydon't go to the, they delay it
on their own.
They're like, you're in mychair, I'm just gonna take it
(28:56):
off and send it on.
I changed the way I practice.
and I'm more vocal about sharingmy journey with my patients, and
other people because it reallyopens up.
Patients feel that empathy and Ihave a very different
relationship with my patientsnow.
What happens after you'rediagnosed, the psychological
impact, the treatment, thefluoride trays, the radiation
(29:17):
trays, the, dry mouth syndrome,the, you know, your mucus is
thickened, what do you do?
And these patients are going tobe in your chair.
And how do you help them?
I didn't know these thingsbecause I just.
I didn't deal with it and nowI'm sharing that and this is why
(29:38):
I created the Dua Good Job.
It's a pun off my maiden Manu'slast name..
Dr. Dean (29:44):
Yeah.
Dr. Dua Makkar (29:44):
I'll give Manu the credit he came up with it.
He used to call his website usedto be Dua Good Job where he used
to share his blogs.
And and the whole symposium ison this to that cancer is not
just an isolating thing thatit's a multi dimensional
approach.
There is an oral systemic linkthat it can metastasize to
(30:06):
people who have other forms ofcancer like breast and stuff.
They can have oral lesionspresent.
You need to be knowledgeable.
and that's my motive is bringingthis awareness throughout and
have an open conversationsbetween medical professionals
and dental professionals andtruly understand how you can
practice empathy as a doctor,
Dr. Dean (30:27):
Mm hmm.
Dr. Dua Makkar (30:28):
empathy to the family, because your patient is
so overwhelmed with how muchinformation they're being given.
And the person who's watching onthe sidelines is so overwhelmed
with having to take care of thissick person that you need to.
their support also in theprocess.
Dr. Dean (30:47):
absolutely.
My background as a psychologistin, oncology settings, I
actually worked in the head andneck survivorship clinic here at
UPMC before I left.
And, that's a verymultidisciplinary, clinic there.
And the reason I, as apsychologist, was there was to
support both the patients.
and the caregivers because it'ssuch an adjustment and that
(31:09):
coordination of care between adentist and the oncology team is
difficult at best, given ourhealth system here.
So I'm glad that you're doingthat.
Dr. Dua Makkar (31:19):
yeah, and I have I have cancer surgeons in there,
I have oral surgeons, who aretalking about oral systemic
links.
I have a psychologist talkingabout anger in the dental chair.
And I'm sure you've experiencedthat, right?
Your anger, sometimes you'reangry at the doctor who's
diagnosing you, because youdon't know where to shift your
anger to.
Dr. Dean (31:38):
Mm
Dr. Dua Makkar (31:39):
but yeah, so I have such a diverse group of
speakers.
we're talking about this and andthis is open to all health care
professionals.
whether you're a resident,you're a student, or you are,
any field of medicine,practicing or any field of
dentistry.
Dr. Dean (31:55):
Do you plan to do it annually?
Dr. Dua Makkar (31:56):
This is my 1st year, so I can see what kind of
response I get, but I think it'sbeen pretty good.
Dr. Dean (32:01):
I'll put the link in the show notes.
Okay.
Dr. Dua Makkar (32:03):
Yeah, this is virtually, but it's aired on
the, on Manu's birthday, hewould have been 38, but you can
watch the recordings throughoutbecause it's on a Thursday and a
lot of work and everybody's timeis important.
we have it set up so that peoplecan watch it later on, and it'll
be available for the next sixmonths
Dr. Dean (32:22):
What would you like to say about the book?
And I'm also curious as to howthat has played a role in your
grief process.
Dr. Dua Makkar (32:29):
Yes.
Dr. Dean (32:30):
Yes.
Life interrupted.
Dr. Dua Makkar (32:32):
This is the most tangible thing I have of him.
I don't have his kids.
There's no other legacy.
I don't have him and to sharehim with the world.
This is it.
Manu had expressed that hewanted to be published.
I flew down in December of 2020when he had fluid in his lungs
(32:54):
and he got a chessboard placedin.
And that's when I knew this was,my, I had other medical friends
who were like, you need to geton a flight.
And I was not vaccinated at thattime.
The world was a very scary andNew York was the epicenter and
my parents are like, no, youcan't fly.
We're all losing one child.
We cannot have you.
What if you get COVID?
(33:14):
You've got young kids.
What?
My dad was not listening to me.
So I wrote my dad an email and Isaid, Manu is my only brother.
