The Makcik with Cancer

7:26 PM



"Doktor cakap makcik ada kanser payu dara. Doktor nak bedah dulu. Tapi anak makcik dan orang kampung cakap jangan. Baik berubat kampung dulu katanya."

She's in her early 60s. She came to the clinic for her hypertension follow up. I happened to go through her records and noted that she might have cancer. My colleague referred her to the Surgical Outpatient Department (SOPD) nine months ago. She earlier complained of a breast lump. Mammogram was done and she was duly referred to SOPD. A biopsy was taken and she was confirmed to have breast cancer. A mastectomy was planned and she defaulted subsequent follow up after getting advice from wannabe doctors.



MOf:          Sekarang makcik rasa macam mana? Makcik buat rawatan macam mana?

Makcik:     Rasa sama je. Merata rata makcik pergi. Pergi urut, beli air alkali, ubat penawar dan                         macam macam jus.

MOf:         Berapa banyak duit makcik dah pakai?

Makcik:      Nak dekat RM 6000 jugak. Tak masuk tambang sewa perjalanan lagi. Itupun nasib baik                      ada anak tolong bawak.

MOf:          Macam mana dengan bengkak tu? Ada kurang?

Makcik:      Tak membesar sangat. Tapi dekat ketiak ni rasa macam ada sesuatu. Makan minum                            semua ok.

My heart sank. She most likely has a lymph node involvement. Not a good sign. I wouldn't be surprised if there is a metastasis (cancer cells spread to other organs) somewhere else in her body. Usually, I would be frank in my advices and just wish her the best of luck. But by looking at her face, I could tell that she was indecisive. She was torn between getting advice from a doctor and her relatives. I could sense that she felt regretful of her choices.

MOf:        Anak - anak makcik ada yang kerja gomen?

Makcik:    Ada. Dia kerja di pejabat XXX (I would consider her son as someone educated).

MOf:        Makcik cuba dengar nasihat saya. Sepatutnya anak makcik boleh dapatkan subsidi                               rawatan. Tak perlu lagi habiskan banyak duit. Semuanya hampir percuma. Kalau anak                         makcik nak dapatkan penerangan dari saya, datang je. Saya akan terangkan. Makcik dah                     habiskan banyak duit dah dan saya nampak penyakit ni makin merebak.
                 
                  Saya tak dapat duit apa.
                  Saya tiada apa - apa komisyen.
                  Saya hanya nak lakukan yang terbaik untuk makcik.

                 Saya beri makcik nasihat semua ini berdasarkan apa yang saya belajar dan pengalaman                        saya. Jika apa apa jadi, orang senang nak tuduh doktor salah. Tapi jika benda buruk                              berlaku adakah orang yang menasihati makcik ni akan ambil tanggungjawab yang sama?

Makcik:     Nanti saya fikirkan.

Its been a few weeks now and I have yet to see her again. Hopefully, she doesn't become one of the patients that only comes to the hospital when her condition deteriorates. I have seen countless of breast cancer patients who seek treatment at the very last minute. They get diagnosed years before and defaults on any form of treatment.



A year later, the initially painless breast swelling turns into a fungating mass with pus.
The lungs get filled with fluid (pleural effusion) and breathing becomes difficult.
Pain becomes unbearable as the cancer cells spread to the bone.
The abdomen becomes swollen with fluids as the liver starts to fail.
Surgery is impossible and chemotherapy might not be suitable as body functions fail. The only option is palliative care.

Then, doctors become the scapegoats of the patient's relatives.

"Tu la. Datang hospital bukan lagi baik jadinya tapi lagi teruk!"

"Doktor biar je mak saya macam ni?! Buat la sesuatu!"

They fail to realize that doctors CAN NOT treat everything. The window period for treatment has lapsed.
They also failed to reflect and point the finger at themselves. Point the finger at the doctor wannabes whom charge exorbitant fees without any scientific proof of success. Scientific here refers to results that can be replicated in a sizeable population and backed by data. NOT just testimonies.


