May 22, 2014

A touch of feelings too close to home

This morning my friends and I went to SCOG (Specialty Clinic of Obstetrics and Gynaecology) in order to observe the doctors working there and as well to learn cases from the patients. So we went to find Dr B who is known to be friendly to medical students and he himself is a specialist anyway so it's only proper to tag along his consultations.

What I did not know at that time was that he is a gynaecology oncology specialist, meaning that he is specialized in dealing with cancers of woman's reproductive organs (uterine, cervical, ovarian, etc.). So the first patient that we saw was the one my friend clerked outside in the waiting area. She is an elderly lady, 55 year old I think and already had her menopause 5 years ago. She was internally referred to the specialist by the house officer in the ward of the same hospital because of her post menopausal bleeding.



Now, when women had menopause they don't normally have bleeding coming out of the vagina because the only time bleeding is normal in women is when they are menstruating. Simple enough, right. So because she has per vaginal bleeding, that is of great concern.So they did speculum examination and made a swab I think and they had a biopsy of the cervical tissue to know if there is malignancy in the cervix. The results of the investigation came out three days ago and it was confirmed that she has stage IIb cervical cancer.

So you have to imagine the scenario I was in. We were standing at an angle behind the doctor's back, and the elderly lady was sitting in a chair beside the doctor's desk. There's a chair directly opposite the doctor where the relative of the patients normally sits. She came in here alone, the door was opened, and the doctor was reading the referral notes about the results of the investigations.

He began by asking questions about her life; does she have a job, how many children, where are they, etc. and I have an inkling that he was trying to make rapport with the patient. It was not easy, I tell you. Try imagining reading the results: You know she is confirmed to have cancer. She doesn't know it. She's circling her thumb over a small piece of paper clutched in her hand over and over and over. The doctor started by telling her that "the results are back, and it is not a good one." Imagine that please. Imagine you are her.

Then the doctor asked where is the husband. She said he's outside somewhere, maybe in the cafe having a coffee. He called for a nurse and ask her to call this lady's husband. In my opinion this is the right way to break a bad news. I'll tell you why in a moment.While waiting for the husband the doctor will continue to write report about the progress of the consultation. Still no husband coming. Then an MO (medical officer) came by the door and ask for an opinion about a patient. A quick answer of what to do and who to call was given by the doctor. And throughout the time I was looking at the poor old lady who was getting more and more agitated about the nature of the 'not good news'.

Now please understand what I must be feeling at that time. I already know what is wrong with her. She still doesn't know. She is getting more scared by the moment. Her back was hunched, her face was lined with worry. Her gaze was at the floor. She did not know what to do with her hands, so she hold that crumpled piece of paper like a lifeline that she couldn't bear to get away from.

Then the husband came. And the doctor began telling him, softly and slowly, of what is wrong with her. She has a cancer of cervix. He took out a diagram of woman's anatomy and showed to them where is the cancer and how bad the situation she is in. I guess by the moment the doctor mentioned the word "barah" she went blank already. I can see that from the look of her face. I know that look. Her husband was there listening to the doctor and I guaranteed you that she is listening to none of that.

I think the doctor already know that that is going to happen. He is not stupid. He is not cold-blooded. So he took it upon himself to explain the whole thing to the husband instead to the one who actually has cancer. But he gave her a few chances for her to ask questions but like I said, she is gone already. No one can blame her: That is a shock that not all can bear and few can overcome. But she said nothing and just sat there.

The husband was a bit talkative. It's a given as that is one of the ways to cope with bad news. You ask questions. You ask how long does the doctor think the cancer is already there. You ask what is the cause of the cancer. You try to justify yourself by telling doctors that you never go to see a doctor for the past 20 years. You are always healthy, so there is no point in troubling doctors to have a check up to see if they have diseases or anything. And that is what saddens me. That they didn't bother to have an annual medical check-up. That she didn't do pap smear to screen for cervical cancer. It makes all the differences in the world. A stage IIb cervical cancer has a prognosis of 50% and the treatment left is radiotherapy. If she did pap smear and they detected the cancer early, her vagina can be saved and she would be in stage I where prognosis can reach up to 85% and the treatment includes surgical intervention that can brings cure to the cancer.

This scenario made me sad because when I looked at her all I see is a mother. A mother having a cancer and too shell-shocked about it. A father who tried to be brave for her but had ruined it when he left her all by herself early during the consultation. A doctor who was responsible to break the bad news and being reminded again and again this is all can be avoided if adequate education about the importance of pap smear screening program is present to the public.

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