And at that time, I didn't tellhim he was going to die, but I
just said you need to let mecome see him.
I have not seen him, since hisdiagnosis, he had flown in
(33:34):
September, but I'm like, I havenot seen him since his second
surgery, all the chemo,everything.
I've not been there foranything.
Let me just come.
And I put on a mask and I flew.
My husband was scared.
Everybody was scared.
But that's when he told me, he'sI've been writing, I really want
to be published.
And then I said, okay.
I found a publisher and I toldhim in February,"I found a
(33:55):
publisher, let's get you, I needyour manuscripts" he's like, no,
I've got time, I really want towrite more.
And then I said, okay, you'vegot nothing else going on.
Go ahead.
there was, he was barelywalking, he had lost so much
weight struggling to breathe,drink twice a day sometimes.
And, so when I found all hiswritings, the unfinished pieces,
(34:19):
I put it in the samechronological order as he had
put in them, and it was my wayof doing something for him
because I felt a failure as adentist, as a sister, as a
daughter in so many aspects.
I couldn't be there.
I couldn't save him.
I couldn't push him.
there's always, there's a guilt.
There's a survivor's guilt.
(34:40):
I have the same gene pool ashim, why him, not me.
I've been reading this bookcalled Worthy and in that, I
read there's a special reasonwhy you've been picked and, your
purpose is different than, andyou have to live to your
purpose.
And there's a lot of healing andthis book was part of that
healing.
yeah, I couldn't be there, but Idid something else for him that
(35:02):
he wanted.
I still got to do something forhim.
And.
I helped finish it.
I wrote the epilogue, TheAftermath of Cancer, that it's a
joint project and it's tangible.
And when I read it, it's infirst person.
So if I ever feel like talkingto him, I read him.
Dr. Dean (35:26):
hmm.
Dr. Dua Makkar (35:26):
You're still talking to me in first person.
Dr. Dean (35:29):
It struck me because I reread it and it felt like what
a gift to be able to have hiswords on paper.
And so many of the entries feltvery much about how he perceived
the world and engaged in theworld.
And so it, it felt like inreading it I was like, Oh, I
have a little bit of a sense ofwho he was.
And as his sister, that must be,like you said, the thing that
(35:49):
you can hold on to, because youdon't have a lot of other
things.
Dr. Dua Makkar (35:52):
I don't.
His house is sold and his carsare gone and there's nothing
tangible.
Dr. Dean (35:59):
Mm Hmm.
Dr. Dua Makkar (36:01):
And and I knew when he had given up, He never
gave up.
I don't think he ever stoppedfighting.
Dr. Dean (36:08):
Mm
Dr. Dua Makkar (36:09):
But in Jan of 2021, he was admitted for two
weeks in isolation.
Complete isolation because itwas still COVID.
He had a lot of fluid buildup.
He had a demand.
They were draining him and hehad high white blood cell
counts.
And so silly, he would shy awayfrom telling us the full details
(36:31):
of what he was going through, hewas protecting us, He was
admitted one time for highcalcium levels.
I'm like, Manu, why do you havehigh calcium levels?
And he's like, no, don't worryabout it, Didi, it's because I
had too much calcium pills.
Not because your cancer is downto your pelvic bone and you're
slowly degrading.
(36:52):
Manu, why do you have a highwhite blood cell count?
Not because you have a cellnecrosis.
he's no, it's just someinfection.
They're just going to fight itoff.
I'm in two weeks at thehospital.
And when he was in thathospital, he had written, the
chapter, the last blog, NewBeginnings.
last chapter, that lastparagraph, and he always shared
(37:14):
his writings with me, right?
He's okay, Dee, this is what Iwrote.
and when I read it, even then Iknew.
It was any day now,
Dr. Dean (37:23):
Mm Hmm.
Mm
Dr. Dua Makkar (37:24):
and then he stopped writing after that
because he just got really sick.
And then February, and he wasgetting immunotherapy.
And it's again, I don't know ifhe knew and was eminent because
in Feb, I told him, I'm like,kids are off.
I'm going to come.
He's don't come now.
I'm getting more radiation.
I have another lesion and that'spositive for cancer.
(37:45):
Also, the chest port was movedand the initial chest port side
had fluid retention, and thatwas cancer.
And he's I'm going to get moreradiation on my abdomen.
I'm going to be done by Marchsomething.
And so why don't you come thatweekend, March 21st?
So I was to fly.
