‘It is not that I need to keep my breast at this stage’

The patient’s name was Phyllis Mutuki and she was 45. Beyond the cold statistics, entered routinely on the office file, as usual, I was interested in her persona, which I found more interesting. ILLUSTRATION | JOHN NYAGAH

What you need to know:

  • “I have no husband and no need to keep this breast. As far as I am concerned, the breasts have done their job. I would worry about the cancer coming back if I kept it. Considering everything, I would rather get rid of the breast and the soil in which the tumour can grow again.”
  • “I have every reason to smile,” Phyllis replied. “All tests on me conducted by the transplant team prove that I can safely donate one of my kidneys to my daughter because I am compatible. Anyway, after suffering from breast cancer, I reckon I don’t have long to live so I might as well live in my daughter’s body.”

As the new patient sat in front of me, holding her doctor’s note, I looked at her file again. It had been left by my secretary on my desk, when she ushered her in.

The patient’s name was Phyllis Mutuki and she was 45. Beyond the cold statistics, entered routinely on the office file, as usual, I was interested in her persona, which I found more interesting.

 On her face there was an aura of intelligence, mixed with anxiety about what I would find. There was also the maturity and fortitude of middle age, indicating that she had gone through vicissitudes of life as we all do by that age. It all forced me to look at her file more carefully because I was now curious to know her profession. It had been entered as “university lecturer”.

“Good morning,” I greeted Phyllis warmly as she handed me her doctor’s letter.

“Good morning,” she reciprocated as I slit open the envelope and read the note from Dr Florence Mwanzia, a budding medical oncologist, which, in lay terms, means a specialist in cancer.

 I read her note and it tallied with what she had told me on the phone. “Phyllis came to see me with a lump in her right breast of six months duration,” she said.

“Clinically, I found it suspicious. Mammogram shows abnormal calcification in the lump and the core biopsy I did under local anaesthesia has confirmed the diagnosis of adeno-carcinoma.” She then added why she was sending Phyllis to see me. As a medical oncologist, she dealt with diagnosis and chemotherapy but not surgery. “In my view, she needs a mastectomy”, she concluded.

I felt very proud of Dr Mwanzia because she had dealt with Phyllis in a most professional manner. As I was basking in the reflected glory as one of her mentors, I asked the patient a few relevant questions. One of them was “How many children?”

 “Three,” replied Phyllis.

“All of them well?”

JOB DONE

“Except the last born daughter, who is 10” Phyllis replied.” She had throat infection as a child which went to her kidneys and caused nephritis for which she is under the care of a kidney specialist.”

I did not want to be distracted by sideshows and did not dwell on the matter further. “Periods still coming?” I asked.

“Yes but irregular and scanty,” Phyllis explained. “I think I am nearing the change.”

At the end of an exhaustive history taking, I examined Phyllis, saw her mammogram and biopsy report and came to the same conclusion as Dr Mwanzia. I decided to take her cue and said “I am sure Dr Mwanzia has told you your diagnosis and what needs to be done.”

“Yes, I am ready for it,” Phyllis replied in a manner which convinced me that she had been properly counselled. “I have one question though,” she added. “Not that I need to keep my breast at this stage of my life but, in case I want to, can it be saved?”

Considering that many patients refer to internet these days before they see their doctor, I was prepared for this question. “Your lump is too big for a lumpectomy. Also, though I can’t feel enlarged glands in your right armpit, going by the duration of your lump, they are likely to be involved but are too small to be felt by a surgeon’s fingers.”

As I saw Phyllis listening intently, I continued: “If you are serious about keeping your breast, we have to change our strategy. We explore your armpit first and, if we find enlarged glands there, we check them microscopically and then decide. I might add that if we decide to preserve the breast, we would have to give radiotherapy.”

“Why?” Phyllis asked.

“Because breast cancer is a multi-focal disease and there may be foci in other parts of the breast, which have to be destroyed by irradiation,” I explained. 

Phyllis thought for a while with a studious expression and then replied. “I have no husband and no need to keep this breast. As far as I am concerned, the breasts have done their job. I would worry about the cancer coming back if I kept it. Considering everything, I would rather get rid of the breast and the soil in which the tumour can grow again.”

