(I first wrote this article in September, 2008. Subsequent additions were made in March 2012 and November 2016.)
(For the non-medical fraternity, I have italicized the technical sections of this article, that can easily be skipped without missing out on the storyline.)
This is the true story of a young 13-year-old girl.
She had been diagnosed with a large abdominal tumor and the consensus of opinion of the doctors in her hometown was that she suffered from an advanced, untreatable cancer, that was best left alone. She was brought to Mumbai from her remote village in central India in the slender hope that something could be done for her.
This is a heart-wrenching trend that occurs far more often that one would care to admit. Where poverty-stricken patients from the interiors of India sell everything they own and travel huge distances to the major cities like Mumbai, Calcutta, Delhi etc., to seek medical services. Only to be told, often within a few hours of arrival, that nothing could be done for them and it would best that they went back home.
In this particular case however, despite it’s ominous appearance, there was an outside chance that it could well be a treatable disease.
She did come from a very poor family and initial investigations were kept to the bare minimum. Just enough to confirm the tumor type, based on which a decision would be made on whether to proceed with aggressive treatment with a curative intent or adopt a more palliative approach.
This 13-year-old girl presented with abdominal distension that could easily be mistaken for advanced state of pregnancy. It was first noticed a year ago and was gradually increasing in size. Though initially painless, she did complain of a dull pain for the past month or so.
On examination there was a hard, fixed, non-tender, abdomino-pelvic mass.
An Ultrasonography of the abdomen and pelvis (done previously in her hometown) reported the presence of a huge, solid tumor arising from the pelvis and extending into the abdomen.
Tumor marker tests were then performed. Elevated levels of BHCG (Beta Human Chorionic Gonadotropin) clinched the diagnosis of a Germ Cell Tumor of the Ovary.
In short, the initial investigations confirmed the diagnosis of an unusual type of ovarian cancer.
Germ cell tumors are a relatively rare type of ovarian cancer that tends to occur in younger females, often in children. These are exquisitely sensitive to treatment, and, even in advanced cases, the cure rates are excellent.
This diagnosis instantly changed the prognosis from a deadly and terminal disease to one that was eminently curable despite its huge proportions!
Usually ovarian cancers require surgical removal of both ovaries and the uterus. However, in germ cell tumors, fertility-sparing surgery is often possible, (sparing one ovary and the uterus) without compromising survival. Which is great, as many of these patients are young, often in their teens. Most of the patients who undergo fertility sparing surgery will retain menstrual function and many will go on and attain pregnancy if they so desire.
An exploratory laparotomy was performed under general anesthesia. Intra-operative findings revealed a huge mass arising from the left ovary with adherent small bowel loops. There was also mild acites. The right ovary was normal.
A comprehensive abdomino-pelvic staging and fertility sparing (left salpingo-oophorectomy) cytoreductive surgery for ovarian malignancy was performed.
Surgery entailed removal of the left ovarian tumor. The right ovary and uterus were retained preserving her ability for menstrual and hormonal function and even, possibly, future child bearing.
She made an uneventful post-operative recovery following which she underwent a complete course of chemotherapy.
Chemotherapy drugs are expensive and to her good fortune, a total stranger, whose mother was being treated simultaneously at the same hospital, was sympathetic to her cause, and provided the financial support that allowed her to complete her treatment.
She followed up regularly for a year thereafter.
September 2008 (1 year later):
On her last visit, before she finally returned to her village, her tumor markers had returned to normal, there was no evidence of recurrence and her scars had healed well. Her menses had resumed which meant that there was every possibility of her starting a family and living a normal life.
From a purely medical standpoint this was a success story. There were however, other issues that we were concerned about.
Apart from the slight probability of recurrence, this 13-year-old had to undergo major surgery with its attendant ugly scars, and months of toxic chemotherapy with its own set of side effects, not least of all the severe loss of hair rendering her absolutely bald. Adding insult to injury was the fact that she was now permanently stamped with the dreaded ‘Cancer Patient’ Label
To say her psychological scars far exceeded her physical ones would be a gross understatement.
Rural Indian culture can be cruel and unforgiving and we worried about how she would cope.
March 2012 (5 years later):
A young woman walks into my consulting room. She gives me a big broad confident grin and though I smile back, I haven’t the foggiest idea as to who she is.
