By Dr. Kenneth D. Kemp
There is a line in Les Misérables wherein one of the characters affirms there is often a grief that can’t be spoken and the pain goes on and on.
On October 7, 2013 my closest cousin and one of the greatest persons that I’ve ever known tragically lost her battle with Stage 4 cervical cancer. Her name was Angie and this is her story.
Two years following early retirement from a government desk job she’d held for 31 years, Angie began experiencing back pain that became progressively worse, over time radiating to her lower abdomen and both hip joints.
She had no precipitating injury to warrant the pain and assumed she needed to change her mattress. When that didn’t work and over-the-counter medications did little to alleviate her pain, she sought help from her primary medical doctor.
At that point she was experiencing a notable decrease in muscle strength in her lower extremities with mild numbness in her feet. X-rays were performed and were normal so she saw a neurosurgeon and had a MRI of her lumbar spine performed locally on December 21, 2012. Results indicated she had multilevel spinal stenosis with resultant disc bulges at the L3/L4, L4/L5 and L5/S1 portion of her back.
Neither rest nor therapy were enough to subdue her symptoms. She opted to have another MRI performed in the US on March 25, 2013 and results continued to indicate severe spinal stenosis with associated nerve root impingement within the aforementioned regions. At the advice of her neurosurgeon, she underwent surgical intervention two months later.
A few days after her surgery she realized her pain hadn’t improved and seemed to worsen. The pain was so severe that she often cried for hours on end. No medication was strong enough to alleviate it so she was relegated to sitting in ice baths for comfort.
This once vibrant and jovial person was now crippled and bent over because to stand up straight exacerbated her back and abdominal pain to unbearable proportions.
It was shortly after this that I found out that she hadn’t had a pap smear in several years and I suggested she see her gynaecologist immediately for an abdominal and pelvic ultrasound and a cervical biopsy to be performed; the final pathological diagnosis being moderately differentiated squamous cell carcinoma.
By this time, she preferred to sleep on the floor than in bed because the cool bedroom tiles offered a modicum of relief.
All semblance of normalcy she had ever known was gone and she often gripped her hands in agony even while asleep. Her pain ultimately became so intolerable she had to be admitted to PMH.
This was the first time she was in the hospital as a patient since her birth 52 years prior. While there, a CT of the abdomen was performed and was positive for Stage 4 cervical cancer with liver metastasis.
She was advised there was nothing they could do for her except pain management and she died four months later.
Cervical cancer is a form of cancer that occurs within the cervix at the lower end of the uterus where it connects to the vagina.
Early stages have no symptoms and paradoxically, if it is found early, it is highly treatable and associated with long survival outcomes. Arguably the most effective screening test available is a pap smear and Dr. Mildred Hall-Watson, the renowned Bahamian obstetrician/ gynaecologist (Ob/Gyn) and founder of the ‘Healthcare Centre for Women’ suggests women start having them at the age of 21 or 22 if they are not sexually active.
Once sexually active, however, the papillomavirus is pathognomonic for the development of cervical cancer so she suggests earlier screenings in this patient population.
The reason being that these virus cells when undetected (or when detected and untreated) can invade neighbouring cells.
Dr. Hall-Watson iterates that fortunately there is a vaccine for cervical cancer and a pap smear is a relatively simple procedure when looking at the sequelae of not having the pap smear when appropriate.
Angie loved crab salad, native fruits, freshly baked coconut bread and macaroni. She loved to bake cakes, read Danielle Steel novels and decorate her home for Independence Day, Christmas, Valentines and Halloween. She always cried when watching romance movies, exercised daily on her treadmill and loved to watch soap operas. She loved to travel, laughed often and filled our family with pure unadulterated happiness every single day.
The final line of the Les Misérables quote is that there are empty chairs at empty tables where my friends will sing no more.
Every family will face having to navigate through their own version of a new normal at some point. But to know better is to do better and I encourage you to encourage your loved ones to visit their Ob/Gyn and get a pap smear regularly because I pray that your new normal is far, far away.
• Nick-named ‘The Prince of Podiatry’, Dr. Kenneth D. Kemp is the founder and medical director of Bahamas Foot and Ankle located in Caves Village, Western New Providence. He served as the Deputy chairman for the Health Council for five years and he currently sits on the board of directors for the Princess Margaret Hospital Foundation in his role as co-Vice-chairman.