A surgeon referred the patient to him. It was a tragic case, the surgeon said; a 33-year-old woman with inflammatory carcinoma of the breast. The woman, he added, was going through a hard time accepting the diagnosis. Having endured a lumpectomy, she now said she could not face chemotherapy. The thought of being sick for months and losing her hair was too much for her.
Soon, Dr. Sattar Memon, oncologist, got the woman's records. He flipped to the biopsy report. It showed that before the surgery, the cancer had spread to the surrounding skin. Memon knew what that meant. The skin's blood vessels and lymphatic channels could easily have spread bad cells throughout the body - threatening brain, bone, liver, lungs. Chemo, he felt, would be strongly indicated. But the books told him there might be a good argument against it.This, he knew, was one of the most aggressive of carcinomas. The average survival rate, even with treatment, was only a year and a half. It left him in the kind of dilemma that most depressed Memon about his work. Chemotherapy might prolong the woman's life by a year but also turn most of that year, her final months, into a time of sickness. What to do? Which way to go?
Soon, she arrived at his office for her first appointment. She had brown hair and brown eyes. Her skin was pale, her lips dry from anxiety. He still remembers the first thing she said to him.
"I hope you're not going to give me chemotherapy." Then she started to sob. She had a young child. A few years before, she'd come to America from Ireland, pursuing opportunity. Now this. Memon told her they would decide in a week, after he looked closer at her reports.
He did look at the reports, then immersed himself in the literature of the illness. He found little good news. Still, in the end, he decided there has to be hope. There was always the matter of statistics. The 18-month survival rate was the average. Perhaps she would be a rare aberration.
Together, Memon and her husband talked her into giving chemo a chance. Memon did not tell her what the prognosis was. She finally agreed.
To perform chemotherapy, a good vein is needed. Memon was only able to find one on her whole body, on the back of her hand. With no backup, he could not afford to damage this vein, something that happens in chemo. A needle inserted a fraction too far can perforate. A jet of chemo injected too quickly could pop or scald a vein.
He chose the smallest needle he had, stabilized her arm, and began the procedure - the injection of Methotrexate. When it was over, Memon had to sit alone in his consultation room to collect himself before moving to his next patient.
Two weeks later, the woman was back for a second treatment. And then a third. And a fourth. After six months, the therapy was over.
Her hair did fall out. She did get very sick. But the tumor shrunk dramatically. In gratitude, she gave Memon a bottle of Bailey's Irish Cream.
Now came the question: How soon would the cancer come back? According to the books, it was a question of time.
Six months after the treatment, he brought her in for a first set of tests. She tested clean. Twelve months later, she was clean again.
He told himself she was one of the lucky ones; she would probably survive to the outside edge of the statistics.
At 18 months, she came for tests yet again. He knew that this time, he was bound to see something. The tests were taken. Afterward, he went to the radiology department to see the mammogram, bone scan and chest X-rays placed on the viewer. The radiologist came in to give him the reading.
"Tell me," said Memon.
"There's nothing," said the radiologist.
This month marks the fifth year anniversary of the woman's completion of chemotherapy. Tests continue to show her healthy.
On each anniversary, she gives Sattar Memon another bottle of Bailey's Irish Cream. And with it, a reminder of a lesson he still holds onto, a lesson that has to do with not giving up.
(Distributed by Scripps Howard News Service.)