But I already had my tickets.
I had, and that's why I got thecompassion release because it's
(38:05):
only valid for a month.
So I had it applied in Decemberand then I applied it for March.
And I said, okay, so February isgoing to take me time.
I'm vaccinated now.
Okay.
And my husband's going to cometo, we planned this all,
unfortunately passed before allof it, but had he not told me I
Dr. Dean (38:24):
You would have been there.
Dr. Dua Makkar (38:25):
I would have not been able to make it.
I would not have my paperwork.
I would not have, been ready tofly.
and the day I was supposed tofly was his actual cremation.
So in some ways he knew and.
He just told us as much as hefelt he needed to tell us.
and and that was his sense ofcontrol, He couldn't control the
(38:47):
other aspects of life.
So this is what it was, he didthings his own way.
He never came to anything, Hefought to the end as much as he
could, and he did it on histerms.
Dr. Dean (39:01):
How are you doing now?
Dr. Dua Makkar (39:03):
MMM.
I've come a long way.
I've definitely become moreempathetic.
when somebody passes, it's sorobotic to say, I'm so sorry for
your loss,
Dr. Dean (39:16):
Mm hmm.
Dr. Dua Makkar (39:17):
I
Dr. Dean (39:17):
Mm hmm.
Mm
Dr. Dua Makkar (39:18):
can't imagine what you're feeling unless you
have gone through that process,unless you have watched a loved
one die and been there throughthe aftermath, you don't, I, and
like I said, I lost mygrandparents and I was like,
okay,
Dr. Dean (39:36):
mm hmm
Dr. Dua Makkar (39:37):
That's life, but to watch somebody die in front
of you, Is very, it's adifferent road and few travel
it.
so now when people pass, peopledon't need support as much when
somebody has gone, hasexperienced loss.
(39:59):
the few days after people come,they call, they do the phone
calls.
And you don't need that anymore.
You need it when the nextholiday comes or you need it a
few months later.
And you feel alone and nobody'scalling and ringing and checking
up on you.
(40:19):
And it's made me realize howimportant that is.
And I do it.
Those death anniversaries, thebirthdays, that's when it
matters.
I've become stronger, and I'verealized how much strength I
possess.
That what I have had to gothrough endure.
(40:41):
In my loneliness in ways.
Yes, my husband's there forsupport, but that's not his
brother.
His life didn't alter.
My kids are too young toremember.
They didn't make an impact.
and so you learn to stand up foryourself because no one else
will.
so, when you ask me, like, isthere any question off topic?
(41:03):
There isn't because I want thisto be candid and I've shared
this even with my family, likemy in laws and everybody that
like we celebrated my father inlaw's 80th birthday and my
husband saw my face.
It's not that I'm not happy.
Yes, I'm happy we'recelebrating, my father in law's
(41:26):
there with his grandkids and thewhole family and all his
friends.
I'm like, I'll never have that.
My dad will never have that.
We planned to go away in Marchof 21 as a family to Hawaii.
To celebrate my dad's 70th, andthat trip never happened because
of COVID.
And then a month later, Manu wasdiagnosed for the second time.
(41:47):
We were going to celebrate Manubeat cancer.
We're going to celebrate hisfamily.
My dad's turning 70.
Mom's turning 65.
to do this whole thing as afamily trip.
That trip never happened.
My parents don't want tocelebrate birthdays anymore.
And it was that realizationthat.
And that's when grief hits you.
And I took a walk and myhusband's do you want to come?
(42:09):
I'm like, no, you need to bewith your family and enjoy your
dad's birthday.
I'll be fine.
I just need to take time out formyself to process what I'm going
through.
I'll be back.
And it's realizing when to stepaway and be present when you're
ready.
And it's okay to say no tothings that I just genuinely was
(42:32):
like, I can't be there.
especially right after thedeath.
even if time has passed, itdoesn't just affect you that few
months, a year later, the griefhits you at any time and you
just have to be ready for it andlearn how to cope.
And that's what this process hastaught me that, and I need to
take care of myself.
(42:53):
No one else is going to.
I need to step away and comeback.
Dr. Dean (42:58):
I think that's a nice parallel to your self advocacy
statement from before about selfadvocacy for health, but I think
also in grief we have toadvocate for ourselves There's
different people in your familygrieving, your parents are
obviously grieving differently,so I wonder if your boundaries
and your needing to take breaksfeels different than theirs and
(43:20):
how you've navigated that.
