Love in the face of cancer

The 60 days of January are finally over and we can all take a moment to exhale! The month of love is here and despite the difficult economic times, the mood is beginning to change as the warm spirit of Valentine’s day peers around the corner. This Valentine’s day, I choose to celebrate love in the face of cancer.

Mid-last year, I received a call from a gentleman who introduced himself as Samuel*. He indicated that he had been referred to me by his doctor. He wanted to schedule an appointment for his wife, who needed a gynaecological review. She would travel from the farm to Nairobi for the consultation.

A week later, the middle-aged couple arrived at my office. Samuel accompanied his wife into the consultation room, introduced her and explained that she had been seen elsewhere with general complaints and then referred to a gynaecologist of her choice. He presented all her medical reports and begged to be excused as he had to attend to work. He promised to come back later to pick her up.

Lucy* was extremely shy but such an open and easy to talk to person. She was quite apprehensive of what her medical reports might mean. I took a moment to go through them and they all seemed alright, except for an ultrasound scan of her pelvis. This scan had been done three weeks before and indicated that Lucy had a solid mass in her cervix, but everything else looked alright.

I asked Lucy to walk me through her history. She had developed what sounded like hot flashes with heavy night sweats over the past several months. She also reported developing painful, heavy menses, though they remained quite regular. This is what prompted the clinician who saw her to order the scan.

From her history, and most certainly her age, Lucy was seemingly manifesting perimenopausal symptoms at 49 years of age, which may not have warranted an untrasound scan, but thank God for it, our attention was now drawn to a potential problem.

I explained to Lucy her predicament with regard to menopause, which greatly put her at ease, but this did not last long. I did have to talk to her about the cervical mass and its potential for highlighting a more menacing possibility of cervical cancer. The description of the mass did not classically sound like a cervical malignant tumour but it was the most life-threatening, hence until we ruled it out, there was no way we could breathe easy.

After a thorough examination, the findings did not quite point to cancer. The cervical mass was present but was actually in the core of the cervical wall. Unlike most cancers that are usually originating from the surface of the cervix and growing outwards like a cauliflower, Lucy’s was a firm rubbery mass covered with smooth, intact cervical mucosa. It appeared more like a cervical fibroid than a cancer.

Lucy’s fear was back, gravely heightened. She looked so small and scared and it broke my heart knowing we had to discuss such serious medical matters in the absence of her husband, who obviously appeared to be her rock. We spent the next hour trying to reassure Lucy and give her hope on the way forward. By the time her husband came back, Lucy was regaling me with her childhood stories and why she spoke three native languages fluently, yet could not speak her own mother tongue. She was calmer and could now focus on the next steps that required to be executed with urgency. Samuel took the news stoically like men do when they must remain standing while everyone else is crumbling. He knew his wife was sorely depending on him for support and he could not afford to let go of his emotions.

Lucy was scheduled for further evaluation with a biopsy of the mass, imaging and lots of blood tests for surgical preparedness. The gynaecological oncologist was brought on board and it was all systems go. The biopsy still did not confirm cancer and the imaging showed no signs of cancer spread. A decision was taken to proceed to surgery and treat the mass as cervical cancer anyway.

Lucy underwent radical hysterectomy, losing her ovaries, uterus and cervix. Well, at least she no longer had to worry about heavy, painful periods! The organs removed were all sent to the pathologist for a proper confirmation of what the mass was. We kept our fingers crossed for the next five days while the pathologist worked his magic.

On the day Lucy was due to come for her post-operative review, her husband took the afternoon off from work. We all knew this was the day of reckoning. The report came through and there was no easy way to say it. It was confirmed that the mass was indeed cancer. The good news was that it did not appear to have spread beyond the cervix!

Amazingly, Lucy was less frightened than the first time. She simply looked at her husband and he squeezed her hand; a silent communication that they were in this together till the end. Lucy opted to go back to her farm and complete her post-surgical recovery before the next phase of treatment, chemotherapy and radiotherapy.

 A more confident Lucy came back six weeks after surgery, ready to proceed with chemotherapy. While she was away, Samuel came by so that we could handle the money matters. He knocked on doors until Lucy’s private insurance granted preauthorisation for her treatment. I reached out to my favourite oncologist and briefed her about Lucy.

She gave guidance on how to schedule Lucy into the radio-oncology unit for her radiotherapy and chemotherapy as soon as she was ready. For 25 days, Lucy attended her radiotherapy sessions, escorted by her husband. His commitment to this journey was above board. He took her to the hospital by 6.30am and waited for her session to end. He then took her back home before starting his own workday. He was the one who updated me on her progress every week. He cared for her himself, never once asking for help from anyone, despite the fact that he could easily get the help of their adult children.

Today, Lucy has been given a clean bill of health. She will remain in care, with frequent visits to the oncologist for the next five years to ensure she crosses the finish line, but she is certainly back to her normal life. I was exceptionally thrilled to hear her voice in the new year, telling me that she was visiting her friends in the neighbourhood like the past year didn’t even happen! May this Valentine’s day be dedicated to couples who truly live by their vows, for better or for worse!

Dr Bosire is an obstetrician/ gynaecologist