“I think we are making the right decision for you,” I concluded.

“I have good news for you,” I said to Phyllis when she came to see me after being discharged from the hospital following an uneventful surgery. “The report on the mastectomy specimen has come and I have discussed it with Dr Mwanzia and also Dr Waweru, our pathologist. The oestrogen receptors are positive which means two positive things. Hormone positive tumours have a good prognosis and anti-hormone tablets will help you. Furthermore the enlarged glands from your axilla, which I removed for sampling show no metastasis. Dr Waweru has described them as reactive which means that they are enlarged in the process of fighting the disease.”

Seeing no overt signs of happiness on her face, I was impelled to remark. “I thought you would jump with joy at what I told you.”

More bad news

“I would,” replied Phyllis, “if you could give similar news about my daughter Jennifer. Her kidneys have packed up and she is under the care of a kidney specialist.” As this information dampened my exuberance, she added: “All this happened while I was in the hospital, under your care. So, soon after I was discharged, I went and saw the nephrologist and he frankly told me to look for a kidney donor.”

From then on, the problem of the mother went on a backburner and Jennifer’s dialysis three times a week and her eventual need for a kidney transplant took centre stage. I just put Phyllis on anti-hormone tablets and followed her up, while she was on chemotherapy administered by Dr Mwanzia roughly once a month.

KIDNEY DONOR

Since she did not want to disrupt her work, as most of us want, we arranged for her to come on Saturday mornings to take her chemotherapy course and go to work on Mondays. The treatments are now less toxic and the little toxicity they cause can be controlled by oral medication.

On one of her follow-up visits, she complained to me: “We haven’t been able to find a suitable donor for Jennifer from either our immediate or extended family.” She shattered me by what she said at the next appointment: “I am the latest candidate currently undergoing a host of tests to see if my kidney is compatible.” 

A few weeks later, I noticed a strange smile on her face when I went to see her while she was resting over a cup of coffee and mandazi in the Chemotherapy Department after the drip containing the fifth dose of chemotherapy drugs prescribed by Dr Mwanzia had finished and she was waiting for the doctor to come and discharge her. I often did that so that the patient feels that the treatment of breast cancer is a team work, which it is meant to be. “I have never seen a smile on the face of a patient who has just finished receiving her chemo,” I remarked.

“I have every reason to smile,” Phyllis replied. “All tests on me conducted by the transplant team prove that I can safely donate one of my kidneys to my daughter because I am compatible. Anyway, after suffering from breast cancer, I reckon I don’t have long to live so I might as well live in my daughter’s body.” After making that memorable remark, she kept looking at me as if seeking my reaction.

“I have two comments to make,” I said. “One, your fatalistic view is wrong because, according to the latest statistics, you are likely to be with us for many years. The outlook in cancer breast has changed radically in recent years because of newer treatments and better understanding of the disease.” As I saw her taut facial muscles relax, I plonked my next point.

“Secondly we must make sure that your kidneys are clear though I must admit that in all the years I have been dealing with breast cancer, I have never seen metastasis from breast ever going to the kidneys. In fact I can safely say that kidneys are immune to secondary spread from cancer of any organ in the human body.”

Delicate surgery

“All checked and found clear,” Phyllis announced with glee. “Mine being  such an unusual situation where a mother who has suffered from cancer of her breast is donating a kidney to her daughter that my kidney transplant team has taken an unusual step and has recommended to my employer that I be sent to a centre in the UK where they have done many similar transplants.”

“And have they agreed?” I asked.

“Yes. In fact my daughter and I are thinking of flying there soon after I have recovered from my sixth and final dose of chemotherapy in about a month’s time. I was going to inform Dr Mwanzia all about it when she came to see me here before I went home. Also I was planning to see you soon and update you on the latest developments.”

I realised that my patient was not only mature and intelligent; she was also adventurous and intrepid. To relieve my readers of further suspense, I can inform them that Phyllis and Jennifer are back after their joint surgery and are being regularly followed by Jennifer’s nephrologist, Dr Mwanzia and myself and all is well. Long may it last. The report from UK which came with them assures us that it will.