By Emmanuel Fashakin
On a bright unseasonally warm Saturday morning in January 2023 in New York, I arrived in my Brooklyn office full of energy, and ready for the day’s grueling work. Saturdays are usually good for our practice; that is when we see many patients with high paying private insurance, who had no time to come to the doctor during the week, due to work commitments.
My first patient was Carl, looking melancholic as usual. Patients appreciate when you know them and are familiar with their family members. So, trying to cheer him up, and knowing how close they are, I casually asked after the wife: “how is Clara?” I was expecting the usual generic response, “she is fine”, or “she is okay”, but what Carl blurted out deflated me completely, and had me upset the rest of the morning.
“Clara is dead”, Carl said sadly. And went silent. “Clara is what?” “Dead”? “How?” “What happened?” I went into a tirade of questions. “Cancer of the Cervix”, he replied slowly. “Cervix!” I drew in a deep breath and exhaled slowly. Anyone who has a primary care doctor and who keeps up with her preventive care should not get cancer of the cervix, because this cancer grows slowly, most times taking three years to develop, as the cells go through dysplasia before becoming cancerous. If a woman undergoes the gyn exam and papanicolaou smear in that time, the dysplastic abnormal cells would be detected and the area merely frozen up during colposcopy. Cancer of the cervix is what kills women in developing countries; not in our New York, except women who don’t take care of themselves.
I looked up Clara’s records. Her last Gyn exam was in 2015. Over seven years! She preferred to do her Gyn with outside gynecologists, rather than in our Family Medicine practice. That is ok, except that Clara would not go, despite our repeated urging. Clara was always anxious that something bad was going to happen. She was always very anxious. And fearful. Whenever she did tests, she would have a thousand questions about her results. I usually assured her that everything was okay.
In February 2022, Clara finally summoned courage and went for her Gyn exam. The results were not good. The gynecologist told her that she needed colposcopy and biopsy immediately because of abnormality in the cells. Clara waited and came to our office only in April for blood tests and medical clearance for the procedure. Two days later, she came to pick up the results. We did not know it at the time, but that was the very last time we would see Clara.
The husband picked up the story. He said although Clara was told in February 2022 that she had cancer of the cervix, she did not tell anyone in the family. She had her sixty years birthday celebrations in March. The husband said that he sensed that she was not very happy, as if something was on her mind. Carl said he now thinks she purposely kept the information from everyone so that they would not be sad. In April, after all the celebrations, she went for the colposcopy, LEEP and biopsy. She maintained her silence even after the procedure.
In July 2022, Clara went to the Gynecologist for follow up appointment. Carl was sitting in the car on the street waiting for Clara to finish her consultation with the doctor. Suddenly, Clara called him to come up to the consulting room. This was very unusual. As he entered the room, Clara got up and hugged him. She tearfully told him the truth, that she has cancer of the cervix. Clara died in the third week of November. The course of the disease was short and aggressive. I strongly suspect that Clara told them to do nothing. I chose not to ask Carl.
Clara was my patient for over twenty years. She never caused us no trouble. She brought her husband to our practice and we took care of them all these years. Her death hit me hard, like a family member. The news ruined my day completely. I kept playing in my head Clara sitting across the table asking this and that questions about her tests. As if she was expecting something bad to happen. Sadly, it did. I could not but feel that the outcome might have been different if Clara had not been so fearful and had done what she ought to.
Finally, my head stopped spinning and I turned to Carl. “How are you coping? Who is at home with you? How are the children coping?”. “I am all alone, all our children are grown. Our first son is 45 years old?” “What?” I exclaimed. “You mean Clara had a baby at 15?” A rare smile crossed Carl’s face. “You are very smart doc. Yes we were teenagers. I met Clara when I was 17 and she was 13. We had our first child when she was 15. We were married for 45 years”. I found that most remarkable. Most teenage marriages never lasted more than a couple of years. They lasted 45, till death parted them.
Clara’s case reminded me of Wanita, another fearful patient who suffered a sad outcome. A very unusual case. Wanita was a devoted single mother of three. They were registered patients of the medical practice in Jamaica Avenue when I took over and purchased the practice in August 2000. She doted on her three boys. I remember a funny incident about fifteen years earlier. Wanita brought the children to the office and I was discussing the case of David, the eldest son, then 14 years old. Wanita said something and David exploded. He yelled at Wanita that she should shut up. Wanita cowered into a corner away from her huge oversized son. I was furious and jumped out of my seat. I waved my fist in David’s face and gave him a stern warning, never to talk that way to his mom in my presence. David backed off from me — I don’t think that he has ever had a big man in his face before.
It was this same David, now 29, who filled me in on Wanita. David has grown up to be a fine young man, got a job and is taking care of the junior brothers. Wanita and the rest of the family had disappeared from our practice in the last few years. When I saw David few months earlier, I was so happy to see him. Where is Wanita? I asked him. David shook his head. Wanita is dead. Vuat? Cancer of Breast. Vuat?
I quickly pulled up Wanita’s medical records. Then I remembered. For more than 15 years, we gave Wanita referrals for mammograms. She confided in me that she was terrified that they would find something, so she never did it. I explained to her the essence of early diagnosis and treatment for cancer, especially the breast. Many of my patients have survived breast cancer. Hundreds. Many of them have been cancer free for over ten years. One of my Nigerian patients has been cancer free for over fifteen years. Her cancer was detected by routine mammogram. She told me that she would live and not die in Jesus name, but she kept all the medical regimen prescribed for her. She is now in her sixties, a cancer survivor.
Wanita refused to do a single mammogram. All the mammogram referrals over several years remained in her drawer. David said four years earlier, Wanita discovered a lump in one of her breasts. She refused to come to the office. She stayed home. The cancer grew bigger and bigger, until it spread everywhere. She died at home after she lost a lot of weight and she was unable to eat. She stayed locked up indoors until the cancer consumed her and killed her.
Wanita was so scared of cancer, and when she got it, like Clara, the fear paralyzed her. She did nothing. For many cancers, detecting them early make a big difference in survival rates. You have to be proactive and keep up with your preventive care. Paralyzing fear could kill you. These were really good and decent folks and it is sad to see them succumb to illnesses they could have prevented. May their souls rest in peace
Emmanuel O. Fashakin, M.D., FMCS(Nig), FWACS, FRCS(Ed), FAAFP, Esq.
Attorney at Law & Medical Director,
Abbydek Family Medical Practice, P.C.
Web address: http://www.abbydek.com
Cell phone: +1-347-217-6175
“Primum non nocere”
