The business of life & death

2015-02-02 08:00

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Dr Keo Tabane (37) is wise beyond her years. This is most likely because, since 2008, she has dealt daily with patients who think they are dying. Her empathetic yet straightforward approach is apparent minutes after you enter her office in the Sandton Oncology Centre.

We immediately plunge into a cancer-related conversation. We talk about telling patients how long they might have to live, and whether cancer is a good way to die.

The latter is a startling concept. She explains that some people think that it gives the patient, friends and family the time to prepare for death, as opposed to death from trauma, “though I’ve yet to meet a patient who thinks cancer is a good idea”.

Her eyes crinkle with a smile as she elaborates on how highly individualistic the treatment of cancer has become in recent years.

“Sometimes in our profession, no treatment is the best treatment. The oncologist needs to know when to stop,” says Tabane.

“Furthermore, patients need to have autonomy on how to walk their cancer journey. Some don’t want to vomit and others cannot bear the thought of losing their hair.”

Tabane has a great deal of respect for patients who tell her they understand the treatment she’s proposing, but say: “I don’t agree with you. This is what I want for myself.”

Then she will provide treatment options, as far as she’s able to, that best fit their lifestyle, “because sometimes the journey can go on for years”.

She asks patients about their lives. “Cancer doesn’t happen in isolation.”

Tabane might prescribe a particular treatment for a pianist who needs to feel her fingertips, or might try to ensure that an athlete does not have a drug that would affect his joints or his lung function.

“The treatment must be tailored to the patient as far as it is appropriate.”

Some doctors who diagnose cancer do not tell the person what stage they are in. Stage one has a good prognosis, whereas stage four does not.

“It is your information and you have a right to hear it,” she stresses gently. “Patients should be told if that’s what they need to hear, and I believe it’s good and allows for reasonable expectations about their treatment to be determined upfront.”

She feels that a patient should have some idea of what to expect on a first visit to an oncologist. “Someone who’s just been diagnosed needs to know what questions to ask, not least because the information a doctor gathers is crucial to their treatment.

“We have to ‘read’ a personality so we know what to say and when to say it.”

It’s like walking a tightrope, but Tabane believes she has to be truthful without being abrupt. “So it is more about how you say it, as opposed to what you say.”

It’s been an ongoing learning curve, she says, to educate herself about different communication styles “and maybe we don’t get it right all the time”.

She wishes that medical schools provided training in communication skills.

Tabane has posted features on cancer topics on the Sandton Oncology Centre’s Facebook page, hoping that people will comment and, in so doing, generate debate.

“But I’ve been surprised that people don’t comment on our Facebook page,” she says, disappointed.

She could not be more different from the public perception of oncologists, who, because they deal with death every day, often distance themselves from patients and their families.

Here’s an oncologist who goes home and agonises over how to best manage the treatment of a cancer patient.

“I take it home because that’s where I can relax and it’s in that frame of mind that I make my best decisions.”

Tabane grew up in the village of Hebron, north of Pretoria. Her mother was a teacher, and her father an Anglican priest and librarian.

Her mother taught at Hebron Primary School and she took then four-year-old Tabane to school with her, “because I refused to stay at home”.

It’s no surprise that she matriculated at the age of 16 and was about to register at university for a career in physiotherapy when she realised her real passion lay in medicine.

She graduated from Medunsa in 1999, did her internship at Kalafong Hospital in Pretoria and in 2005 qualified as a physician nearly a year ahead of the time she had been allocated to pass.

The next year she decided to subspecialise in medical oncology and qualified in May 2008. There are three subspecialities within South African oncology: medical, radiation and clinical oncology.

She chose the less popular field and became one of only 17 medical oncologists in the country, as opposed to the then 209 radiation oncologists.

She joined the Sandton Oncology Centre in 2008 as the first and only black female medical oncologist in the country.

“But please mention that there are several black male doctors in this field now,” she stresses with characteristic modesty.

Initially, Tabane had a tough time as patients were surprised to meet a young black female doctor.

“Sometimes they were rude and some cancelled future appointments. In retrospect, I realise it had nothing to do with me. They were just afraid.”

The happily married mother of Ona (2) says, as we end our interview, that she often thinks: “If only we, the healthy ones, could appreciate how precious life is while we are still well.”

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