About a year ago, I was unfortunate enough to break it to a twenty seven year old that he had cancer. He had just walked to the hospital with anemia. When we first asked for an OGD, we were just doing it as a routine test to rule out the underlying cause of the anemia. I had expected that the OGD would turn out normal; except it didn’t. He had a small tumor in the duodenum and a biopsy had been taken. It turned out to be an adenocarcinoma, with metastases to the liver which meant curative surgery wasn’t an option for him. As we sat with the oncologist to draw out his chemotherapy regimen and to just talk to him, I couldn’t help feel extremely sad for him. I was twenty seven and I hadn’t even started living. He had graduated from a teacher’s training college and he was yet to get a job (you know how hopeless our country is in this front). In the face of illness, his joblessness would fade into nothingness. Now he had to devote his life into fighting cancer. 2019 was particularly a bad year for Kenya. We lost a lot of people to Kenyan, in addition to all the “faceless” Kenyans we lost to cancer, there was Ken Okoth who succumbed to colorectal cancer, Bob Collymore who had acute myeloid leukemia and former Bomet governor Joyce Laboso. Today is world cancer day and in line with the theme, I want to do my own share of building the nation by sharing something on breast cancer screening. Screening is defined as the tests and exams used to find a disease in people who don’t have symptoms. The purpose of screening is to enable earlier intervention and management and in the case of cancer, to achieve cure Breast cancer screening The goal is to find it before it causes symptoms For women at average risk of breast cancer, they should be screened as follows: 1.Start a screening mammogram between age 40 and 44 every year 2.Women 45 to 54 should get mammograms every year 3.Women 55 and older can switch to a mammogram every other year or continue yearly mammograms
Women at high risk for breast cancer should get a breast MRI and a mammogram every year starting at the age of 30 You are at a high risk for breast cancer if you have any of the following: 1.History of breast cancer previously 2.Genetic mutations such as BRCA1/2 3.History of radiation therapy to the chest in childhood Clinical breast exams are not recommended for breast cancer screening among average risk women at any age It is important to aspire to prevent cancer and if this is not possible, then early detection is the next best shot if we are aiming at cure.
I have been seated across from this woman for four or five minutes now. I have been wording and re-wording the sentences I will say to her in my mind. It is an incredibly cold morning. Been raining all cats and dogs, and still, the skies are heavily laden with dark clouds. It is windless outside, but the relative calm is punctuated with the sound of thunderstorm from time to time. I can’t stop thinking that ‘I am cooking a storm’ for the young lady seated before me. She looks older than her thirty eight years. Must be the doings of cancer. Her once beautiful face is now just bones covered in a thin sheet of muscle and skin, with minimal fat.
She looks at me for the first time our eyes meet. I have been hoping that she will somehow read my mind, pre-empt my thoughts and save me from having to open my mouth and utter the very words. But there are no signs this will happen. So I clear my throat and look in the general direction of her face. She avoids my eyes and looks right past me to a point on the wall behind me. “It is stage four (b)”, I say. She sighs and focuses her eyes on mine. She frowns and I count five lines on her forehead. “surgery?”, she asks. “No”, I reply. Before I explain further, she stands up, unties her wrapper and re-ties it. She walks to the door then walks back to her sit and lowers her little self onto it. Today is one of her good days; she can actually walk without feeling dizzy, thanks to the multiple transfusions she has had.
There is a knock on the door as I lean foward to tell her more. Whoever is on the door shouldn’t have cared to knock in the first place. she lets herself in even before I let her in. Turns out it is the counsellor from the palliative clinic. I had been waiting for her. I am over- joyed. I quickly forget her bad manners and offer her my chair. I had briefed her about this lady. She will definitely do a better job than I have been trying to do. I leave her to it and quickly close the door behind me without as much as glancing behind me.
I let out air from my lungs once I step out. Didn’t know I had been holding my breath all this while. As I walk away, I can’t stop thinking about this lady. She will be lucky if she lives to forty. Cervical cancer stage four (b). It means it is no longer a local disease. The cancer cells have spread to the liver, and the spleen. The only option we have is to palliate her (add quality to her remaining days, not quantity). Send her for radiotherapy to reduce the local disease, take care of her pain and do serial blood transfusions. Sad, right? It is actually sadder when you think about her children who will remain mother-less thanks to a highly preventable and treatable disease like cervical cancer.
It is sad because women will experience symptoms up to one year, others two years before finally walking to a hospital. And why is that? You ask, it is because of fear. While some fear discussing ‘embarassing’ topics like vaginas, breasts, and sex, others fear being tested and diagnosed with illnesses like cancer, HIV and AIDS, and other sexually transmitted diseases. We all know a person or two who would rather die than be diagnosed with cancer. These are people who will never show up for voluntary screening and testing. For some weird reasons, they believe knowing they have a certain terminal illness will kill them faster. What they forget is that, the earlier some of these conditions are caught, the better for them.