She has an attractive face and one couldn’t but help but notice her stunning head of hair that was plaited in a style typically adopted by girls from rural India.
It was only when I looked at her case file did I realize it was the same girl we had operated 5 years ago. She’s almost 19 years old now. All her tests reveal that she is free of disease and her menses are normal.
The reason she was brought to me after all these years was to get my blessings so that her family could initiate the elaborate Indian nuptial ritual of finding her a groom!
To me it was quite clear that there remained only one major cause for concern.
And that belonged to potential suitors in her hometown.
As, judging by her appearance and confident demeanor, I wouldn’t be one bit surprised if some Mumbai boy snaffled her up in marriage long before she even had a chance to return home!!
November 2016:“It’s a boy!”
Her uncle works for the hospital where she had undergone her treatment. So, although she was in her village and I hadn’t seen her for years, I was regularly updated on her health.
A few months ago he informed me that she was pregnant and I’ve been keeping my fingers crossed and praying that all would go well.
So you can understand why, when he dropped by my OPD this afternoon with the news that she had delivered a healthy baby boy, and that both mother and son were doing well, I have been walking on air ever since!!
Carmen Kagal says
Lovely heartening story. Carmen
Thanks A. Carmen. In the profession I’m in, news like this really make my day!
Prem Savio Colaço says
Lovely read sir…… These are the kind of stories people need to hear and not ones of doctors fleecing patients… And as always, I insist that you get out a book on these kinds of stories as soon as possible. It will make for a really wonderful read.
And congratulations!! I look forward to hearing your own stories and experiences as you begin your surgical career. Knowing you I’ve no doubt that they will be every bit as good, if not better!
Prem Savio Colaço says
Thank you sir ,for your kind and encouraging words.
What a heart warming story from a doc that has a huge heart! So proud to have you in the family.❤️
Thanks Lou! I don’t know about the huge heart, but I must admit, considering what she has gone through I am absolutely thrilled for her!!
Rayna Fernandes says
How wonderful to be an instrument in such an amazing healing process! Our world needs intelligent, talented and generous hearted doctors like you. I am thrilled for that young woman and she is really lucky to have landed in your clinic, and have some generous donor pay for her treatment. Thanks for sharing your story Ian
Rayna you are too kind (though I’m not at all sure that all those adjectives really apply)!
Thelma Rodericks (I used to work for Kosmek Ltd.) says
Dear Dr. Ian. I was the person who commented on your post mentioning that I knew first hand about medical miracles. My daughter was 43 years old when she started noticing changes in her digestive system. In spite of bringing this to the attention of her primary care physician she refused to take my daughter seriously and told her it was all in her “head”. This went on for a year and eventually they did an endoscopy and diagnosed Cancer of the whole stomach – linear?? You will understand this. She went through a whole year of chemo both intravenous and oral. Then five weeks of Radiation. It was a truly traumatic time for all of us. Exactly a year after the diagnosis and treatment she had a total gastronomy at the M.D. Anderson Hospital in Houston, Texas.The Gastroenterologist -Oncologist – fashioned her intestines into a pouch which serves as her stomach. This was exactly 10 years ago. She has two lovely daughters, 20 and 17 years old. They were so small when this happened. She lives a very busy normal life now and has to take many supplements, one being a B-12 nasal spray jet every week. She is a walking miracle as there are not many stomach cancer survivors. We praise and thank God for his mercy of sparing my daughter for her daughters.
I wish you continued success in your dedicated calling.
Incidently, I was one of the crowd celebrating your dad’s election to Mayor. I also knew your cousins, Ivor and Joanne D’Souza.
Thanks for sharing your story Thelma. The fact that your daughter is cured of Linitis Plastica of the stomach is truly miraculous. Yes I remember Kosmek Plastics and the Rees family. My mum was their doctor if memory serves me right.
Lucio Fernandes says
Touching Story Ian. You operated, He cured !!!
Thanks Luce. Couldn’t have put it any better – or succinctly – myself!
Nalini Pinto says
Such a simple yet detailed account of a truly miraculous recovery at the hands of a kind and positive thinking doc like you! Am sure many more of your patients ha e been as lucky.
May God bless you and other docs like you, if there are more!
I’m not sure I deserve them, but many thanks for your kind words!