Where Cancer Doctors Go to Cry

There’s only one female breast surgical oncologist in Kenya; Dr Miriam Mutebi, also an assistant professor at Aga Khan University.

She does not necessarily find it celebratory. Together with others, they formed the Pan-African Women’s Association of Surgeons to provide mentorship, networking opportunities and support for women interested in surgical specialities.

Currently they have 150 female student surgeons across Africa being groomed. A graduate of University of Nairobi, Aga Khan University (Master of Medicine in Surgery), University of Cape Town (research fellow) and Weill Cornell, New York (Master’s degree in Epidemiology/Health Systems Research) she was recently awarded the African Cancer Fellowship with UICC as a Young Leader.

She met JACKSON BIKO at Nairobi Serena for a chat about life as a breast surgeon.

How does it feel like removing a breast surgically? What emotion does that come with as a woman?

To be honest: Science 10, cancer 0. It’s a win for us. The whole idea of the surgery is not to see the cancer tumour by removing it and lymph nodes together with healthy tissues. But there is much greater satisfaction after the reconstructive surgery because basically the patient goes under and when they come to they have a new breast that is cancer free and with the new technology now we are able to preserve the skin and sometimes the nipples.

If you think of an apple, we retain the skin but remove the cancerous underlying tissues. This helps with the patients’ quality of life in terms of body and self-image. Reconstructive surgery, in this case is a critical part of cancer journey.

Why a breast surgeon, why not heart?

Your life choices follow your experience. As part of our general surgery rotation in medical school, I ended up spending a great deal of time in the breast clinic. Over time, of course, we saw more and more cases of breast cancer in younger women as opposed to women in their 60s and beyond, according to earlier statistics. This of course made me more curious and I was convinced into taking up this speciality.

How many breast surgeries have done in your four-year career?

That’s a tough one. (Pause). Including my fellowship, say about 250 because we do something like 50 to 60 a year. The bulk of other breast surgeries have been and continue to be done by general surgeons, which makes the whole thing more complicated because of the nuances involved, even though the training is uniform. This normally brings complications and a bit of mismanagement, which then we have to deal with.

Do you play music during surgery or it’s radio silence in theatre?

Well, we normally have soothing classical music in the background …(Laughs) … No, I’m joking.

Sometimes you are at the mercy of the anaesthetist who will ask whatever you want to listen to or what they prefer. Sometimes you just want quiet. Everyone is different. I like music during surgery but not too loud although what I usually do is ask patients what they want to hear before we put them to sleep. Some prefer rock, or blues, others rhumba, whatever soothes them, normally we will oblige.

Does dealing with cancer frequently make you more or less fearful of your own mortality?

Well, to some extent, yes it makes you think of your mortality, but I like to think I’m in the hope business. That’s the one thing that’s missing in the cancer narrative; that cancer equals death. That’s not true at all. This doesn’t mean we give our patients unrealistic hope but hope within the practicalities of where they are on their cancer journey.

Cancer is largely treatable irrespective of the stage it’s in but it’s the goals of treatment that change. Stages one to three are curative. We let them know. With metastatic disease and with advances we can control the cancer but with the aim of curing.

But yes, it brings you in touch with mortality. In the last three months I have seen a considerable number of my patients under 40 with breast cancer. It makes you think and learn to be more grateful. In fact, I’m maintaining a gratitude log now and trying not to lose sight of what’s important and what’s not.

Do you get emotional support in your line of work, like therapy?

Yes. There is a sense of hopelessness and burn out in oncology, you know, constantly having to break bad news and deal with the kind of emotions that come with cancer. When I was in training it was mandatory for us to see a psychologist every three months. Now we have a group of oncologists that we normally debrief to and learn actively.

Are these sessions usually over drinks or in windowless rooms?

[Laughs loudly] Not over drinks, for sure. But they are more informal. We just sit and chat about our distresses because often you are just like, ‘no, I’m not going to cry before my patient!”

When was the last time you cried?

Good question. (Sigh) We normally get referrals and one time this girl came in to see us. She was HIV positive and had been on medication for the last four years, which meant she had been seeing a clinician every month. But we discovered that she also had stage 4 cancer and I was like, how is this possible? How did anybody not see this all those years she would go to a clinic. I mean this is madness! I asked her if she had done a Pap smear and she had never heard of a Pap smear. I was ashamed because we had all failed her, the medical fraternity.

What’s your passion other than what you do?

I read a lot. I also have a love for slam poetry. In my youth, I used to write some horrible poetry. [Laughs]. I also love theatre, my first love. I’m currently taking flying lessons … don’t laugh. (Laughs) The reason I got into med school was because I wanted to be a flying doctor but it was super expensive but now I’m finally in the right head space and saving space and hopefully that can be a reality and I can disseminate medical skills far and wide in the remotest of areas.

Are you living your best life now, or your best life already passed?

I’m a firm believer of embracing each stage you are in, even though it’s tempting to look at the past with nostalgia and the future with immensely possibility and hope. What my patients have taught me is to enjoy today because everything, all these is fleeting!

Last meal on earth; what would you want to eat and where?

Wow. (Laughs) Tough one. Can I have different courses?

If you have the appetite for it.

(Pause) This is choice paralysis. (Pause) I’d order in a salmon from Five Sense restaurant at Galana Plaza, I had a nice salmon there on my birthday. I’m a sweet tooth so a tiramisu will top it off. I will be at a beach looking at a sunset. I will tell God, “I’m ready Lord, but after I finish this tiramisu.” (Laughs)