Take cervical cancer for example, stage one is a totally treatable condition. Stage four is un treatable. The difference between stage one and four is just time. A person will be stuck in stage one cancer for a while before the disease becomes stage two, then three, then eventually four. While a few are lucky to be diagnosed with stage one disease, majority will show up three years too late when there is virtually nothing that can be done. Those who show up late will tell you that they feared coming early. And fear will be the cause of their death.
Men are worse off than women. First off, they are poor healthcare seekers. That coupled with the fear of the unknown will make them shy away from hospitals. That is why most of them will hide at home with their big prostates and only show up in hospital accident and emergency department in the wee hours of the morning when they can’t ignore the burning pain in their bellies thanks to retained urine.
I believe it is time we all took our health a little more seriously. Let us make use of all available screening tools. Let us have annual health check-ups. Let us make those decisions to lose a breast than a life early enough. Let us give up those problematic prostates. Because when we are dead, we won’t even need the breasts that we so refuse to part with in life. Or the prostates for that matter.
In my final year of med school, I remember standing at the assistant’s side during a breast-removing surgery, which is otherwise known as mastectomy. After removing the breast tissue, the surgeon asked me if I felt like crying. He had performed several such surgeries and from his experience, mastectomy is a surgery that irks females the most. I have seen diabetics refuse toe amputations. Men will do anything to avoid prostatectomy (a surgery to remove the prostate gland). It is not easy for a woman to sign that consent form that will lead to the loss of her breast(s). Even those women who undergo breast reconstruction surgery soon after mastectomy have a hard time deciding to undergo mastectomy. It is certainly harder for those who undergo the surgery only to spend the rest of their lives with one breast and a large scar in place of the other one. While some are able to go on with their lives without a care, life changes for most of them. Such surgeries don’t just change the way they look, they change marriages. Most women will spend hours before the mirror trying to make their padded bras to “work” with their outfits.
While most women undergo mastectomy once diagnosed with breast cancer, Angelina Jolie, a Hollywood actress had a double mastectomy to reduce her risk of getting breast cancer after testing positive for BRCA1 gene. BRCA1 gene is basically a ‘breast cancer susceptibility gene’. Jolie’s mother had died at age fifty six to breast cancer ten years after she had been diagnosed with the disease. Jolie stated that the decision to have a mastectomy wasn’t an easy one. She was however glad to have undergone mastectomy as that reduced her risk to develop breast cancer greatly.
Unlike Angelina Jolie, most women who undergo mastectomy in our set up do so for curative rather than preventive purposes. Most of them present when already suffering from breast cancer. This is either because of our poor health seeking behaviors or because of poverty or ignorance. As we draw towards the end of October, I would like to make you aware of some factors that may increase your chances of getting breast cancer. Women with these risk factors should visit their doctors for regular check-ups. Those with a high probability of suffering breast cancer should consider mastectomy early enough just like Angelina Jolie, because you are better off alive with no breasts than dead with breasts.
HERE ARE SOME RISK FACTORS;
Advancing age. The risk for breast cancer increases with age. Average age for diagnosis is fifty years.
No pregnancy. While pregnancy is protective of breast cancer, those who appear to be protected are those who get pregnant during their twenties.
Breast cancer in the contra lateral breastP. eople who have suffered breast cancer in one breast are at risk of developing cancer in the opposite breast. T hat’s why most people opt for a double mastectomy once diagnosed.
Family historyB. reast cancer tends to run in families. Daughters of mothers who have suffered breast cancer are at a higher risk of breast cancer.
Early onset of menstruation and late menopause. Onset of menses earlier than thirteen.
Late onset of menopause of later than fifty
Age at first delivery. If aged 30 years or older, relative risk is 2 times that of patients who gave birth when younger than 20 years.
Oral contraceptive pills.
Hormonal replacement therapy.
Cigarette smoking and Alcohol consumption. Smoking is actually a risk factor for several other cancers.
Exposure to radiation in the chest
NOTE1; while these risk factors increase the likelihood of suffering from breast cancer, they in isolation don’t cause breast cancer. People with certain risk factors are likelier to suffer from breast cancer than others. Case in question here is a family history of breast cancer. Therefore, people with these risk factors are advised to be extremely vigilant. Don’t forget to perform those regular self examinations on yourselves. Make a point of visiting a doctor for regular check-ups. If a suspicious lump is found during the course of these check-ups, have it investigated. Remember cancer, if found early enough is curable. When it comes to your healthy, be proactive
The procedure room is not technically a room, calling it a room is a misnomer. If you doubt it, then you can come and see for yourself. It is just a space with an examination bed that can be transformed into various shapes, three large bins; a red, yellow and a black one labeled highly infectious, infectious and non-infectious respectively, a white bucket containing a jik solution, and a large table holding stitching packs, an emergency kit, needles, branulas, syringes and bottles upon bottles of drugs. It basically contains a doctor’s paraphernalia. The ‘room’, is delineated from the rest of the ward by two almost blue or green (I don’t know colors) curtains that are stained by the brown of rust. The curtains only cover the front part, the part where people pass when they want to get to side A of the ward, or to the nursing station or the doctor’s admission desk. It is open on the part that faces my bed.
