Global Doc: Smile

Author: Dr. Vincent DeGennaro Jr. ’02

Alexandra entered the internal medicine clinic, a bandana covering her bald head and a dress flowing down to her ankles. Her smile was infectious to say the least; it was also too expansive for the number of teeth that remained after a lifetime of poverty.

She handed me a folded note, its French scrawled in blue pen.

Alexandra cannot afford any more chemotherapy. Please accept her into your program for treatment.

After six cycles of a planned eight, Alexandra had run out of money. Paying out of pocket, she’d already asked her friends and family to pitch in.

Over the next two years, her life intertwined with the growth of the cancer treatment program at Hospital Bernard Mevs. With every new initiative we launched, she participated, helped shaped it, and benefited from it. At 60, she was one of our older patients and brought a matronly presence to the ward.

When she showed up at my clinic in August 2013, Alexandra was our first referral from an outside doctor, a hopeful sign of acceptance from the local medical community. We partnered with a crowd-funding website called Watsi and Alexandra’s was one of the first profiles we posted, raising $1500 for her treatment in just a few days. We completed her last two cycles of chemotherapy in the Women’s Cancer Center and performed a mastectomy, all free of charge.

Alexandra was free from cancer for the next six months and she became the program’s poster child. Not because her story was particularly sad or happy, but because of the glow that emanated from her soul, enveloping those around her. Her gap-tooth smile lit up the cancer ward — no small feat given the size of the room and the number of patients. Her big belly jiggled with every gentle laugh. She couldn’t complete a sentence without expressing her gratitude to God for all things large and small.

The graying shock of hair grew back slowly after her therapy, lending more character to an already full face. She happened to be present for one or two visits from program supporters and she loved it. From then on, she became an invited guest for such visits. She’d thank the doctors and nurses, who were second only to God in her words.

Later, the cancer returned as small pink nodules on her skin slowly creeping up the side of her left breast, adjacent to the scar where her right breast had once been. A visiting specialist prescribed another six cycles of chemotherapy: We would benefit from Alexandra’s presence in the ward once again. She slung a towel rag over her shoulder to wipe the sweat from her face and tied the bandana atop her once-again bald head. She never flinched, never showed anything but her huge, gap-toothed smile, accepting the new course of chemotherapy as if nothing had changed.

Over time, I discovered more about her life outside the cancer ward. Alexandra sold school supplies on the street. She raised her granddaughter by herself after her daughter had died a few years back. Needless to say, she attended church regularly, singing and worshiping as if each day might be her last.

After four more months of chemotherapy, we performed another mastectomy, leaving her with two matching, jagged, diagonal scars. Partners from Miami visited us, bringing external prosthetic breasts. Since Alexandra required both sides of her bra filled, she was actually the easiest patient to fit, the same size of prosthetic used bilaterally. She posed for pictures in the bra, bosom proudly back in place.

Three months later, the bandana gone and her hair coming back in, Alexandra learned the cancer had returned a third time. She restarted chemotherapy. We later tested all our patients for the BRCA 1/2 genes through saliva samples. Alexandra dutifully filled her sample tube. The test results turned out negative — her cancer wasn’t passable. Good news for her granddaughter.

One day a professional photographer asked if we had patients who might volunteer to pose for pictures for awareness and fundraising purposes. Those who did were brave enough to admit publicly that they had cancer, a stigmatized disease in Haiti as it is in many parts of the world. The photos demonstrated the women’s strength and pride in their bodies. It made them feel normal after a mastectomy. Alexandra courageously displayed her two scars in the black and white photos.

During a visit from the Jack Brewer Foundation, Alexandra told the professional football players, models and business people in attendance about her journey with cancer. She detailed the many doctors and hospitals she had seen before finding a diagnosis and treatment at the public hospital. However inexpensive the services, chemotherapy had bankrupted her family. She thanked God aloud for having found the Project Medishare program and said she was proud to be undergoing chemo once again.

After the Brewer visit, Alexandra showed me how the cancer nodules had spread to her back. She said they didn’t really bother her, beyond some minor pain. I handed her a prescription for Tylenol and she smiled, thanked me and God, and walked slowly out of the ward.

Alexandra died last week. In the coming months, the Women’s Cancer Center will transform into a Women’s Health Center, adding services like basic gynecology, prenatal care and family planning. Alexandra didn’t need many of these services at her age, but we know she will watch over us, smiling as we push to make things better.

Vincent DeGennaro is an internal medicine doctor and a global public health specialist at the University of Florida’s Division of Infectious Diseases and Global Medicine and works half time in Haiti with the nonprofit Project Medishare. See his An American Doctor in Haiti blogs.