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Facing the Consequences of the Pandemic as an Oncologist-in-Training

For the first time in history, a pandemic has shut down the entire globe. COVID-19 has affected our lives in many ways, including significantly impacting health care services. Many people, sensing an unseen danger looming in the air, have become increasingly afraid to visit their primary care physicians, and we are now discovering the catastrophic consequences of this delay. 

As a medical oncology resident at the National Cancer Institute in Egypt, part of my job involves screening and examining numerous patients from every corner of the country. People of every color and stratum of society are all touched by this infamous malady. I see, on average, 30 patients every day with common and rare types of cancers who each have their own tales to tell. Recently, I met one of the casualties of delayed care due to this pandemic. I felt the weight of the unseen burden, the heavy impact of the pandemic, and the bleak consequences we’ll have to endure.

On the morning of the July 21, 2020, a 19-year-old woman from the Red Sea Governorate in Egypt visited our institution in Cairo, which was a nine-hour car drive. I had started my encounter with her, and I was struck by her story immediately.

It all started six months ago with an odd sensation in her flank that quickly evolved into pain: unusual, nagging and persistent pain. But the pain wasn’t enough to get her to drive all the way to Cairo. The fear of catching COVID-19 was stronger than her flank pain which forced her to stay in her small hometown as an unwelcome visitor was insidiously and maliciously growing inside of her. Five months later, she noticed a palpable foreign lump in her flank.

Then came the tipping point — she noticed blood in her urine. She had morbid thoughts of death as she saw the red horror seeping from her.

This finally prompted her to make the journey to Cairo. After going through an extensive workup of imaging, blood tests and biopsies, she was diagnosed with metastatic renal cell carcinoma. My mind went numb. I couldn’t believe it. A cheerful 19-year-old college student with a bright future ahead of her was being sentenced to death just because she was afraid to visit her doctor. If she had just come to the clinic earlier, she possibly would have had a five-year survival rate of 95%, rather than having a median survival of only 10 months. 

I spoke with her about her interests and hobbies; I felt the need to connect with her before delivering the devastating news. Then came the moment of truth. Her already pale, sunken eyes seemed to sink further in her tears. As she was trying to process her diagnosis, her mother held her hand and said, “Everything is going to be okay, sweetie.”

On the contrary, I felt helpless in unspeakable ways.

This patient is just one of the many other patients who has come to our clinic with undiagnosed late-stage cancers and unfortunate PET scans lighting up like Christmas trees due to delays in diagnosis. Because we were unprepared for this pandemic, we are continuing to suffer miserable drawbacks. By spreading awareness of timely check ups and expanding telemedicine appointments, our society can be better prepared to care for others during times of crisis. Then, we can hopefully mitigate the needless loss of lives caused by delayed care. No one deserves delays in receiving health care or being told that they have only 10 months to live simply because the risk of catching a virus is deemed more consequential that being diagnosed with a terminal illness.

Image credit: Small cell lung carcinoma by Ed Uthman is licensed under CC BY 2.0.

Mariam Saad (1 Posts)

Resident Physician Contributing Author

The National Cancer Institute of Egypt

A physician-scientist in the making. Graduated from Cairo University School of Medicine in Egypt and is a medical oncology resident physician at the NCI in Egypt. Former trainee at Harvard's affiliate; Brigham and Women's Hospital. Is an aspiring artist and believes that empathy is the main ingredient of humane and compassionate care.