It was my first week in the radiation oncology department as a resident. The day had been busy, and most of the consultants and staff had already left the outpatient department (OPD). I was exhausted and famished, with thoughts of dinner dominating my mind.
Just as I was beginning to wind down, the physician assistant (PA) rushed in and informed my consultant that a patient from a local hospital required immediate consultation. My mood soured; hunger was the only thing on my mind.
Moments later, attendants wheeled in a young woman on a stretcher. She appeared to be in her early 30s, frail, and in agonizing pain. I hastily took her medical history. She was a mother of three, a homemaker, hailing from a lower-middle-class background, a non-smoker, with no family history of carcinoma. The only medical document in her possession was an MRI spine report, revealing multiple lesions in her thoracic and lumbar vertebrae. On examination, she was paraplegic, with a 1/5 power rating in both lower limbs.
As I examined her, my consultant interrupted and asked, “Have you examined her breasts?” Regrettably, I had not. I returned to the patient, uncovered her, and was astonished to find that one of her breasts was shriveled, stony hard, with thickened and discolored skin. I inquired about the lump’s duration, to which she replied, “Oh, this? Don’t mind it; it’s been there for years, and it’s painless, so I never bothered to consult a doctor.”
We promptly admitted her for a comprehensive evaluation, including a bone scan, CT staging, biopsy, and breast immunoprofile analysis. The findings were disheartening: extensive liver, lung, and osseous metastasis. We initiated steroid treatment and urgently administered radiation therapy to address the spinal lesions causing cord compression. The biopsy confirmed invasive ductal carcinoma, which was estrogen and progesterone receptor-positive but HER2-negative.
Given her poor performance status, we initiated weekly chemotherapy with lower doses. When she learned about her condition, tears welled in her eyes. She worried about her young children, as there was no one else to care for them. I spoke with her husband and reached out to her siblings, and eventually, everyone rallied around her. In each cycle of chemotherapy, she would ask me with hope in her eyes, “Dear doctor, will I get better soon?” I consistently reassured her, reminding her of the importance of her fight for her children and the need to maintain hope. When she wavered, I reminded her that we were all here for her. Her family became incredibly supportive after counseling sessions.
Over time, she regained the ability to sit with support, and her lower limb strength improved. After several cycles of chemotherapy, her scans indicated improvement, and with further treatments, there was marked regression of her disease. We performed ovarian ablation and initiated hormonal treatment with aromatase inhibitors, as well as targeted treatment with CDK4/6 inhibitors. Four years have passed since then, and her disease remains stable.
Whenever she visits the OPD, she walks in on her own two feet. My consultant never fails to call me when she arrives, affectionately referring to her as “your friend.” She always kisses my cheek, expressing gratitude for the hope I provided. Every time she visits, she serves as a reminder of the invaluable lesson I learned: never let a female patient leave the OPD without a breast and gynecological examination. In our country, where limited socioeconomic resources, inflation, and inadequate access to health care prevail, females often neglect their health and seek medical attention only when it’s too late. However, it is our responsibility to treat them with the love and care they deserve to the best of our abilities.
Damane Zehra is a radiation oncology resident in Pakistan.
