In Summary

  • “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.

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