Cancer Sucks (warning – graphic pics)

I’ve been thinking a lot about cancer recently.  One of my good friends and former nurses, Tammy, was just diagnosed with breast cancer.  I know that diagnosis is devastating to receive.  I know that it changes your life forever.  I also know that in Tammy’s case she should do just fine.  She found it and immediately had the right testing done, quickly saw a fantastic breast surgeon who performed the needed surgery, and will next have radiation therapy.  Her insurance paid for these critical services and her chance of survival is near 100 percent. And THAT is good news!

The news in Africa, and what I’ve seen here, is not as good.  In America I mostly dealt with finding breast cancer and referring them to our amazing surgeons.  If I found other gynecologic cancers they were usually referred to one of our specialists to receive care.  I always knew that my patients were in the best of hands.  I knew that my hands were not trained to deal with these cancers, especially the advanced ones.

Here in Ethiopia I’ve been repeatedly challenged in dealing with cancer.  And many times it’s very advanced and there’s nothing I can do.  In other cases I’m forced to deal with these cancers to the best of my ability, and many of those cancers have been extremely rare types.  I couldn’t do this work without the expert advice of one of my friends in Birmingham: gyn oncologist Monjri Shah.  I’m literally texting her every couple of weeks with multiple questions and for advice.  She is making this possible here for me and I’m so thankful for her!

 

One patient was a sweet 19 year-old young woman from a very rural tribe near the Kenyan border.  She had been bleeding and had noted a mass for over a year.  I took her to the OR to examine her and I found a tumor that I had never seen before.  It filled the entire birth canal and looked like clusters of grapes.  It was a cancer called sarcoma botryoides – I had read about it medical school and residency but had never ever seen a case of it. Her only chance of survival was to go to the capital for further surgery and chemotherapy.  Whether her family actually took her and arranged for her care I will probably never know.

 

 

A second patient was this precious 30 year-old woman who had very large benign tumors called fibroids.  These are very common here and can lead to infertility, pain, and heavy bleeding.  During her surgery I discovered another growth – again one that I had never seen before.  We biopsied it and it revealed another rare and aggressive cancer of the lining of the womb.  I called her family to have her brought her back in for further surgery which she desperately needs but she is declining surgery and praying for God to heal her…

These were the benign tumors – the deeper tumor we found was cancerous

My most recent patient is an equally tragic case. She’s a wonderful 28 year-old woman who is 19 weeks pregnant.  She noticed that her belly was more swollen than it should be and came to see us here. We found a lot of fluid in her abdomen (called ascites), a mass in her pelvis, and a blood clot in her neck (I’ve NEVER seen anything like this before).  We took her to the operating room where we found that she had very advanced ovarian cancer.  Her prognosis is VERY poor and my current hope is that she will survive long enough to deliver a baby that is able to survive.  Even that may not happen.  The odds are against her.

A rare ovarian cancer in a pregnant patient

These are absolutely heart-breaking cases.  It’s even harder because… in most cases I can’t even tell the patient what is going on.  “What?!?!” you are saying to yourself.  Culturally here, if there is bad news such as cancer, you tell the family members but not the patient.  It’s up to the family to share the news with the patient.  When I told my pregnant patient’s husband about his wife’s prognosis, he told me I could not tell her.  He did not want her to give up hope.  In America this would obviously never happen.  But here, this is the cultural way that this is handled and I must respect that.  I may not agree or understand, but it’s not my place to violate this cultural practice.

One other unusual thing here is that the families want to literally see the tumors that we remove.  Not a picture – the ACTUAL tumor.  So usually at the end of the case the OR tech will carry the tumor out to show the family as I explain what we found, did, and what to expect.

We initially thought this nearly 20 pound tumor was benign – but it turned-out to be cancerous and after some additional surgery she is cancer free!

So between doing surgeries on cancers that I would never do in America, respecting a culture that I’m still learning about, and dealing with rather limited resources, I’ve had my hands full here. Simply trying to do the best I can with what I have and showing the love of Christ to all who enter our gates.

Please pray for these patients that I’ve mentioned as well as the others that I’ve not shared about yet.  And pray for Tammy too!  She would appreciate it!