The bed next to mine is occupied by a small boy, about fifteen. He walks around wrapped in two lesos, with blood trickling down his legs, discoloring the tiled hospital floor. You would be forgiven if you asked him, “why don’t you get a pad for your menses?” but he is a boy. His bleeding is a result of circumcision gone wrong. The doctor, the big one says that he needs to be referred to a bigger centre, like Kenyatta National, otherwise, he will bleed out all he’s got( God grant him life). He has hemophilia, hemophiliacs should NEVER be circumcised.
I have been here for six weeks, six and a half days now. When I look to my left, my eyes lock with those of the young man. It is boring watching him. He is so young, and helpless. He should be in some forest picking berries, or herding cattle, not seated in hospital thinking about life. But now he is stuck here, his old man cannot afford the money to transfer him.
When I look to my right I see the whole procedure room. Sometimes, there is nothing going on in the procedure room. Sometimes I look as doctors suture (fancy name for stitching) patients. Other times I see them inserting their index fingers up the anuses of old men with large prostates, I watch as they close their eyes trying to estimate the real size of the damn prostate, and finally as they withdraw the finger and give it one long look, to see if it is blood or stool that stains their glove. Watching, you would think they enjoy doing it. I see as the nurses dress the young man who is burnt all over his body. I listen to the way he keeps screaming as layer after layer of gauze is brought out of his body. I hear the way the nurses tell him to behave or they will leave. I hear the “shit” of the nurse when he accidentally steps on her. I even heard when one nurse told him, “but I never sent you to steal”. So he is a thief, he could have died, he didn’t. He cheated death. I always close my eyes as the last layer of gauze is pulled off his body. His screams become continuous at this point. I guess real tears flow down his cheeks. I never look until after twenty minutes when the last layer of gauze is being applied.
The air is no longer acrid. The tablets don’t even nauseate me these days. I am used to the retching, and the bilious smell of vomits. It is not cold any more, not even when windows are left open. I have learnt to ignore the dark tall nurse who acts as if she is in her periods forever. I have stopped feeling ashamed of my frame. I have resigned to the fact that I no longer have dignity. I don’t even tell people about four years ago. I don’t tell them that once there was fat and flesh under my cheek bones. I don’t even tell them that there was a time when my collarbone couldn’t be felt let alone being seen. I don’t even bother to tell them that once, my ribs were deep inside me. I no longer have a private part. The doctors have seen my body as many times as I have seen it in these four years that have passed. I don’t find it shameful to be stripped in front of thirty pairs of eyes. I have become used to the fact that I am special. I don’t squat to poop. That, I used to do four years ago. I miss walking to the toilets. I miss sitting on the toilet seat; I miss flushing water down that seat. I no longer use my ass hole. Colon cancer took that away from me as well. The surgeons said I had an inoperable tumor. It was too large that it blocked the intestines. That explained the long, long calls that I used to have before diagnosis, and the bleeding per rectum. I didn’t know. I should have sought treatment early, when the tumor could be operated.
I don’t know how I never thought about cancer. My grandfather had colon cancer. He even died of it. It should have been a learning process. It wasn’t. We buried him and thought we were done with cancer. “But these things run in families,” I remember a young doctor telling me. I wonder why it picked on me, at twenty. It stripped away my youth, the fat from below my cheeks and all my dreams. I wonder why it came again after claiming my maternal grandfather. Why it came when my life was just beginning, when I was just waking up to live my dreams, when I was plunging myself to the business of living. I wonder why it is claiming me this early, even before I leave any seeds here.
Every time I fall asleep, I just want to wake up and live. I think of all the dreams I had and tears drip down my face. I have spent a fair share of my cancer life in hospital. I no longer feel the pain of the injections. I should be used to the hospital by now, it has been my home for long, long enough to last me another life time. I am used to the sighing of pain, and to the cries of distress. I even don’t mind the attitudes of the nurses and the cleaners and the doctors.
The cancer has been progressing over the four years, in two years it had already spread to the liver, making my eyes yellow. Over four years, it has converted me from an independent man to almost a toddler. The change has been a drastic one, but now it has paused. Now I am suffering the effects of radiotherapy. I got a perforated gut and fecal matter dripping from below my umbilicus. I have lived for three weeks on some fluids but no food. I have not been able to move. The doctors don’t know what to do yet. Miraculously, the perforation stopped draining, and I am eating again. A lady from the palliative care came to see me and we talked about end of life. I am reading two leaflets now, entitled light and darkness, they are about heaven and hell.
I know where the journey comes to a close, but I still hate the sound of a trolley being pulled over concrete. I hate the masked be-gloved men in green. I hate the way they look and how they handle the dead. I hate fridges and I don’t want to be in one any soon. I hate yellow and white roses. I hate my mother’s tears, and my father’s long depressed face. I still want to drink my mother’s home made carrot juice. I still want to be held. I want to watch one more sun-rise. I am not ready yet. Heaven please, wait. I will be on my way soon. Grant me another day God, that I may see the white that’s my mother’s teeth one more time. Until then, it is not over yet.