Tigist awoke abruptly, her sleep fractured by the pain in her bones. A pain so fierce it pried a groan out of her. In the darkness, John’s hand found hers locking their fingers together. “I am here. It’s ok,” he whispered as he got on his knees to prop her up and rub her body. On some nights, he would pick up his guitar and sing softly to mentally distract her from the discomfort. This night was different. She remained tense and the next thing he heard was a sob followed by an ugly guttural cry. The sobs raked over her and all he could do was hold her until she slept. When she did, she dreamt she was back in her hometown.
Dr. Tigist Gebre now Muiga comes from Moyale, a border town in Marsabit County, 780 km from Nairobi — Kenya’s capital. She has Ethiopian roots but was born and bred in Kenya. A lastborn in a family of eight now seven siblings. Add their folks and they easily made a softball team. “Growing up in a huge family is all the rave,” she said to me, “it’s some form of pre-school. You learn fast enough to fight for your space or just share, laugh a lot, play even more. But what I loved most was that we were a team.”
The first time Tigist came to Nairobi was when she joined high school. She was 14 years old. Her outstanding performance had earned her a place in a National School in Eldoret — over 900 km from her home. At that time the road network from Moyale was non-existent making the journey to school gruesome.
She would leave home in a truck ferrying a cocktail of passengers. Cows, goats and a few other people. That was the only transport available. Her mom would drop her off and tell the driver, “Please take care of my child,” as she hoisted her up on the back of the truck. “It’s by God’s grace nothing ever happened to me on those trips. It didn’t even occur to us that anything could.” Tigist said.
The driver would only start the journey when he was satisfied that there was no room left to spit on board. He would then fasten the arthritic doors and the truck would heave and sigh all the way to Nairobi; stopping twice on the way for them to catch some shut eye. It was a two day trip at most.
Once they arrived in the city, the animals would be offloaded first. Then Tigist would be delivered at her aunts house in Eastleigh looking like she’d been chewed up, spat out and stepped on. That was not the worst of it. The strong musky odor, characteristic of goats would cling to her like an extra membrane of skin. “I would spend a day in Nairobi shopping for my necessities and then board a bus to school.” This was her routine throughout high school which she sailed through, scored an A and gained entrance into medical school in Turkey.
It’s hard enough to study Medicine. Imagine studying it in Turkish! It’s like falling up a tree! But even that went well and she came back, met her beau John, got married and had two boys.
It was when she was 21 weeks pregnant with their third child that her life splintered into a before and after. She was taking a shower when her palm caught on a pebble sized mass in her left breast. ‘Huh? What is this?’ she thought to herself as she continued to feel it. Tigist was careful to have scans done every year since her mum died of ovarian cancer. The last scan had not picked anything.
“John,” she said to her husband when she got out of the shower, “there is a lump in my left breast. Could you feel it and tell me what you think?” John is a General Surgeon and the human breast is his area of expertise. The jury is still out on whether the Surgeons stole it from Gynecologists but we can discuss that later.
John examined her and said, “When is the next antenatal visit? Let’s have a scan done then.”
She was due for an anomaly scan of the fetus at the visit so after the sonographer had finished Tigist asked, “Could you also scan my left breast? I felt a lump the other day and I just need to know what it is.”
The sonographer moved the ultrasound probe to her breast; running over it, changing angles, then said, “This looks like a cyst. Nothing to worry about doc.” And that was that.
But now that Tigist knew it was there, her hand liked to gravitate to it every so often. Waiting for it to disappear. Only it didn’t. Like the pregnancy, it grew. Barely two months had passed when she told her Gynaecologist, “There is this lump in my left breast. I did a scan that showed it was a cyst but it feels like it’s growing.”
“Ok. Let’s take a look.”
He examined her first while she was seated and then while lying down. He moved slowly, methodically, creasing his brow and pursing his lips as he went along. “I think we should do another scan,” he said when he was done.
The second sonographer was more thorough. When Tigist asked, “So what do you think it is?” She looked at the screen dead on and said, “Doc, let me call the Radiologist to have a second look,” and bolted out of the room.
The Radiologist came in seconds later, took a look and said, “This mass looks suspicious, you will need a biopsy.”
That’s the thing about medicine. When words like suspicious are thrown about, you start to wonder how something suspicious got into your body. Was it loitering and saw your breast and thought, ‘hmm that breast looks empty, let me invade.’
Two days later she had a biopsy. They used a vacuum powered device to extract the tissue. “I remember the click sound it made just before I felt a part of me being suctioned out.” After he took out the sample and dropped it into a container filled with fluid, she asked him, “So…can you tell what it could be?” while studying his face for clues. But he might as well have been reading the newspaper. His expression remained unchanged the whole time. “Let’s wait for the results Doc.”
On the day the results were to come out, Tigist could not stop the buzzing in her stomach. She tried to sleep to pass time but that didn’t work. So she left the house for a walk but came right back. “I must have called the Pathologist a hundred times to ask whether the results were out.”
“Not yet. Another hour or so,” he would say.
She called back in 45 minutes, “Are they out?”
