I work as a general surgeon and being a woman in a part of the world which is still very conservative, my patients are mostly ladies. A large number of these patients are those with breast cancer; each person with a different story to tell, and behind every story, a different reason.
As a woman, one can easily empathize with these patients, and one tends to listen to their stories: financial constraints did not allow them to seek treatment; the children had exams; they were waiting for the harvest; a daughter has to get married. Women tend to put their families first, and in doing so, often suffer in silence. For those living in more affluent and developed societies, this may be hard to comprehend.
The next few words are about a conversation that I recently had with a 25 year old, final year, female, medical student. The father, an educated man himself, insisted that he introduce his daughter and that he would leave and wait in the adjacent room whilst I examine her. I thought it best to allow him to speak as I could see that he was extremely proud of his daughter, especially that she had made it to medical school despite all the odds.
The young lady was extremely beautiful. She belonged to the valley of Swat; the region where Malala Yousufzai hails from and the region to which I, myself also belong. She had a lump in her breast, which she had been too shy to disclose, though she is a medical student herself.
As I examine her, she comments about how breast lumps are often benign in her age group. My clinical assessment suggests the contrary but I do not comment. She undergoes imaging and a biopsy is scheduled.
The report finally comes. I read and reread the words of the report, hoping I have misread it. The cruel words stare back at me: Invasive Ductal Carcinoma, Grade lll…the next day she comes for the result. We talk about the diagnosis. I stop now and then, looking at her for signs of grief or disbelief…she remains unfazed.
"Dr Khan. I've always won, I shall get through this too."
I can feel the steadfastness in her words, the defiance in her eyes, and the courage in her attitude. I must say that such rare behaviour can be helpful for the clinician too, especially in our role of psychologically helping the patient; here there are no breast care nurses like the ones I worked with in the UK who make the task so much easier.
I moved on to discussing the need to see how far the cancer had spread. Further investigations and more bad news. I see the reports and it seems that the cancer had been in a hurry to spread its tentacles. Let me confess, there are times when I wish I could hide from such emotionally draining situations. I dread the day she has her next appointment but it has to arrive, and arrive it does. I walk into the room where she is seated and anticipate fear, disappointment and tears, as I disclose the extent of the disease to her.
She is alone. There is an uncomfortable silence and then she speaks: "Dr Khan, I have two choices. Either I cry in a corner and feel sorry for myself, or, I get up and fight it. I choose to fight it. I will get through my final year exams. I will do my training. I will specialize just like you. Just do me one favour. My father is going to ask you about the extent of my disease. Please do not tell him. I cannot bear to disappoint him."
This is where I stood some years ago. She tread the same path, neared the end of formal education, ready to take on the world, ready to go into a specialty. We were destined to take different paths thereon. Her dreams would not be realized. Cancer had struck when it should not have.
With this, she gets up, gives me a hug, opens the door and calls in a voice that remains unfaltered: "Father…"; her words continue to echo in my mind. She had taught me so much in such a short time.
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