First time really being a cancer doctor...

Over the past week, I have been seeing my friends mom and working her up for a breast problem which did turn out to be cancer. This is my friend who is well educated, wealthy family, spent lots of time abroad as her dad was diplomat. She owns one of our favorite restaurants in town. She was one of the main organizers for the Think Pink breast cancer awareness event in October. She called me because her mom had this swollen breast  that she went to 2 different doctors for and they each prescribed her antibiotics. Lets pause here, the chance of a 67 year old otherwise healthy women having a serious breast infection is pretty slim. It wasn't getting better and they got an ultrasound, which was also inappropriately interpreted. The mammogram, even though they could afford it, was down.  Finally I saw her and knew right away it had to be cancer, and pretty involved, with the appearance of her breast. We did a biopsy and came back as invasive cancer. I sent her for a full staging workup, which fortunately they were able to get and ultimately she was a stage 3. I first told my friend and then her sister in person when they came to get referral letters and drop off results. On Monday, we met them in clinic with Satish and Bongoni (Satish's clinical officer) and spent nearly 2 hours discussing everything. I was the one who was in the room by myself with them and had to tell her the diagnosis. she was shocked. she didn't expect or even think that was a possibility at all---which also just demonstrates the lack of awareness and knowledge about breast cancer in Malawi.  I have been present for this conversation as a medical student and resident many times, but this was my first time that I had to tell a patient that she has cancer, and that its advanced. It was hard. Satish joined soon after and took over most of the conversation since she needs chemo first. They are currently discussing if they will stay in malawi or try to go abroad. It sucks that this all happened as i'm leaving, but i'm glad I got to see her and do the right thing before more doctors sent her astray and only prolong diagnosis and reduce treatment options. This too makes me hate leaving. I feel so much more useful in Malawi and like I can really make a great impact.

Tiwonana in 6 weeks!

I'm currently at the JoBerg airport on my long layover to NYC. The last 2 nights were nice but of course bittersweet. I'm really glad i'm coming back at the end of August so i will still be able to see most of my friends and of course a more manageable time to be apart from Ben. Actually the last 2 summers we spent 4-6 weeks living in different places (Boston- NC and Malawi-NC). On friday night, I had an impromptu farewell dinner at one of my favorite restaurants in town--Fantasia, korean. Tuesday during the day we had a nice lunch with Jared. Dr. Charles was supposed to come, but got stuck in the hospital. Our last night we moved some of the stuff i'm leaving into Ben's new Malawi home which is very nice, hung out with a friend for like 30 minutes while we had an electricity outage. Then I made us a feast for dinner.

Last weekend in Lilongwe...at least till vacation in August

We had a fun and relaxing weekend, just hanging out with friends and hanging out with each other. Friday night we had a few friends over for dinner. Saturday Ben played 2 soccer games adn we had dinner with other friends at night. sunday, Charles my tailor came over for last time. I will really miss him and his amazing work. We had a lovely breakfast, watched shows, and had a couples massage. At night we had dinner with a really interesting work colleague of Ben's, another consultant, but with a quite  dynamic and international career.  I'm sad to leave this great life we have here!

Last quiz night

It's been a fun year playing quiz night on team "Dirty Kwatch." This was probably my last one :( unless there will be one in August when i come visit. We did pretty well at least!!

Marta's Going Away

Last week it was Chris (and Lauren from week before) now it's Marta (one of our Italian friends). We went to Mamma Mia for dinner. I will miss her, but she will likely be starting a new job in Mexico City in September so it will be close enough to visit I hope!

Return Home :)

Lilongwe definitely feels like home now. I arrived back last tuesday and its been really nice to be back and also really sad to be leaving so soon. One of the couples we were really good friends with now left so it was sad to say Bye, but they they live in London so we will definitely be able to see each other, which i'm very much looking forward to. We had a fun weekend of Malawi World cup soccer tournament where Ben played on the Australia team even though there was only 1 Australian.  We saw the Vagina Monologues on Saturday night which was very good. It was a whole drama to get it put on, but i'm glad that they did. The Malawi censorship board actually didn't allow it and there was all this protest on social media. Anything related to women is still very taboo here, especially with sensitive issues like rights, violence, and even menstruation! The production was excellent. Sunday we hung out with friends and watched The Wire.

Reflections from across the pond

I am now writing from the Calagary airport as I wait to board my flight back to NYC then off to malawi for last trip during my time off on Monday. I was at a global surgery conference here where it was the first time I presented some parts of my work from Malawi. It was well recieved :) I've been in North America now for 10 days and it's been odd. I kept feeling sad most of the time, even though I was at my best friends wedding ( yes another one!) and found us a really nice apartment ( even though I looked at literally 20) and got to see a few friends for the last time in a whole at least as they are moving out of NYC. The past 2 years off residency have been incredible both personally and professionally. I achieved my dream of doing my MPH and research at Harvard. I got prestigious grants to spend a year working and living in Africa which had been the experience of a lifetime ( the good and the bad but mainly good). I accomplished a lot in research inclusion being published in the lancet and actually made real progress in breast cancer care in Malawi. I was even extended funding to stay another year and really expand my work to make even more impact ( but unfortunately my program wouldn't hold my spot another year). I traveled to 13 different countries and made amazing friends from probably just as many countries. Ben and I had some of our best years yet together where I wasn't working like crazy and we really had time to enjoy each other's company. It's been amazing and so hard to believe that it's almost over in a few weeks and I go back to residency ( first 6 months will be alone without Ben :( ). 

I also didn't realize until this trip how living in Malawi changed some of perspectives. I always used to say I like cities only if they are like NYC or like Europe and otherwise I don't like it. Well Calgary doesn't fit either, but I actually reakky liked it. I stayed with a friend who owns a beautiful condo on a resident salary and says her mortgage was less then her rent for her studio apt in boston. The city is young, hip, modern, and fun. There are lots of great restaurant and entertainment. The hospital is great and it's surrounded by beautiful mountains and a river. It also is just so much more friendly and collegial. The few friends I did see in NYC, of course we went out (except Parisa and her baby Amin). I really love the friends we have in Malawi and how we always hang out at each other's houses taking turn making dinner and just enjoying each other's company. I miss the simplicity and small achievements that make such a big difference in Malawi. Everything feels so rushed and complex and siloed in NYC.  I also didn't  even want to go shopping (something i do normally like to do). It's hard to shop in a store after meeting and supporting an amazing local tailor who made me a beautiful wardrobe from local African fabric at a very low cost.

I guess I sort of went through something similar, a long readjustment when I moved back from Israel. It took several months then and I'm sure it will take at least that long now. On to the next adventure...