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Empowering Pakistani women: Surviving cancer and challenging traditional norms

We have a female patient admitted to our oncology ward for a week. I’ve known her for a long time. She works in our hospital’s dental department as a technologist. She is currently 40 years old. She was diagnosed with a brain tumor in 2009. She underwent maximum safe resection; it was oligodendroglioma grade 3. She underwent concurrent chemoradiation followed by chemotherapy and received a few more cycles of adjuvant chemotherapy. She remained disease-free for many years. We monitored her with serial MRI scans. Fortunately, she had no neurological deficits and continued working in our hospital. She was a really pretty, intelligent, and hardworking lady. She was married but had no children.

She belonged to a low to middle-income class family. In 2020, she started having focal fits. We repeated her scans, and it was a disease relapse. She underwent surgery again, and it was glioblastoma multiforme this time, which is a very high-grade tumor. She was started on chemotherapy again. Her disease was controlled for some time, and she still had no neurological deficits, continuing to work. Whenever she came for a follow-up, she was mostly alone; her husband never came with her. Later, I learned that she was supported throughout her treatment by her brother, who was working abroad.

She was lucky to survive this long with recurrent brain tumors. She experienced another disease relapse in 2023 and started on second and third-line chemotherapy, but her disease kept progressing. Last week she came with a complete loss of vision in both her eyes, expressive dysphasia, and right-sided weakness.

When I took her history, she was accompanied by her elderly mother, her only caretaker. She told me that her condition had been deteriorating for the past 3 to 4 months. They didn’t bring her to the hospital earlier because they were short of money. Her husband had left her because she was in bad shape and couldn’t earn anymore, so she wasn’t able to bear the expenses of her treatment on her own.

When I examined her, her ECOG performance status was 4, which means she was completely bedbound and unable to take care of herself. She had a complete loss of vision in both of her eyes, extreme weakness, significant weight loss, 0/5 power in her right upper and lower limbs, and even Grade 2 bedsores on sacral areas due to prolonged illness and immobility.

We did her MRI, and it showed a frank progression of the disease. Her brother came back from abroad just for her. He was emotional and begged us to try our best and explore other chemotherapy options. He was even willing to take her to another country if better options were available there.

We discussed her case with hospice, and her case and scans were even discussed in the multidisciplinary tumor board, mainly because of her young age. Finally, we decided to provide her with the best supportive care only because given her performance status and deteriorating condition, we couldn’t take a chance on subjecting her to further chemotherapy. We decided to change her code status from Full code to DNAR. We counseled the family that she needed the best supportive care only.

This is just one example of countless cases that I witnessed during my four years of training in clinical oncology in Pakistan. We treated a case of triple-negative breast cancer in a young female who also came on her own throughout her treatment. When she had a disease relapse, her husband came to the clinic and blamed us for her treatment. Obviously, he knew nothing about his wife’s treatment details and only became interested when he had a chance to blame the oncologist. Later, he left his wife.

Another case I’ll never forget is a young girl with medullary thyroid cancer. We treated her with surgery, radiation, and chemotherapy. She remained disease-free for quite some time. One day, she came to the clinic with freshly applied henna on her hands. We found out that she had recently gotten married into a very nice family. But then her tumor markers started rising. We were in a dilemma about breaking this news to her because of her recent marriage and blissful state of mind. It was difficult to do so. We were more worried about her husband’s reaction and her marriage’s future than the disease progression.

I’ve seen many young girls who are either divorced or left alone by their husbands just because they couldn’t have more kids due to their treatment. I’ve even seen female doctors fighting on their own against deadly diseases like advanced cancer, without the support of their husbands.

I’ve also seen many cases of male patients with different cancers who were supported by their wives through thick and thin. These women not only took care of the treatment process, showered them with love and care, but also dutifully performed their household duties and looked after their husbands’ parents and family members patiently.

It breaks my heart to see such examples of Pakistani women fighting cancer on their own. There is a lot of physical and emotional trauma involved. They not only fight cancer but also loneliness and depression. I’ve witnessed many loyal women and the egoism and careless behavior of Pakistani men. The women in our country are extremely loyal, hardworking, and loving, but they are never appreciated for their sacrifices.

I’ve seen many women who were very supportive of their doctor husbands throughout their residency, but when they became consultants, they shamelessly found another partner just because they no longer found their husbands attractive. If marriage is all about physical attraction and great sex, what about compromise and the promises of building a life together? The kids also suffer due to this selfish behavior of their fathers.

I am 30 years old, an accomplished doctor, and my family is worried about getting me married as soon as possible because in our country, we think that 30 is too late for a girl to get married. After 30, the chances of finding a good match become slim. I am well-educated and not the type of girl who will marry any guy selected by my parents just for the sake of getting married. I met many guys to understand their thoughts about marriage, and I was extremely disappointed by the attitude of Pakistani men towards women. Firstly, due to inflation and economic crises in the country, guys in the age group of 25 to 30 are themselves in an existential crisis. They don’t know about their future or source of income but are eager to get married as soon as possible. Obviously, they don’t have the ability to start and support a family when they can’t even support themselves.

On the other hand, guys in the age group of 30 to 35 are financially and emotionally stable, but most of them have grown bitter towards women, either due to traditional mindsets or past heartbreaks in their old relationships. Most meetings with these guys end up in disappointment because things often revolve around whether I can make “gol rotis” (round bread) or have children as soon as possible, solely because of peer pressure to marry and have children quickly. Compatibility seems to be a foreign concept in our country. People get married under family pressure and then either endure unhappy marriages due to the stigma of divorce or end up divorcing after a few years when they can no longer live with their partner or find a better option.

It’s challenging to live and survive in this country as a woman. Men want women who are not only pretty, have professional degrees, can cook, earn, take care of their families, bear children, and raise them, but also demand unconditional love for their husbands throughout their lives. I’m fed up with this mindset, and I’m willing to stay single rather than stay in an unhappy marriage. I haven’t grown bitter towards men because there are good people too, but the majority of our society has set difficult criteria for girls just because they are girls and are willing to compromise on anything. I believe educated girls need to acknowledge their own potential and rights; otherwise, they’ll end up in a miserable life.

Damane Zehra is a radiation oncology resident in Pakistan.

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