He left his wife when cancer arrived ... then karma struck

I have often mentioned in this column that before I claim to be a breast specialist, I spent two weeks at Karolinska Institute in Stockholm, Sweden to refresh my knowledge about breast surgery. During the first week, I sat at the feet of Prof Einhorn, a world-renowned oncologist, especially breast cancer.

I passed the second week in Gavle to study the structure of a breast clinic with Prof Norin, who had started the radiotherapy unit at Kenyatta Hospital. When I inaugurated the very first ‘Breast Clinic’ in Nairobi, I realised that there was dearth of data about breast cancer in Kenya.

At my teaching outpatient clinic at Kenyatta, I therefore asked questions pertaining to risk factors associated with the disease.

The questions related to family history, age at menarche and menopause where applicable, age at first pregnancy and breast feeding. I added one question of how women discovered the painless lump in their breast. The reply to this question was interesting and sometimes amusing. Although most women found the lump while bathing or showering, others felt it when assessing the damage after knocking the breast and perceiving pain as a result. Some bashfully confess that it was discovered by their husband or boyfriend. Apropos to this, I recall the poignant case of Avril, who came to see me complaining of a lump in her breast. In my history-taking I asked her my usual question. “How did you find it?”

Grim news

She candidly replied. “I didn’t.” Pointing to her husband, sitting beside her, she added. “He did!”

When I finished examining her, I gave her the grim news and said. ”Of-course we will do a confirmatory core biopsy but my clinical impression leads me to believe that you might need a right mastectomy.”

Based on her knowledge derived from the internet, Avril said. “I know that in some cases, you do lumpectomy and leave the breast intact.”

“Sorry,” I replied “Your lump is too large and you have enlarged glands in your right axilla. In our present knowledge, these two factors contraindicate a lumpectomy. Preserving the breast might endanger your life.”

The husband intervened at this point and said. “Life is more important than the breast any day.’’

That beneficial intervention settled the argument and Avril underwent a mastectomy and clearance of her right axilla. Both went off very well except that the glands were involved, a fact which did not surprise me.

I was surprised to see Avril looking gloomy at one of her follow-up visits after she completed her chemotherapy and radiotherapy courses. I said, ” You have been a breath of fresh air usually, but today you seem a bit sad. Please tell me if I am a good mind reader and if I am right, kindly tell me what is ailing you if you don’t mind.”

Sad saga

“You are a good mind reader.” Replied Avril. ”I will tell you the reason because you might be partly responsible for it.” As I waited with baited breath, Avril continued her sad saga. “Ben has not touched me since he took me home after my mastectomy. Initially I thought that though he encouraged me to have it, he had not come to terms with it. He had not accepted a flat scar, where he used to see a soft bulge. Then I realised that my disfigurement pushed him into another woman’s arms.” As I sat there shocked, she dropped the bombshell. “Ben came home last night and announced that he wants a divorce and freedom to marry the woman who has won his heart.”

I knew that I was facing a fait accompli and therefore changed my tack and said. “There is a lot more fish in the sea and you are an attractive young lady. If you feel that Ben could not accept you with your right breast missing, this new man in your life will start with one breast being absent and ‘what the eye does not see, the heart does not grieve for’.”

In time, the equation was solved; Ben married again and Avril found another husband. The day he proposed, Avril rang me and sounded happy on the phone. When she finished giving me the good news, I only had one question. “Does he know and has he seen?”

“Both.” Replied Avril in her cheerful manner. “Things have changed. Nowadays, both partners want to see what they are committing to!”

In time, wedding bells rang for Avril and Mark, her new husband. I wish, I could end the story here with a traditional end with two weddings. But life is obviously more complex.

Urgent appointment

Six months later, Ben rang me to say that he wanted an urgent appointment for his wife. On me asking what it was all about, he was cagey and replied. “Will tell you when I see you.”

That evening, at the end of my scheduled breast clinic, my secretary fitted in Eunice, Ben’s new wife. You could have knocked me with a feather when Eunice started to tell me her tale of woe. At the end of my clinical examination, I could have been brutally frank and could have said to Ben. “New wife but old disease!” I didn’t. Instead, I was very sympathetic and repeatedly said to Ben what I had said to him when he brought Avril with a lump in her right breast. In my shocked state, I even forgot to ask Eunice my standard question; how she had discovered the lump! I was simply flabbergasted by the similarities in the two cases.

Even the treatment remained the same — right mastectomy. A naughty thought floated through my mind; poor Ben will have to get used to a scar instead of an erotic bulge on the right chest of his wife.

As I drove home that evening, I could not get Ben out of my mind. Was it a random roll of the dice or divine retribution? Neither, I summed up, it was a sign of divine wrath!

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