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I am a big fan of Angelina Jolie. So what is the big deal about it? Half of the human race is possibly her fan..her looks and her acting prowess has had the world swooning. I am her fan for a different reason. I haven’t followed her movies, her drop dead gorgeous looks or her personal life but I admire her for her courage. Some years ago, this remarkable lady announced to the world that she is having both her breasts removed. She knew that she was carrying a genetic mutation which made her susceptible to breast and ovarian cancer. Her family history was strong for both breast and ovarian cancer and once she tested positive for the mutation, she knew she carried a 60-80% risk of developing either of these cancers. She was faced with the prospect of prophylactic breast and ovarian surgeries. I can only imagine the sleepless nights, the battle within-to do or not to do, several rounds of long discussions with her doctors, family and friends, the impact on her career which relied heavily on glamour, her children... and so much more. And then she made that decision to have both her breasts removed and subsequently her ovaries. She shocked the world but at the same time catapulted herself to that realm of courage and fortitude that rarely people of her standing dare to tread. I joined her fan club and her story of courage became the benchmark for women caught in a similar situation. Why I recalled this story was when I encountered my own Angelina Jolie. This young lady of 35 had a very strong family history of breast, ovarian and colon cancer on her maternal side.Her husband was gutted when she was diagnosed with breast cancer. I advised her for a genetic consult while planning for her surgery. The genetic consultant had barely advised her gene testing and was discussing the possible implications, when she said that she had made up her mind. She very calmly told the consultant that irrespective of what the test says she was going ahead with bilateral prophylactic mastectomies and bilateral ovarian surgeries in the same sitting. She came to be and conveyed the same to me. It shook me inwardly and took me a while to gain my composure as her husband stood by her, rock solid in his support of her decision. ‘COURAGE’ as a word probably does not do justice to the tenacity with which one arrives at this supremely difficult decision. I have done these surgeries before and this one was certainly not the last. Such decisions are rationalised within the multidisciplinary board, the molecular oncologists, the psychologists, the family and most importantly, the patients!! While I see more of these Angeina Jolie clones, I will always hope and pray that these amazing ladies’ decision translates into long, meaningful and inspiring lives!
Breast cancer is not a battle that is fought alone, if the goal is to win. Victory comes to those who are supported by family, friends, doctors.....and a positive attitude.
I was brought up in a middle class Malayalee family, extremely open minded about education ( like all Malayalees) but as close minded about display of any form of affection. I used to envy my north Indian friends when their parents would hug and kiss them, completely oblivious to being watched. It came naturally to them. By just watching this momentary expression of affection, I used to be suffused by an inexplicable feeling of warmth and also experience a certain positivity percolating into the environment. This seemingly innocuous expression of many positive emotions... love, kindness, a blessing, a prayer, gratitude, healing... came to be extolled as ‘Jaadoo ki Jhappi’ in Munnabhai MBBS. While I always believed in the magic of Jaadoo ki jhappi, it is my patients whose firm belief in its power to heal, that made my belief stronger. I don’t know when, but it has come to be a usual occurrence for my patients to walk up to me and almost ‘demand’ their Jaadoo ki jhappi. The awkwardness of my childhood has given way to the concerted belief that it does good to both the giver and the recipient. And that brings me to my dear Champion, Mrs C who spends time between Australia and India. She is having her regular checks post breast cancer treatment in Australia.She was here last week and waited for a couple of hours in the Outpatients for her Jaadoo ki Jhappi.And I was only too happy to oblige. If she believed it was healing for her, it was for me too! Isn’t it true, the more you give, the more you get?
Yesterday I visited my niece and was on the phone talking to my patients, sorting things for them. When I finished, she asked me, ‘Isn’t your profession stressful?’ I was quick to say NO. The conviction in my tone has taken many years to come. I recall my early days as an oncologist and in particular, this vivacious young lady who had a relatively advanced colorectal cancer with involvement of her ovaries. She had undergone surgery elsewhere, 4 weeks prior to coming to our unit. Her abdominal wound lay open and was pouring out fecal matter and abrasive intestinal juices, consuming her skin.I could not come to terms with the unfairness of the situation, then. Why was this young lady with the most sparkling, hopeful eyes dealing with this horror? I wanted to pull her out of this mess and diligently did my best to improve her nutrition, take care of her wound and her medication. She and I would talk a lot- her dreams, her aspirations, her twins, her loving husband, her family...we became good friends! Her surgery was planned and executed well. She was recovering well and she wanted to be home to celebrate her twins’ birthday. I assured her she would. And then that day arrived, when she walked. She walked for the first time after 8 weeks. I was thrilled and went home thinking she would be out of the ICU the next day. I was going up to the hospital the next day when I got a call that she had had a cardiac arrest. I thought I had heard wrong. I ran up to the ICU and before I reached, she was gone. Pulmonary embolism had taken her away. I was distraught and I cried, rather howled, like I had lost one of my own.An elderly physician put an arm on my shoulder and said, ’ This is certainly not the last time you will have to deal with this. Don’t get attached to the outcome of what you do. Do your best but remain detached from the outcome’. Those words have stuck and I have grown since. My focus is entirely on what I can do for the person who sits across the table and entrusts his or her life to me. I do my best to understand the problem, execute treatment, handhold them and try and do whatever I can to make the experience as seamless as possible. Cancer outcomes are never a 100%. You do lose some at the end of the day but if I have contributed to making their life easier through their suffering, I have done something worthwhile. While it is easy to be overwhelmed by these difficult situations, I need to remain detached from them so that I can do more for those who need help. I have come a long way since, but it is not as if I am not affected by what happens to my patients, anymore. It is just that I have taken better charge of the emotional me and replaced it, not entirely, with the professional me!
WOMEN SHOULD BE ALLOWED TO MAKE THEIR CHOICES.............. I see a lot of lady patients in my practice since I deal with breast cancer and other breast related conditions all the time. What has struck me as the rule rather than the exception, is that, women don't have a complete say in matters dealing with not just their breasts but their life.....whether she should keep her breast or sacrifice it, whether she should go for chemotherapy or not, how much should she be told about the disease etc. etc.The people involved in these crucial decisions involve men ranging from a husband to the father-in-law to a second degree male relative or sometimes even an 'educated' male neighbor. Women empowerment is the only answer....her issues are her own, her body, mind and intellect are all her own.Only she must be allowed the right to decide what is good for her, with gentle gestures of support from her immediate family.
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