For most people, the word tumor is synonymous to cancer: the diagnosis of which is likened to a ‘gift’ delivered from the grim reaper himself, with not-so-much love. Medical truth however suggests otherwise. From it, we know that benign and malignant tumors exist. It is the malignant ones that most doctors dread: and the doctors who (as it seems) don’t are called oncologists. I wouldn’t wish a malignant tumor on my worst enemy, nor advise them to pursue oncology. The latter is indeed (and infamously) the most depressing specialty in medicine, reasons behind this being rather obvious. Some encounters with malignancies however, are worth recounting.
Now, for many a student there are those moments when your conscience tells you that you would rather sit out a class than attend and let yourself down. This happens to me sometimes: after all, some classes can be quite a task! On this particular day, I was with a close friend of mine. We made our way to the hospital’s casualty where after entering the consultation area, a familiar voice caught our attention. It was one of my good doctor friends who I am tempted to describe as follows. He is an ample guy; indeed, an aspiring epitome of the consequences of unhealthy eating. He is a jolly one too; often punctuating his sentiments with billows of chesty, heartfelt laughter. He even lightly comments how the KNH Trauma department is a refuge center for thugs whenever we assist him in the minor theater. In essence, he has a contagious personality- an infrequent thing from a doctor working in this particular hospital.
He beckoned us into his consultation room.
There, we found a half dressed sexagenarian lady on the examination table. Many similar scenarios had trained us to put professionalism and deep respect for the patient before shyness or lad-ish mischief. Our host immediately got to work on our now eager minds. He pointed at a swelling on the lady’s right loin, asked us to examine her and make a diagnosis. My friend and I asked for consent then got to work- inspecting keenly for color changes, deformities, scars or swelling then palpating for tenderness, lymph nodes, edema and any other notable things as per protocol. All we detected were the inguinal lymph node swellings the doctor had earlier pointed, a mildly edematous right leg and a dark, irregular patch on the heel of her foot on the same leg. The patient was not in pain. This, in our naïve minds was puzzling.
We got to thinking and mumbling guesses that sometimes screamed loudly of our ‘ignorance.’ The doctor however exuded a fatherly sense of patience. He guided and probed us further, merely asking us to dig deep into what I would consider our ‘shallow lakes’ of knowledge. In a last and almost desperate attempt, I uttered- ‘Melanoma.’ He smiled at me, a gesture which he complemented with a solid affirmative ‘YES’. At last I had gotten it. He then produced a chest X-ray of the same patient. Her lungs’ morphology was uneven with rounded zones of what the doctor told us were metastases. I then turned to the patient, curious for a brief history.
Her foot had started hurting five months earlier as she was working on her farm- a pain which receded after a short while. It was only after she had experienced repeated episodes of coughing that she sought treatment from a local healthcare centre; a journey which ended at our teaching and referral hospital. She was not in pain. However, her body was now an unwilling host to a fast spreading, inconspicuous yet lethal tumor- a malignancy called Melanoma. We let her dress as I exchanged ideas with my classmate. And when she rose to receive her documentation and advice from the doctor, I trained my eyes on her yet again.
She was a simple country woman. Her headscarf had slipped further back now perhaps from her prolonged recumbent position on the examination table. Her hair was jet-black, plain and kinky, few streaks of grey standing out augmenting the subtle creases on her face. Her eyes were sunken, whether because of worry or the disease creeping upon her- I couldn’t quite tell. There was a slight aura of hope on her demeanor though. This hope, I thought, was founded on ignorance. Her lack of knowledge about her current predicament was her shield; a weak one, but a shield nonetheless. As expected, her body looked fairly healthy: save for the X-ray images we had just seen. Our conclusion; she was sitting on a ticking time bomb. Prognosis is guarded.
I pitied her. Deep down, I wanted to give her the benefit of doubt. But I knew a tad better. If not by the disease, chemo-radiation and depression would take its toll on her. There was little chance that she would live through it. The outcome however is always in the hands of a Higher power. Having learnt something new though, we left hoping that whatever her fate was, she would dig deep into her soul and find the courage to face it all.