Dr. Dua Makkar (43:23):
Yeah, I think they're more isolated because
they don't have me around.
and they are invited to events.
And they say no to a lot ofthings.
You're like, we're not ready.
We're not in the happy zone andlife doesn't stop
Dr. Dean (43:36):
Right.
Dr. Dua Makkar (43:37):
and they have their own healing to do and they
are going to have to do it ontheir own time.
And I cannot force it on them.
life does go on, I can't forgetManu, but I can keep him as long
as I can with me.
But do something good andpositive in a way, try to let go
of the anger and shift it tosomething else because
Dr. Dean (43:58):
hmm.
Dr. Dua Makkar (43:59):
otherwise it's going to eat me away.
Dr. Dean (44:01):
It sounds like through this work that you're doing, the
speaking engagements and thesymposium, And the book, that
you're carrying him with you.
Dr. Dua Makkar (44:11):
Yeah.
And that's what I wrote in thebook, my last
Dr. Dean (44:16):
page.
I probably read that, I read itbefore bed, maybe.
Dr. Dua Makkar (44:21):
It's the last page, it was my note to him.
Dr. Dean (44:25):
Oh.
That'right Have you been en ableto share with your kids about
him?
Dr. Dua Makkar (44:29):
They weren't there for the funeral.
but when we did the dispersionof the ashes, they were with us,
we did it together.
And it was so overwhelming.
I'm like, okay, this is youruncle in a jar.
And because they didn't see thefuneral.
So they didn't see the actualprocess.
I had to explain it to them,this is circle of life, it's
(44:50):
just, you had to learn thelesson a little early.
Usually it's your parents orgrandparents that you experience
this with, not your uncle.
Not so early on.
And, and we still talk abouthim.
And, my older, who's 14 now, heasks me questions.
He's like, if they called himmamu, which mama in our language
(45:13):
means mother's brother.
So in Deerling, they called himmamu and they said, would we
hang out?
Would we do stuff together?
Dr. Dean (45:24):
hmm.
I
Dr. Dua Makkar (45:25):
would he like me?
you know, stuff like that.
And I said, yeah, you guys wouldplay Legos together.
he loved cars.
You would do this.
and my son wears his oldclothes.
Is there about the same heightnow?
Manu shopped, When Manu's cancerhad stopped.
He came to New York and he wentshopping.
(45:48):
He came with an empty suitcaseand he goes to the outlets and
he shopped so much.
And he never got to wear thoseclothes because he got sick
right after.
And so my son has all thesebrand new clothes and, shoes and
everything.
So he feels so much closer tohim.
It's cool.
Mamu left me this and Mamu, hegets all excited.
So yeah, Manu is still a part oftheir lives in a way we talk
(46:11):
about him.
We celebrate his birthday.
We'll take a cake.
We'll put a balloon out.
We do Rakhi, which is acelebration of a brother, sister
bond.
And.
Dr. Dean (46:21):
was going to ask you about that.
Yeah.
Dr. Dua Makkar (46:22):
Yeah.
so I still carry that tradition.
I have a tree in front of myhouse that was gifted and we
have a plaque that was alsogifted.
And, that tree represents Manuto me.
It's living, it's alive.
And so I tie it to that and mykids watch it.
So yeah, Manu is still a partand we talk about it.
We, and if you feel sad, it'sokay to feel sad and, they've
(46:45):
seen me break down and I said,I'll, I just need a few minutes
and mommy still loves you.
I'll be right back.
Dr. Dean (46:53):
So even being able to take those breaks with your kids
is a healthy process.
Yeah.
Dr. Dua Makkar (46:58):
And I want them to know that life is not always
all about ups.
It's downs and you need tolearn.
To pick yourself after if youhave a down,
Dr. Dean (47:07):
Which it sounds like you've really learned to do.
Are there other things aboutgrief or sibling loss that you
wish you had known then?
Dr. Dua Makkar (47:22):
I wish I'd never known.
Dr. Dean (47:24):
Yes, of course.
Same.
Dr. Dua Makkar (47:26):
I don't think I ever in my wildest dreams wish
I'd known any of this.
I don't wish it upon anyone.
In fact, I think I thought abouthaving a third child.
I'm like, God forbid, somethinghas to happen.
At least they'll have anothersibling, cause it's so
isolating.
So lonely.
Dr. Dean (47:43):
That's funny.
My aunt always said that becausemy dad had three siblings and
she always said she was havingmore than two kids in case they
lost one another because theyknew that experience.
