Two women, same cancer diagnosis, different reaction

I saw a variety of reactions from these women when I disclosed to them that the lump in their breast was malignant and they might have to undergo a mastectomy and lose their breast. ILLUSTRATION | JOHN NYAGAH

What you need to know:

  • They both were university graduates, professional women and highly educated. One of them was Dorothy, a woman of 55 with a husband and three grown up children.
  •  “I want to express two wishes,” she replied. “I hate the idea of having chemotherapy, because I understand the treatment is worse than the disease.”
  • I didn’t like the idea of losing my breast because I was in a relationship. I went to a witchdoctor who promised to cure my disease with herbs, without removing my breast.”

My surgical practice has been a two-way traffic for the last 55 years. I have had the gratification of treating many surgical patients and proud to have cured some. On the other hand, I have learnt so much human psychology from my patients. As my favourite author, Somerset Maugham, said, as a medical student he saw life in the raw and witnessed pretty well every emotion which man is capable of. As a surgeon, I too have had similar experiences.

I recall patients telling me: “You can be frank with me; you know, I can take it”. Believing them implicitly, when I told them the whole truth, they sobbed like a child making me feel guilty at not using my own discretion.

I remember men and women with excessive wealth and smugly living in their comfort zone succumb, suddenly age and develop wrinkles of despair and despondency on their faces when I truthfully told them their diagnosis, often at their bidding. As I talked to them, the expressions on their faces changed like a kaleidoscope showing in turn hope, faith, tears, laughter and despondency. Finally like Maugham, I too saw the gallantry with which men met their death with feigned equanimity because they did not want anyone to see the terror of their souls.

I thought that over a practice which has lasted more than half a century, I would grow thick skin and detach myself from the turmoil going on in the mind of my patients but it never happened. I could literally feel my coronaries getting progressively clogged, as I talked to them. As a breast surgeon my patients were predominantly women and, therefore, as I have mentioned in this column before, there were more women in my consulting room than in the office of the gynaecologist one floor below.

I saw a variety of reactions from these women when I disclosed to them that the lump in their breast was malignant and they might have to undergo a mastectomy and lose their breast. In this connection I clearly remember two patients with a completely contrasting response when I informed them of what they were suffering from. The two cases were identical in their diagnosis, stage of disease and their prognosis.

They both were university graduates, professional women and highly educated. One of them was Dorothy, a woman of 55 with a husband and three grown up children. As I obtained her medical history and examined her, I realised that all she knew was that she had a lump in her right breast. She had no idea what it was and how far her disease had progressed. “I am afraid that the lump in your right breast is malignant,” I said gingerly after I finished examining her.

“You mean it is cancer?” she asked. “What stage is it?”

PROPER GOODBYES

Knowing that staging has different connotations with patients and surgeons, I replied in non-scientific terms. “It is at an advanced stage and will need a mastectomy, chemotherapy and probably radio-therapy as well.”

“I am not scared of dying. My worry is how I will say good-bye to my family and friends.” That was her immediate reaction.

“I don’t think that we need to go there yet,” I tried to soften the blow but Dorothy saw through it.

“I want to express two wishes,” she replied. “I hate the idea of having chemotherapy, because I understand the treatment is worse than the disease.”

“There are now newer drugs which are not very toxic and also medicines to combat the side-effects,” I replied. “And your second wish?”

“We are in July now and would like to keep going till Christmas. I can say a proper kwaheri to everybody who comes to see me. Also the festive season will lift off the sadness of me going to higher services.” I couldn’t help noticing that the word “death” did not come easily to her, as she made her final point. “I hate the idea of people gathering around me when I am on my death-bed.”

Dorothy must have willed it strongly because both her wishes were fulfilled. Her mastectomy, though technically difficult because her breast was stuck to the muscle underneath, her surgery from her point of view was uneventful. When her operation wound healed, she was started on her chemotherapy, of which she had three courses only, when Christmas came. She had a very happy festive season with her family at her rural home near Meru and passed away peacefully, early in the New Year, according to her immediate family, which came to thank me for my help in their ordeal.