MOfrust










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15 comments

  1. Replies
    1. Thanks. I'm worried about her coz her face says 'I can't do much' and she felt sorry for herself. But it is not the end of the world for her, there's still a chance of survival but time is ticking

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  2. Scenario yang typical di kalangan Orang Melayu . Sewaktu Saya bertugas di pantai timur seorang pesakit di rujuk ke wad surgery . Advance billiary ca. Dalam wad round bermati-matian dia mendakwa masalah nya bermula Dalam 2 Minggu sahaja . Akhir nya dia mengaku kepada Saya beliau sudah menghabiskan ribuan ringgit dan menjual tanah untuk berubat dengan bomoh ,pawang, dukun, homeopati dan sami buddha (tok cha) juga . Hal itu berjalan Hampir 3 tahun hingga lah 2 Minggu yang lalu datang ke hospital sebab sesak nafas (tok leh nyawa) . Satu soalan yang dia tak Boleh Jawab . "Kalau pak cik mati masa berubat dengan tok cha, pok cik rasa iman pok cik masih Allah Terima ?"

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    Replies
    1. nape org melayu (Islam) camtu eh?suka sgt percaya tahyul n unscientific stuff, bukan ke Quran tu a scientific and evidence based book?

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    2. Mentality and in denial. I've seen one too many cases already when I was an Oncology MO. Even patients as going as 13 too.

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  3. Scenario yang typical di kalangan Orang Melayu . Sewaktu Saya bertugas di pantai timur seorang pesakit di rujuk ke wad surgery . Advance billiary ca. Dalam wad round bermati-matian dia mendakwa masalah nya bermula Dalam 2 Minggu sahaja . Akhir nya dia mengaku kepada Saya beliau sudah menghabiskan ribuan ringgit dan menjual tanah untuk berubat dengan bomoh ,pawang, dukun, homeopati dan sami buddha (tok cha) juga . Hal itu berjalan Hampir 3 tahun hingga lah 2 Minggu yang lalu datang ke hospital sebab sesak nafas (tok leh nyawa) . Satu soalan yang dia tak Boleh Jawab . "Kalau pak cik mati masa berubat dengan tok cha, pok cik rasa iman pok cik masih Allah Terima ?"

    ReplyDelete
  4. man, i understand how u feel. patients decision on the mode of treatment (let it be their's or their family's decision) can sometimes really hurt your pride as a doctor. and its worse when they cite 'bomoh' or 'tradisional' treatment.

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    Replies
    1. True but in the end, it's back to patient's autonomy.

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  5. It is years of ingrained mentality. Will take time to change.

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  6. It is years of ingrained mentality. Will take time to change.

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  7. Thanks for being a caring doctor. Maybe you can go a step further, like connecting her and her carers to many available NGOs support groups, where ppl who had similar experience volunteering their supports thru patient sharing sessions and even hospital visits.

    ReplyDelete
  8. Thanks for being a caring doctor. Maybe you can go a step further, like connecting her and her carers to many available NGOs support groups, where ppl who had similar experience volunteering their supports thru patient sharing sessions and even hospital visits.

    ReplyDelete
  9. I feel you even though I am not a doctor.
    There are plenty of people like this makcik, regardless of being educated or not. They are more afraid of needles and chemotheraphy compared to 'pergi berubat merata' for life. Duhhh...

    -an ovarian cancer survivor, insya-Allah-

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  10. every good of Alternative/Traditional Medicine will be amplified
    while all the bad forgotten

    every bad of Western Medicine will be amplified
    while all the good forgotten


    SS, OPNS

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  11. My patient diagnosed with breast CA.. for op.. she defaulted follow-up. Went to bomoh diagnosed as santau.... i feel you as frustrated as you are... 1 year later.. stage 4. life expectency 6 months...

    ReplyDelete

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