Carol’s Column

Johanna gets first-class treatment at a state hospital

My mother lives with a companion called Johanna. Johanna worked as a domestic for my parents for 40 years, but today my mother (84) makes the beds because Johanna (80) suffers from a sore back while Johanna cooks because she says my mother is useless in the kitchen.

My father, a medical man, doctored them when necessary. Foolish, in retrospect, as now neither has medical aid.

Last week, Johanna discovered a lump in her breast. We immediately took her to our general practitioner who recommended a mammogram, then booked an appointment with a private surgeon. My mother, an old-timer, does not believe in credit and pays cash for everything.

The surgeon looked at the mammogram and informed Johanna that she should have a mastectomy because the lump was large and had been present in her breast for a long time. Which mystified Johanna, who regularly examines her breasts- a legacy of my father’s speciality, cancer.

I asked if there were alternative treatments. He said that under the circumstances, a mastectomy (the total removal of the breast plus surrounding glands) was advisable. He booked a room for her at the private clinic (where he works) for the next afternoon. She had to be there at noon and her breast would be removed at 2pm.

We went downstairs (as instructed) to book her in. The clinic asked for a deposit of R3 000 (they said the clinic fee alone would come to R15 000).

My mother (who is not Harry Oppenheimer) was already busy with her cheque book when I suggested we get a second opinion. Lord knows what the final costs (surgeon and anaesthetist, etc) would have been.

A doctor friend suggested we attend the breast clinic at Groote Schuur. It was, he said, the finest in the country. I was apprehensive, aware of all the horror stories about state hospitals.

We arrived at the hospital at 9am and finally departed at 4pm. But what a day of wonder and hope it was. The hospital was frenetic. Sadly, there were many women with potential breast cancers ranging in age from 15 to 90. During that time, Johanna received the most meticulous treatment imaginable. True, it took time, but when you're talking about a lifesaving procedure, so what?

She was seen by a professor of surgery, an oncologist and a radiotherapist. A battery of tests were carried out: Fluid was extracted from the lump and examined by a pathologist, who confirmed the lump was malignant. She had blood tests and a thorough examination by a doctor. She was also sent for chest X-rays.

The attitude of the staff from the lowest orderly, nurses, sisters, the medical students to the head of the department was caring, compassionate and patient. Extraordinary when you consider the immense pressures under which they work, not to mention the paltry pay. There were many patients who were illiterate or perhaps literate but unable to fill in forms. Voluntary workers spent hours assisting patients and escorting them through the procedures.

The final result? Well, Johanna has to attend the clinic today as her case (as is normal) will be discussed by a panel and a final decision on treatment will be made. According to the prof, the lump is minuscule and has been there for a minimal time. It seems the treatment will be a lumpectomy (an excision of the lump) leaving the breast intact.

For me, there are several issues. Under the circumstances, why did the private surgeon recommend a mastectomy?

Then there's the superb treatment at a state hospital. So often these hospitals are maligned. Finally, there's one other thing. I have medical aid. Had it been me I would have gone private. Today, would I have been minus a breast?

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