How you tell someone you have cancer makes a difference in many things.
It may seem like a trifle, but it is not.
Those of us who have received the bombshell know what the story is about
.
María Fernández Abad (40), an oncologist at the Breast Unit of the Ramón y Cajal University Hospital in Madrid, does not allow patients to go to that first consultation alone.
"If I can, I reagent to come accompanied," he explained a few days ago in one of the rooms on the tenth floor.
"It's a shock, a lot of information to process
.
"
And a terrible fear.
Today is Breast Cancer Day, with all the staging of collectives, brands and slogans to remember that this tumor is the most common in Western women.
María is consulting until 3:00 p.m., like every Monday, Wednesday and Friday.
It transmits serenity, although inside, he says, "I am pure nerve."
She is the
first contact for many women before starting the
desert
journey
that is this disease.
"In the psychological part we still have a lot to learn. Doctors do not teach us in the race to manage emotions."
Neither their own, nor the patient's.
"You are looking at how colleagues who have been doing it for more years,
experience gives you the guideline,
" he says, outlining that half smile with which he always receives patients.
He studied medicine because research fascinated him.
"And the most useful part was doing it to improve health," he says.
There were no doctors in his family and no cancer patients in his environment.
"
I chose the specialty because it was relatively new
- it was recognized as such in 1978 - and there was a lot to advance."
He finished his residency at Ramón y Cajal in 2009 and his career began here;
then she spent five years in the private sector and, in 2014, she returned to the public sector to focus only on breast cases.
Fear of the unknown
The first idea that comes to mind when talking about cancer is death, despite the fact that in the case of breast cancer, "
80% are cured today
," says the doctor.
That flash of black that sometimes lasts a few seconds, and others an eternity, is repeated especially at the beginning of the process, when you do not have all the pieces of the puzzle and the 'bug' still does not have last names, that is, we do not know what type of tumor is.
"In a first consultation I like to ask patients how much they know about their disease, if they have had any contact with it. The perception they have of it often depends on that."
Reservoir, relapses, metastasis, chemo, radio, defenses ... Suddenly the conversations begin to focus on terms that you would never have wanted to pronounce.
But there they are.
Ultrasound scans, resonances and analytics are marking a path
.
"All these tests are going to give us the stage of the cancer, the lymph node involvement and if there are metastases in other organs."
With the pathological anatomy of the tumor,
you become the HER2 +++ patient
.
"From stage I to III we know that they are curable," he asserts.
At this point, she is no longer Dr. Fernández Abad.
You already go into consultation with a 'Hello, Maria'.
"We already know what we are facing. First you are going to receive treatment and then you have surgery," he reports.
He says that it is a type of cancer with a good diagnosis: "In 80% it reduces the tumor and in 60% it totally destroys it."
The Her2 +++ is almost 'good news'.
FLEE FROM PATERNALISMS
There is already a timetable for starting chemotherapy.
Initially, four strong sessions every two weeks.
"Normally, the cycles are every 21 days, but in your case we are going to see if you can hold the rhythm," explains the doctor.
Then we will go to weekly cycles and every three weeks an injection of antibodies.
Dr. Fernández Abad
flees from the paternalistic tone
;
he prefers that the patient ask, know and contextualize what he is experiencing.
"You have to avoid sentimentality; convey seriousness, serenity and do it clearly."
Again the shock in the body.
Hair will fall out 17 days after the first cycle.
Until that is measured
.
Almost 900 new cases reach this unit per year;
In Spain
, more than 33,000 were diagnosed in 2019
, according to the Spanish Association against Cancer.
Most of them come to this unit derived from the Community of Madrid's early detection program, which focuses on women between 50 and 70 years of age.
"Maybe it would be nice to lower the age to 45," he says.
There are also patients who are referred from health centers and others who have been diagnosed in private.
"The good thing about the public is that we have access to all medications
.
"
The analytics area and oncology consultations are a weekly reality slap.
You are one more, not the only one
.
There are young people;
more than you think.
Some patients are rhythmic in time and coincide in the day hospital, where the cycles are received.
You look at yourself, you wonder how it will take you, you identify with the look.
At the School for Patients, which started in 2018, doctors like Fernández Abad give talks and guidelines to people who are currently undergoing treatment.
THE MOST COMPLICATED MOMENTS
One in eight women will develop breast cancer.
"The good news encourages you to continue, but it is not celebrated excessively. What weighs is the losses; those are carried on the back for a long time."
Especially when they are young patients.
"The hardest moments for me are when women of childbearing age have to put aside their desire to be mothers for the treatments," she says, "and they don't know if they can be."
It is also very distressing how to tell your children.
There is still a certain obscurantism surrounding cancer
.
And you have to normalize it, name it.
In part, it is to avoid the looks of pity, which rather than help, stir inside.
Children must be told, not hidden.
They are children, but they are not stupid.
Listen to them a lot and adapt the message to each age: 'Mom's hair is going to fall out from the treatment and she's going to wear a wig for a few months.'
And you fall apart, because
throughout the journey you hit rock bottom a few times
.
And the answer, at 6 and 8 years old, disarms you: "Well, Mom, you're going to be just as pretty and your hair grows."
Well that, 6 and 8 years.
There are three complicated moments on the road (the battle and fight against the disease did not quite convince me): the start of the chemo, the loss of hair and the mastectomy.
Hair loss implies the loss of your identity
, but it is also the moment when you look sick.
You are already there.
Seeing yourself in the mirror is a constant reminder of the disease.
Clinical trials are part of the day-to-day life of this unit.
"Sometimes they create objections among patients, despite the fact that it is a process controlled by ethics committees that ensure that the entire legal framework is complied with," he explains.
A year there may be between 20 and 30 in the unit
.
"Approximately half of the patients to whom it is proposed accept and the other do not."
It is a personal decision and the medical team fully respects it.
NOTHING TO LOOK ON THE NET
The only source of information from the beginning is the oncologist, nothing to look at the Internet.
Members from other hospital services are joining the process - there are 12 in the breast unit, the first in the Community of Madrid recognized as a unit of Excellence for its care of breast cancer patients.
Dr. Chiva, head of the radiology service;
Dr. Collado, surgeon;
Dr. Aburto, plastic surgeon ... We are putting a face to what is to come.
After six months of treatment, a date must be set for the operating room
.
They have already informed us that the response to treatment has been total.
Chiva gives us the good news accompanied by two residents.
Dr. Fernández Abad also tells us excitedly, that same Monday, almost at three in the afternoon.
One month after the last cycle, you have to go under the knife.
The surgeon will do the mastectomy;
the sentinel node, which indicates that the cancer has not spread, is clean.
The plastic will rebuild with the expander, the first step in a long process.
And the direct breast to analyze the pathological anatomy: clean 100%.
With no time to celebrate the news, the Covid arrived and shook everything, but the Breast Unit continued with its consultations - in person and by phone - with all the safety and hygiene regulations, but continued.
"Cancer care here did not stop."
It is a perfectly oiled machine where you
always have the impression of being in the hands of the best
.
"In 10 years I see myself here, with my practice and my patients. I really like being in contact with them."
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