Scary

This is going to be long because it’s got lots of bits.

There is absolutely no history of cancer in my family at all, none and so it’s something I didn’t really ever think about until Chris started specialising and then working as a plastic surgeon. People all think that plastic surgery is all about cosmetic surgery while the vast majority of his work is actually all to do with cancer – breast cancer, skin cancer, throat cancer, you name it wherever there is a tumour which needs to be removed, it leaves a hole (sometimes big and sometimes small) which needs to be sorted out and that’s where a plastic surgeon comes in. But before I get into all that please bear one thing in mind.

I know some doctors charge ridiculous fees and I do believe that’s wrong but please don’t ever complain about what your gynae charges. Do you know that their malpractice insurance is R18 000 per month? That is before they have even seen a patient, they need to pay R18 000. It went up R7 000 between last year and this year. Chris pays over R10 000 (even though he’s only part-time in private he has to pay the full amount) and I thought that was a lot. If gynaes don’t do obstetrics it drops way down to between R2 -R4000 I’m not sure but more and more gynaes are stopping obstetrics because it just isn’t worth it. Rant one over.

Chris saw a patient at the state hospital recently that has gone into debt to pay for a mastectomy privately. With a mastectomy the surgeon usually does what they call an axillary clearance which is when they remove some lymph nodes from the armpit to check those for any signs of cancer. The surgeon who did this lady’s mastectomy did that but when the pathologist analysed the sample, it only contained fat tissue, no lymph nodes. Chris saw the lady because she was being seen at the government hospital’s oncology breast clinic which he attends every week. The surgeon had told the lady her lymph nodes were clear, despite the fact that the pathology report clearly stated there was no evidence of any lymph nodes in the sample they received for analysis. She has a very obvious lump under her armpit which may be because of the mastectomy but could easily be a lymph node metastases. The right thing would’ve been for the doctor to admit his mistake, he could’ve even covered for his mistake by telling the lady that the pathology showed that not enough lymph nodes were taken out and he needs to go and remove more. To blatantly lie and tell the patient that everything was clear when you’ve made a mistake is just wrong on so many levels and is why a few incompetent, egotistical idiots give so many wonderful doctors a bad name. The sad thing is that Chris would’ve done the lady’s mastectomy for her and done a proper axillary clearance in the state hospital and it wouldn’t have cost her a cent. She is now in debt and needs to have another operation (Chris is doing this for her in the state). I was outraged when I heard. What does one do as the medical professional? PE is a small place, one can’t very well go bad-mouthing your fellow professionals. I told Chris that I think the best thing to do is to write a letter to the lady’s GP or whoever referred her to the useless surgeon in the first place. He actually has to anyway as when one does surgery on a patient one always needs to inform the person who referred them to you and the patient’s GP (if it’s not the same doctor) and let them know what is going on. At least then that GP will hopefully never refer patients to the idiot surgeon again. People make mistakes I accept that, but when a person’s life is at stake and you make a mistake, then you need to have the decency, guts, whatever to man up and admit to your mistake and make it right.

There’s more though. Yesterday he saw a 31 year old man with a melanoma (the bad skin cancer) on his leg and a big lump in his armpit, a sure sign it has metastasized. That gives this 31 year old man a 20% 5 year survival rate which means he has an 80% chance of being dead within 5 years. This young guy had a thing on his leg and went to have it cut out, he can’t remember which doctor did it – GP/surgeon/dermatologist but lets guess it was probably a GP. I asked Chris, and he said that a melanoma is pretty obvious to a trained eye. He (this other doctor) cut it out and then asked the patient if he wanted it sent away for analysis warning the patient that it would cost him more money. On the advice of the doctor and let’s be realistic here, if a doctor asks you, “Do you want it sent away, it’s going to cost you extra money?” you probably won’t choose that option. But if the doctor says, “Listen this might be nothing, but there’s always the chance that it’s something sinister, we’ve cut it out so let’s be on the safe side and have it sent away for analysis, it will cost you XYZ” you’ll probably have it sent away. Chris sends away absolutely everything that he cuts out for analysis. So, the patient was given his melanoma in a jar to take home!!

What usually happens is that if something turns out to be cancerous the pathologist checks whether it has been cut out completely and there needs to be certain clear margins as well (that means a few mm beyond the cancer on every side needs to be removed and clear of any cancerous cells). Often, if Chris thinks something is cancerous he’ll take out as much as he can (but also as small as possible for scarring) but if it turns out to be cancer then sometimes he has to see the patient again and cut out a bit more to make sure it’s removed fully with wide enough clear margins. By not having the original melanoma analysed one had no idea that it hadn’t been fully removed and/or with wide enough clear margins. Not only did the melanoma recur but it has now metastasized to this young man’s lymph nodes and now at the age of 31 he has a very good chance of being dead before he reaches 36. A good friend of ours (actually the one expecting the twins) found a melanoma after having her second little girl. She found a funny looking mole and went to have it removed, it was analysed and when it was found to be a melanoma she had it cut out further and chose to have some lymph nodes removed as a precautionary measure. She has a 100% 5 year survival rate and never has to think about the melanoma again. She was also 31 at the time and instead of staring death in the face, she is now expecting twins. Melanomas are scary things and there is always the chance that this man’s particular melanoma had already spread before he had it removed the first time but the earlier you start treating cancer, the better and the better one’s chance of beating it. If you don’t know you even have it, you certainly can’t start fighting it.

What’s my advice – never ever have anything burnt off, if it’s burnt you can’t ever analyse it so I know I’m biased but rather see a plastic surgeon not a dermatologist – they have no surgical training whatsoever and are more likely to burn things off and always, always have things analysed. I’m not sure how much it costs but even if it’s R1000, your life is surely worth more than R1000.

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5 Responses to “Scary”

  1. darylfaure Says:

    Very good post Katherine! Makes me so mad when Dr’s and other professionals make mistakes and don’t own up to it, and then other Dr’s cover for them too.

  2. Marcia (123 blog) Says:

    I love when you get passionate about things like this and also how well you speak of your husband. šŸ™‚ He must be beaming with pride!

  3. cat@juggling act Says:

    Oh so true! Thanks for the advice. Speaking about plastic surgery – we took our 6 year old for Otoplasty this year and it was such a great experience – we had the most friendly and great doctor. I have such respect for plastic surgeons after this.

  4. cat@juggling act Says:

    If you are interested: http://juggelingactoflife.blogspot.com/2011/07/it-was-rigth-decision.html and: http://juggelingactoflife.blogspot.com/2011/06/so-it-all-went-well.html

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