“No. I promise once they are out I will call.” When he eventually did, he requested to speak to John.
Tigist was in the bedroom when John walked in and said, “Hey, the results are here. Let’s sit and open them together.”
They sat on the edge of their king size bed and leaned forward like people getting ready for a sprint. He opened the results and read them out loud, “Invasive ductal carcinoma.” Even if you are not a medic those words just sound ominous right?
After those words left his mouth, they sat there — cemented. As if their feet were merged with the floor. The only sound in the room was that of air moving in and out of their lungs. “John kept stealing glances at me. Probably waiting for me to break down but all I could manage was, “I had a feeling.”
Later that evening her sisters and close friends passed by with dinner, dessert and flowers. John had called them earlier for back up. But it was they who needed the comforting. There wasn’t a dry eye in the room except for Tigist who kept thinking, ‘I am 25 weeks pregnant and I have breast cancer. Wow!’
A few days later, Tigist booked an appointment to see a surgical oncologist. Dr Mutebi. Let me just pause here and say it’s pure coincidence that all my articles on breast cancer mention Dr Mutebi. I don’t know her personally. Have never met her. But the patients who speak of her do so with such color that I can’t help but mention her name.
Dr. Mutebi agreed to see Tigist at 5pm when the corridors were largely empty. And she didn’t rush. “I liked her friendly face. She listened to me rumble and when I was done, she spoke. Her voice was low and modulated. She used words like, “we” and “let’s” showing that she was in this with me.” Afterward, she examined her and then they discussed next steps. Especially in view of the pregnancy.
“Normally, we prefer to start with surgery, then chemotherapy, then radiotherapy but because you are pregnant, surgery is not feasible. The anesthesia would be too risky for the fetus. So we will start with Chemotherapy.”
“Will it affect the baby?”
“No, it will not. The drugs are safe in the second trimester but we will space out your sessions. We will also discuss your case in the Tumor board meeting and meet you again.”
Tigist knew first hand what kind of rabbit hole google could take you to if you asked it about a disease. But she checked anyway. Stayed up watching her screen tell her about odds of survival and side effects of chemotherapy and pregnancy and cancer. All of it. She drowned herself in information until she felt she could write a paper on the subject.
Her first session of chemo started when she was 26 weeks pregnant. Here is the thing about chemo. At first, she was eased into it. It almost felt like a lie in the beginning. Until the chemicals reached her tissues and dug in. It went from good to bad to gruesome quickly. The nausea, loss of appetite and feeling like she had been run over by a truck full of animals and people! Her nails and skin looked like those of a coal miner. Let’s not get started on the hair loss. Then there was the bone pain that had an affinity for darkness. It only pained her at night.
As if the diagnosis was not shocking enough, she underwent genetic testing and found out that she was positive for a mutation in her BRCA gene. I promise to explain what that is at the bottom.
It became a physical and mental warfare. She always felt a beat behind and was either having a chemo session, or being tested for the next chemo session or in the prenatal clinic checking on the baby, or working. Her thoughts would be jumbled up in her head, “Will I get better? What if I don’t? Will I die? If it goes, will it come back?”
At 36 weeks, she delivered a healthy baby girl via caesarean section. Now, she had a wound and a baby to think about. But remember that softball team I spoke of in the beginning? They came through. Her two sons had closed school so their grandparents took them. Then her sister who lived in Nigeria moved into her house and took care of their baby girl. Fed her, slept with her, washed her, loved her.
After Tigist completed her eight sessions of chemo, the lump was completely gone. But remember that mutated BRCA gene that she has? Because of that, she underwent a double mastectomy and in addition her uterus and ovaries were removed. I know now you really want to know what BRCA is and tomorrow half of my readers will be asking their doctors, ‘Can you please test me for BRCA?’
The operation took 10 hours. And went well.
Post- op her mother in law took her in and nursed her back to a state where she could comfortably go back home. She is now in remission.
Someone might now think, ‘Yes! cancer is over. Let’s go back to our lives.’ Hogwash! The person she was before the diagnosis is gone. She couldn’t trace her even if she tried. In her place now is a 35 year old girl who is self aware and fearless. “I used to be such a yes girl. Afraid of offending anyone. Now I am open and honest with everybody. What will they do? Kill me?” Pun intended. She knows that your life can slip through your fingers like flour. And so every moment counts and she counts every moment.
Recently her boss told her, “Tigist, you are a completely different person at work. You are kicking it!”
And she wants to kick it all the way back to where it came from. Not her boss, the cancer.
Ok. Let’s start with what everyone wants to know. What is BRCA?
BRCA simply means BReast CAncer gene. It is hereditary.
There are two types 1 and 2.
People who test positive for abnormal BRCA 1 or 2 have a higher lifetime risk of developing breast, ovarian, pancreatic and prostate cancer. Remember Tigist’s mom died of ovarian cancer. That is why she tested for the BRCA gene.
Breast lumps sometimes develop during pregnancy. The most common ones are: Cysts which are fluid-filled sacs or Galactoceles which are milk-filled cysts.