Dr. Dua Makkar (47:55):
no.
And I think, it's you alwaysthink things for granted.
I always took, I took a lot ofstuff for granted.
Like I'm a far away from myparents.
and I, because I thought Manuwould always be there.
It was almost a decade youngerthan me.
I'm like, I'm gonna always takecare of them.
He'll be around.
He had lived always closer.
He went to college, in Calgarywhere my parents lived.
(48:17):
He went to school in Vancouver.
It's only a flight away.
He worked in the same city asthem.
so it was always thispredisposed condition that
they'll always be there.
I left my house at 17.
I was only with my parents for17 years of my life.
And then I went to college.
I went to dental school and Ilived with them for a few years.
Then I got married.
So I joke around.
I'm like, okay, I have them forthe first 17 years of my life
(48:38):
and I will have them for thelast 17 years that they've got
left, they're aging now.
but it's cherish those moments,be there for your family.
I, it's just, take more picturesand videos.
I wish I had more of that.
Dr. Dean (48:53):
Yeah,
Dr. Dua Makkar (48:53):
Even though you may think you're promised
things, it's not necessarilythat they will actually happen.
Dr. Dean (48:59):
exactly.
Do you have any favoritememories that you want to share?
Dr. Dua Makkar (49:10):
I think the most fun I've had with him was when
we lived in the same house asadults, when he had finished
high school, he started college.
And then now he wasn't thislittle annoying brother who
would like to try to eavesdropand I'm talking with my
girlfriends and now he was like.
(49:31):
he became a peer and somewhere,he became the older sibling.
I don't know.
but those are like, those threeyears of sharing the same house,
fighting over the bathroom.
And he's like, all your contactsare all over the place.
I'm like, your toothbrush andyour shaving stuff, like we
would fight over.
(49:52):
We never had that opportunity aswe were growing up.
So it's these little thingsthat.
we could actually go hang outtogether and those three years
are great
Dr. Dean (50:09):
Oh wow, so three years as adults you were living in the
same
Dr. Dua Makkar (50:12):
until I got married and then I moved, you
Dr. Dean (50:15):
and you're now in the states.
Dr. Dua Makkar (50:18):
know, New York back into the States, you know,
Dr. Dean (50:23):
thank you for all of that.
Is there anything else that youwanted to share or say?
Dr. Dua Makkar (50:28):
no, that's been great.
Finding your own people whenlike you said, you've got this
Broken Pack, it's finding yourpath
Dr. Dean (50:35):
Yeah.
Dr. Dua Makkar (50:36):
because we're all broken in all sorts of ways.
And you can never be whole, youcan try to find those pieces and
maybe make it whole.
Dr. Dean (50:44):
Yeah, I like that interpretation.
In fact, That's not why it'snamed the Broken Pack, but I
actually had a couple peoplereach out when I first named it
and the people that I knew andthey're like, I'm not broken.
I'm grieving.
And I was like, I get that.
it's actually called the BrokenPack because the wolves grieve
and their pack is broken as thefamily structure.
(51:04):
And so that's what the brokenrefers to, but it's obviously
open to interpretation.
um, yeah,
Dr. Dua Makkar (51:11):
I know the wolf reference, but I perceive it as
finding your pack.
Dr. Dean (51:16):
yeah.
I like that too, because part ofwhat I'm doing here is building
community.
And I know that you and I havemessaged about this, but also
other things.
And it's been nice to connectwith people.
And so I do plan to build thatpart of The Broken Pack up
slowly because we're smallorganization right now.
But, yeah.
Thank you.
And thank you for chatting withme today and sharing a little
(51:37):
bit about Manu.
Dr. Dua Makkar (51:39):
Thank you.
Thank you for having me.
Dr. Dean (51:42):
you're welcome.
/Thank you so much forlistening.
Our theme song was written byJoe Mylward and Brian Dean and
was performed by Fuji Sounds(feat.
MYLWD.).
If you would like moreinformation on The Broken Pack™,
go to our website,thebrokenpack.
com.
Be sure to sign up for ournewsletter, Wild Grief™, and to
learn about opportunities andreceive exclusive information
and content, as well as grievingtips for subscribers.
(52:05):
Information on that, our socialmedia and on our guest can be
found in the show notes whereveryou get your podcasts.
Please like, follow, rate,subscribe, and share.
Thanks again.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy And Charlamagne Tha God!
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.