Contrast that with the case of Gladys, 34, single, with no children, who knew all about her illness, which was obvious from her reply to my first question. “What’s your problem?” I said when she was comfortably seated, opposite me.

“I have cancer in my right breast,” she replied in a very casual manner.

“How do you know?” I asked.

“I went to a surgeon last year with a lump in my breast,” Gladys explained. “He did a biopsy and told me that I had cancer and I needed a mastectomy.”

“And did you?” I had not examined Gladys and, therefore, did not know.

“No, I didn’t. I didn’t like the idea of losing my breast because I was in a relationship. I went to a witchdoctor who promised to cure my disease with herbs, without removing my breast.”

“And did he?” There was palpable eagerness in my voice because I was hoping against hope that unknown to me, there might be a cure hidden in the bark of one of our trees.

LOSING BOOBS AND CAR

“No, he didn’t. My lump continued to grow and my titti did not wobble, which my friends thought was a bad sign.

“So I decided to consult another colleague of yours and he said that my breast was frozen and no longer operable. He suggested that we could try chemotherapy.”

“So why have you come to see me?” I asked

“Because I don’t want to die yet and I heard of you from my nephew, who is a medical student, and heard your lecture on breast cancer,” Gladys replied.

After obtaining further medical history, I examined Gladys and asked her. “Has a mammogram been done on your left breast?”

Gladys thought that I was mistaking the side and tried to correct me. “My cancer is in the right breast and I have undergone lots of tests,” she said, handing me a large heavy envelope containing X-rays and other reports.

“I am afraid I can feel a lump in your left breast and need to do a mammogram and core biopsy on that,” I clarified. When both came positive for cancer, I told Gladys: “I have seen all your investigations, which show that you have a spread in your spine and skull. This means we give you chemotherapy and try to make your left breast operable. We also irradiate your bone metastasis, because they are localised. If they clear, we do a bilateral mastectomy and that might give us more time.”

“You want to remove both my breasts?” Gladys asked.

I explained to her that she had advanced cancer in her left breast and malignant tumour in her right and added: “This will only apply if chemotherapy makes your left breast operable and radiotherapy dissolves your bone metastasis.” As she was thinking, I gave her an inducement. “These days, we put implants immediately after mastectomy.”

“Brilliant,” she jumped to the bait. “I have always wanted bigger boobs than what God gave me. I am 34A and would like a B or C.”

“No problem.” My plastic surgical colleague, who was going to put the implants and sitting with me in joint consultation, said: “I will give you a C and you will love it.”

My oncologist colleague started Gladys on chemotherapy and, to our delight, with every successive course, her left breast loosened a little and the lump in her right breast shrunk. Her spinal and rib metastasis dissolved like snow under the sun and she did not even need radiotherapy. However, chemotherapy drugs took their toll. She lost all her hair, but took the blow philosophically. “Baldness is in fashion now. Moreover there are so many wigs which I have always wanted to try. This is my chance to do it.” Her reaction to loss of appetite, vomiting and ulcers inside her mouth was. “I need to lose weight and these complications will do the trick!”

Her right breast became operable and she underwent a double mastectomy, which went off very well. She had the implants inserted as well. She was left with a sore chest but hardly complained. The only complication was when her brother came to see her that evening when I was doing my post-operative round to see that all my operated patients were fine. “I can’t see your car in the compound of your apartment building,” he announced in my presence. “I think somebody has nicked it.”

Gladys turned to me and exclaimed: “I should go in your ‘Diary’, as your patient, who lost her boobs and Toyota Vitz on the same day!”     

To end, I want to inform my readers that Gladys is still going strong. We have had a couple of setbacks but, with her usual fortitude and courage, Gladys got over both. So at her last consultation with me, I said to her: “I would like to appoint you counsellor to my cancer breast patients,”

“I would love to do that,” Gladys was elated. “Also tell the disease that you specialise in that this time it has tried to mess up the wrong girl!”