How man’s search for natural sensual bulge ends in flat scar

As a breast surgeon, I am interested in finding out how women discover lumps in their breasts and therefore I ask a specific question to that effect. In my research, I have found that the commonest way a woman finds a lump in her breast is accidentally feeling the lump while having a bath.

Another way is stumbling on it while examining to assess damage when feeling pain in the breast after knocking it on a door or a table, apparently a common accident.

Very rarely, pain draws the attention of a woman to the presence of a lump lurking in her breast. I say rarely because pain is not a feature of the most dreaded lump — a cancerous lump.

That is why all breast surgeons pray at the end of their working day that malignant lumps are excruciatingly painful at their onset to drive the patient to her surgeon quickly.

INTERESTING AND AMUSING

There are also some interesting and even amusing ways by which breast lumps are unearthed and either patients don’t mention it or do so with a blush on their face. This is the story of Avril, who discovered a lump in her breast in an unconventional way.

So when she came to see me and I asked her my usual question. “How did you find this lump?” She honestly replied, pointing at her husband, sitting next to her. “I didn’t, he did.”

“I am sorry,” I remarked feeling the large size of the lump and noting the enlarged glands in Avril’s right axilla.” He didn’t do a good job. He did not discover it early enough.”

In reply to my unkind remark, Ben, the husband retorted. “You don’t fondle a wife’s breast to detect lumps!”

I took a full medical history from Avril, examined the lump, both breasts and axillae in greater detail and took a core biopsy of the lump. I gave Avril an appointment to see me in a week’s time, the usual time the pathologist takes to send her report.

The histology tallied with my clinical diagnosis, so when the couple sat in front of me again, I said in the gentlest way I could muster. “I am afraid, you need a right mastectomy.”

“I read on the internet that you do lumpectomy these days and spare the poor woman the trauma of a mastectomy.” Avril put forward her genuine argument, reminding me that the internet is a repository of facts, which computer-literate women often refer to, thus keeping us on our toes.

“Yes, we do.” I agreed.” This applies to early small lumps with no metastasis in axillary glands. In our present knowledge, a big lump and presence of enlarged glands in the armpit disqualify you. Anyway on a serious note, what caused the delay?” I asked.

“There are many reasons but the main one was Ben’s potential promotion.” As I saw Ben nodding in acquiescence, Avril continued.” Ben’s boss, an expatriate, was due to retire. Ben was a financial director for 15 years and stood a good chance of succeeding his boss if he played his cards right. I too had a role in it and my breast lump was a distraction. So I decided to keep quiet about it until the top job fell in his lap, and I sought treatment after the contract was signed and sealed.” Avril concluded.

SOME PERSUASION

After some persuasion on my part in which Ben took a leading role, his main argument being that life is more important than a breast, Avril agreed to a mastectomy, which was uneventful. So were the chemotherapy and radiotherapy, which followed surgery. After checking Avril quarterly and six monthly for a while, she was put on a yearly follow-up as per our protocol and that was when she cautiously asked. “I feel reassured when I come to see you, but I hope you don’t mind me asking; how long does this annual check-up go on for?”

“I don’t want to disappoint you,” I replied equally cautiously.

“But in breast cancer, we don’t use the term ‘cure’ but say that the disease is ‘in remission’ and therefore the follow-up is for life. It stops when the surgeon dies or...” I stopped there abruptly.

Avril completed the sentence for me.” Or the patient succumbs to her disease.”

“Let me cheer you up.” I said. “With early diagnosis and newer treatment, the outlook has improved a great deal and ‘cure’ is sneaking back into our vocabulary in breast cancer. A lot of work is being done to find a vaccine to prevent the disease. I am eagerly waiting for that happy day when women can heave a sigh of relief and I can also retire.” That factual statement of mine really cheered her up and she religiously kept all her follow-up appointments.

It was at one of these appointments that I was made aware of another drama taking place in Avril’s life. Usually, her visits were like a breath of fresh air, but that particular day she looked very depressed and taciturn. Unable to hold my curiosity, I asked her point-blank. “You are not your usual self today, bright and breezy.”

“You must be a mind reader,” she perked up seeing that somebody cared. “You are right; I am very depressed today.”

There was an awkward interminable silence and I broke it. “You haven’t still told me the reason for it.”

“I will tell you because your surgery is partly responsible for it.” She took a little time and then dropped the bombshell. “Ben came home yesterday and said that he wants a divorce.”

“What?” I screamed. In all the reasons in my reckoning to explain Avril’s depression, this one had not featured at all.

“It has been brewing for some time.” Avril continued. “From the time I went home after surgery.

COUNSELLING SESSION

“He has not touched me since, leading me to believe that though he pushed me into having a mastectomy, he has not come to terms with it.” As Avril continued looking into my shocked face, she went on. “He obviously did not realise what mastectomy entailed and he can’t adjust psychologically to a flat scar in place of a sensual bulge.”

In all the many mastectomies I had carried out over the years, this aspect had never registered in my mind. I had only thought of the emotional stress that the woman undergoes. No wonder the modern breast surgeons include the spouse or partner in the counselling session.

“Is there a third party involved?” Lost for words, I asked.

“Yes, that’s why Ben wants his freedom.” Replied Avril with a sigh. “Unfortunately a friend of mine, making it more hurtful. Ben asked for a divorce so that he is free to marry her.” I could see that she knew the identity of the intruder, but did not name her because in her heart she had become persona non-grata and so naming her was an act of sacrilege.

“There are lot more fishes in the sea.” I changed my tack. “You are an attractive young woman and will have no difficulty in finding a suitable partner.” As I saw optimism in Avril’s expression, I continued. “From what you tell me, Ben married you with both your breasts in place and could not accept you with one breast missing. In contrast, this new man in your life will know what he is getting and will have no reason to feel disillusioned.” I concluded.

She found a potential husband and a very nice chap from what she told me on the phone, the day he asked her to marry him. I only had one question when she rang me. “Does he know and has he seen?”

“Both,” she replied in her usual cheerful manner. “Things have changed since Ben and I were courting! Nowadays, both partners want to see what they are buying!”

My favourite author, Somerset Maugham said that all good stories end in marriage or death. This story has ended happily with marriage in the offing, and I wish I could end it here, but true life stories, which ‘Surgeon’s Diary’ is, have strange tendrils and are likely to have loose ends which make life interesting.

A couple of years ago, Ben rang me and said. “My wife has noticed a lump in her breast, we have seen our family doctor and he has referred her to you.”

“I have a clinic this afternoon and since we treat breast lump as an emergency, please bring her there to see me.” I replied. Even though he had treated Avril shabbily, we had maintained the long standing patient surgeon professional relationship.

On examining Judy, I found to my amazement that her lump was similar to that of Avril in all respects, including the size and even the presence of axillary glands, with one difference. Avril’s lump was in the left breast while Judy had her lump in the right one. The histology of the lump and glands was the same and she too ended with a mastectomy, followed by chemo-therapy and irradiation.

As I drove home late that evening, it dawned on me that after all, Ben ended up in a flat scar in place of a natural bulge. Was it divine retribution or divine wrath — I wondered.