It
was getting close to the end of the outpatient line on Friday afternoon. As I called for the next patient, a 17 yo
teenage girl slowly got up off the waiting area bench and hobbled towards me
down the outpatient hallway. Her mom
walking on her side, trying to offer some support as she made my way into her
exam room. I asked what was wrong and
the girl said her leg has been swollen and hurting since July. Their attempts to go to another hospital
resulted in a supply of medicine and delays to see a surgeon, so they came to
us.
She
gingerly made her way up to the exam table and I started to examine her
leg. The firm hard mass I felt under my
hands in the middle of her femur told me this wasn't good. The other hospital thought this was an
infection of the bone, but after touching her leg I knew an infection of the
bone would have been the best diagnosis we could hope for as I feared something
far worse.
I
feared that this young teenage girl, who was about to sit for her grade 10
exams next week, who seemed was very articulate, and had lots of hopes and
dreams for her future, had cancer of her leg that might just shatter her dreams
of tomorrow. I didn't say much, but I
asked them to go get an xray of her femur.
The xray confirmed my suspicions, showing an area of the bone that was
very abnormal and was eaten away. This
didn't look promising, and so I shared my concerns with Bill, not wanting to
scare the family for no reason, but Bill too agreed this was bad.
Mom asked,
"Is it good or bad?' "Bad, very
bad," was my response. I explained
as best I could and as strongly as I could what we thought was wrong with this
girl. She started crying and her mom almost
fell over in shock. I told them they
were looking at surgery to amputate the leg, and even then there was no
guarantee it would produce a cure, if the cancer had already spread. More tears, the mother asked if she could
get the father. Dad came in and I tried
to explain again that her daughter had cancer of her leg and was going to
require surgery to cut it off in order to try and save her life. He kept saying, "It will be okay, it
will be okay," trying to comfort his daughter, but he doesn't know what I
do and hasn't seen what I have seen.
He hasn't seen
other young kids and teenagers with this same cancer who have delayed having
the amputation and who have died a horrible death. He hasn't seen their legs grow 2 and 3 times
it's normal size from the cancer producing pain that is hard to control. He hasn't seen the cancer break through the
skin producing a horrible odor and drainage that can't be stopped. He hasn't seen the families come back months
after you told them they needed an amputation, which they refused, now to have
the families say they want it, but it is too late - the cancer has spread and
surgery no longer is helpful, and the family cries and weeps over their child
that may have been able to be spared months previously.
I don't like any
cancers, but this is one I HATE. Most everyone with cancer in PNG dies, and
this one kills, but it is the deception that it causes that makes me hate
it. Physical exam findings can be
confused with a fracture or an infection and treated as such, delaying the real
treatment. Xray findings, if you don't
look close enough or aren't looking for cancer may also be confused with an
infection and treated as such for weeks or months, delaying the conversation of
an amputation and giving families false hope.
Chemotherapy to try and treat the cancer is one of the most deceptive
components of this cancer because it can shrink the cancer a little, which
gives false hope and the family never chooses to have surgery, thinking the
chemo will just keep working, but it doesn't.
Families are deceived into thinking that amputation is the worst
possible thing for their son or daughter and take the advice of their extended
family or village leaders over the doctors who have seen the horrible outcomes,
and choose not to have surgery.
The only winner
today is the cancer. No matter what this
family decides, it won't be okay. Her
life, their lives have been changed today.
Dreams have been shattered and hopes have been dashed. She either suffers horribly from the cancer
that grows bigger and bigger in her leg and causes horrible pain and swelling
and disfigurement and ultimately kills her within the next year, or she has a
radical surgery to remove her leg and can never walk again on her own 2 feet,
with only time telling if the surgery was done quick enough before the cancer
spread or not.
I know it isn't
an easy decision, so pray for this family as they talk and pray about the
future of their daughter and for wisdom for us as we treat and love her.
