DAWOOD: Not all patients follow the age pattern written in surgical text books

In October, last year, I was invited by a women’s organisation to speak on breast cancer. It was a topical subject because October is recognised as “Breast Cancer Awareness Month” and, therefore, dedicated to the subject of my lecture.

In my discourse, I mentioned the commonest age at which the disease affects women. “In Western countries where breast cancer is more common, women between 40 and 50 are commonly affected,” I said. “However, in my research in Kenya, I found that it is commonest between the age of 30 and 40.

For comparison, I checked with breast surgeons working in Uganda and their findings were the same. We don’t know for sure the reason for this age difference but one theory is that because of our relatively shorter life span, we get cancers earlier than in countries where people generally live longer.”

Having made that general statement, I remembered a case which occurred over half a century ago and decided to correct the wrong impression I might have unwittingly given. “Though every disease has the commonest age at which it occurs, based on statistics, it does not mean that women outside that age group don’t suffer from breast cancer.” To emphasise my point, I added: “For example, my youngest patient was 14 years old and my oldest was 92!”

Then to inject some humour into what is considered a dismal topic, I elaborated on the 92-year-old woman.

“As per our protocol, I followed up Mrs Mureria for a long time after surgery. At one point the daughter complained to me. ‘Visiting you is becoming expensive and the family is wondering if we can stop the follow-up, considering that my mother underwent mastectomy three years ago.’ ”

Thinking that it was my consultation fees which was the problem, I said: “I am happy to reduce my professional charges or forego them altogether.”

“That’s the least of our problem,” replied the daughter. “Since you admired her new maridadi  dress the first time she came to see you after her discharge from the hospital, every time she has an appointment to see you, she insists that we buy a new dress for her.”

She added: “She says that nobody even notices what she is wearing, leave aside admiring it. Since you did so, she insists on wearing a new dress every time she visits you. Now even buying an item of mutumba, which meets with her approval is becoming an expensive exercise!”

As my audience went into gales of laughter, I completed the story of Mrs Mureria. “This lady lived to be a hundred and died of heart failure.”

BACK TO 1955

As I was driving back home after that evening meeting, I remembered the case of Mrs Richardson, which made me reiterate to my listeners that not all patients follow the age pattern mentioned in surgical text books.

As mentioned earlier, I have to take my readers to 1955, long before some of them were born. It was the year I flew to London to obtain my Fellowship of the Royal College of Surgeons (FRCS) and be trained and qualified as a surgeon.

It could have turned into a foolhardy adventure because I did not know a soul in the UK. All I knew was that I could quickly get a hospital job and study for my fellowship on the income I made from working. Before I left, at least I had the good sense to tap my teachers in Miraj and Bombay to give me some contacts I could turn to in times of distress.

The medical school at which I studied in Miraj was run by American Presbyterian Church and Dr Ranbhise, who taught me medicine there, responded to my plea.

“I am sending you the address of a Mrs Richardson, whose husband worked as an evangelist at the mission hospital in Miraj. He retired and he and his wife went back to their home country and settled in Farnham in Surrey. Dr Richardson, a PhD in Theology, died but the wife still lives in Farnham and keeps in touch with me.”

He then wrote her postal address and added a PS. ‘They did not have any children of their own so they adopted a girl from the orphanage attached to the mission station here, where unmarried mothers came for confinement and left their children. They christened her Anandi, Marathi for Joy so, though she is officially Joy, she was called Anandi by her adopted parents.

“According to the last Christmas card I received from Mrs Richardson, Anandi is training to be a nurse at the nearby Reading Hospital.”      

Armed with this information, I flew from Karachi to London on February 2, 1955 by BOAC Super-Constellation aircraft.

The flight took 26 hours, stopping at Aden, Damascus, Nicosia, Rome and Dusseldorf, en-route. After struggling for a few days, looking for a job, I obtained a Casualty Officer’s post in Maidenhead, a beautiful town by River Thames, only 30 miles from London.

After I settled in my new job, I contacted Mrs Richardson in Farnham by post and she kindly invited me home.

She wrote that Farnham was not far from Maidenhead and told me how to get there by train. I went there on one of my off weekends and found a motherly lady in her eighties.

The myriad wrinkles on her kindly face, partly a result of the Miraj sun under which she had worked helping her husband, betrayed her octogenarian status. Anandi, too, was off for the weekend and joined us at 13, Menin Way in Farnham, a lovely detached

house with a small garden. I was very happy to see firsthand the family life in England.

MOST WELCOME

In August of that year, I finished my job at Maidenhead and the three month course for Primary FRCS, to be held at the Royal College in London, was not due to start till middle of September.

When I enlisted for it, the brochure said that the course was very fast-paced and candidates were advised to brush up their basic science subjects before joining the course to get maximum benefit from it.

I mentioned this to Mrs Richardson on my subsequent visit to Farnham and she said: “You are most welcome to stay here.” She then added a precautionary note:“We have no maids here as you have in your country.

That means a guest has to do some house-work, like laying the table, washing up after a meal and ironing. I think I can spare you the cooking!” she concluded with a smile which changed her wrinkled face like a kaleidoscope.

I thought it would be a new experience for me, also a roof over my head, some company and no distractions. After all, beggars can’t be choosers.

I moved from Maidenhead to Farnham in the middle of August and, true to my character, set up a daily routine. Every morning after a full English breakfast with the old lady, I went into the study and revised my anatomy.

The lunch was at 1 pm and a leisurely affair because it was the main meal of the day. By 2 pm I was in the study again, swatting at physiology text books.

Tea, which was more like supper, was scheduled for 6 pm and then it was the turn of pathology and biochemistry. My working day finished at about nine and I joined Mrs Richardson in the lounge for an hour, watching the news on television and

socialising. Some days I helped the old lady in the garden, weeding, planting and mowing the lawn. 1955 was one of the hottest summers on record in England and I found the outdoor activity healthy.

THE SURPRISE

Come September and I moved to 17, Gower Street, as a paying guest at a weekly charge of three pounds, thirteen shillings and six pence. I completed the course, sat the examination and passed.

I decided to go to Farnham in triumph, give a big surprise to the old lady and give her a present for Christmas, which was round the corner, to show her my appreciation.

To enhance the element of surprise, I decided not to inform her in advance.

I walked to 13, Menin Way from Farnham station, carrying the cut glass fruit bowl I had bought at Harrod’s, packaged in  Christmas wrapper and rang the door bell. Anandi came to the door and opened it. She looked gloomy and did not greet me warmly as

she always did. For a moment, I thought I had upset her and her mum. I told her the purpose of my visit, showing her the gift I was carrying.

“You are a bit late for that,” Anandi said. As my heart sank, she added tearfully: “She died yesterday at Farnham Hospital.”

“Died?” I wailed. “Died of what?”     

“Ruptured appendix,” she replied.

“Surely nobody dies of ruptured appendix in this day and age?” I said.

“It was an autopsy finding,” replied Anandi. “She was 88 and the diagnosis of appendicitis was far down the list of differential diagnosis. By the time the surgeon stumbled on to the correct diagnosis, it was too late.

The appendix had burst and had caused fulminating peritonitis. That is when I was rung up in Reading Hospital and rushed here. Her age was against her, her chest was very bad and the surgeon was scared that if he opened her up, he might lose her on the table.”

I paid her my heartfelt condolences, walked into all the familiar rooms in the house, where I had such a happy time with the old lady, gave Anandi the gift and sorrowfully walked back to the station.