Well, well...parenting a parent is no mean feat

Trina* texted me late in the evening confirming that she would be bringing her mum to clinic the next day. I sent a quick text back that I was looking forward to seeing them both as scheduled.

I have known Trina for years through work, and eventually as a patient. During her last annual general review, she mentioned that her mum was newly diagnosed with hypertension and she was having trouble accepting her diagnosis and complying with her treatment. Getting her to take her medication was proving quite an uphill task. I empathised with Trina and recommended a family physician colleague whom I knew to be quite good with caring for the elderly patients. She was quite excited to report that the two got along famously and her mother was a lot more receptive of her care and had even managed to gradually improve her diet, was more active and was religiously taking her medication. With this new outlook in life, Trina noticed her mum was a lot more open about her health. She even managed to bring up the fact that in the past six months, despite having been in menopause for over a decade, she had noticed recurring episodes of minimal vaginal bleeding. Trina panicked and quickly set up an appointment with my secretary to bring her mum to see me.

What she did not count on was her mother’s stubborn reluctance to come to honour the appointment. She adamantly refused to come. She told Trina that she had a church event coming up the next week and she was in charge of ensuring its success, hence could not afford to head out to the city the next day as scheduled.

To say Trina was upset was an understatement. Despite not being a health professional, she had been around women’s health practitioners enough to understand that post-menopausal bleeding was an ominous sign that needed an immediate review. Even worse was the fact that her mum’s gynaecologist, the one who had delivered Trina and her brother, had passed on a few years before and ever since, her mum had not had a gynaecological review. She refused to start over with a new doctor, especially with the Covid-19 pandemic reducing non-essential visits. However, this new situation changed things.

Trina felt like a failure. She had already lost her father in her twenties and she was not willing to lose the only parent she had. She called me fuming about her mum but I calmed her down and told her we could wait two weeks, to give her mum time to come around. She was due for her visit with the family physician anyway, so we could combine the visit to Nairobi with her review.

I eventually met Trina’s mum and I was taken aback. She looked much younger than I expected for a woman in the beginning of her 6th decade. She had a thick, long, jet-black mop of hair, just like Trina’s. She could easily be Trina’s older sister despite the two and a half decades between them.

After introductions, Trina left us alone. She went next door to the coffee shop to take an online meeting. Trina’s mum looked at me warily and asked me a question I get frequently from older women; how was a little girl like me going to perform such an intimate examination on her, yet I was young enough to be her daughter.

Unfazed, I reassured her and instead took the conversation away from the examination to what I quickly realised was her pet project, dairy farming. For the next half hour, she regaled me with stories of her three, clearly pampered and spoilt cows that gave her almost a hundred litres of milk every day. She had named them after powerful women: Margaret Thatcher, Graca Machel and Ellen Johnson. She said she could never remember the name ‘Sirleaf’ because she could not pronounce it. We struck common ground; we both disliked politics but admired strong women. We finally got to around to talking about her reason for the visit. Her last pap smear was almost five years back but she had had a series of normal ones in the decade preceding that. 

I took her through the reasons why her evaluation was urgent and why we needed to be sure that she did not have cancer, starting from the dreaded pelvic examination and the subsequent tests she would require. By this time, she was ready for the thorough head to toe examination. I walked her through it verbally as I poked and prodded, relieved to find she did not have a cervical mass, and was able to do the pap smear.

Back to the desk, as I wrote out the test request forms, she started off a question but hesitated. I looked up and wondered what was bothering her, yet we were now well past that. I encouraged her to blurt it out, and she did just that. She asked me why she was suddenly having such high libido, after almost two decades of celibacy, half of which was post-menopausal. I put down my pen, looked at her in the eye and asked her why she would think that the woman in her had died along with her husband? She looked at me in utter surprise and we both burst out laughing. This is when the real floodgates opened and she told me that after suppressing her feelings for over five years, she finally allowed herself to get involved with someone.

She was struggling to accept just how much she had repressed herself sexually. The clandestine affair had been going on for two years. So, when the vaginal bleeding started, she thought it was as a result of her sexual engagement. This was the reason she had refused to see a doctor; she thought that her little secret would come out and she was not ready to talk to her children about it.

A little digging into her relationship reassured me that sexually, she was safe, in what appeared to be a monogamous involvement. In a bid to maintain anonymity, the two had driven miles away from home to get screened for HIV before their relationship turned physical. They were both widowed and though the man was ready to marry her, she was not ready for that level of public declaration.

I could feel the relief coursing through her as I explained that her condition was not triggered by sex. She sat back, at peace with herself, as her daughter rapped on the door wondering what had taken so long. She winked at me on her way out. She was ready to tackle whatever it was head on. Trina’s raised brow could only trigger more chuckles from us.

Thankfully, her tests revealed that alongside a normal pap smear, she did not have endometrial cancer. She chose to undergo a hysterectomy to prevent future progression to cancer. During her admission for surgery, I finally had the privilege of meeting her Romeo. It was Trina’s turn to drop her jaw! Indeed, parenting a parent is no mean feat!

Dr Bosire is an obstetrician/ gynaecologist