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.