During Marilynn’s internship in a gynaecological clinic, there was a woman who had been struggling with infertility and finally got pregnant. More than that, she was expecting twins. She became a precious person, a kind of case study and was not to be let out of sight, said the supervising consultant doctor. Finally, after the long wait of nine months she was due for delivery. It was an exciting time for the couple. She laboured but complications occurred with one of the twins and Marilynn was on call.

The consultant gave the go ahead for a caesarean section to be performed given the nature of the complication. “I remember telling the anesthetist ‘her blood looks a little dark, are you sure things are okay? and I was thinking she is finally going to meet this one thing she really wanted in her life,” explains Marilynn. Then suddenly, the anesthetist said they needed to resuscitate her. Marilynn got agitated and even aggressive, her voice was loud ‘why, what do you mean, what has happened,’ she demanded. After some push and pull, they got Marilynn out of the theatre. “It turned out she was out of oxygen for eight minutes, the machine was faulty and we lost her. I was the surgeon, I had to break the news to her spouse.”

The twins survived and when the father saw Marilynn’s face he knew there was a loss. He had got exactly what he wanted but he was going to have to do life without his wife.

That experience shaped Marilynn’s life as a doctor. Life can be fleeting and things can instantly change. “Even if I am a doctor, a higher power is in control,” she says. “I felt guilty and it took me a while to accept that sometimes this will happen in my career; we treat but God heals.”

These are some of the gaps in the local health system – when equipment does not work as it should even when the doctors work as they should.

To deal with this, the doctors normally sit together to have a debrief session with their consultant doctor while in training and talk over the experience. “We get to understand there will always be these two sides to it: the happy story and the sad story,” Marilynn says.

Every month, doctors are to sit with psychologists but again, already low on capacity, Kenya has not yet managed to implement this systematically. It can push one to depression, alcoholism or lead them to stop practicing medicine, as they have witnessed with colleagues.

Marilynn’s husband is a positive force in her life. She describes him as understanding that he has married a woman who the world will sometimes need more than they will need her and he enjoys raising their daughters when she is away. There is a lot of give and take in creating that balance, she explains.

Tracing back to her childhood, living with two brothers as the only girl, she was a tom boy climbing over walls and trees. She once fell and injured her arm. They called their mother using a phone booth. When she arrived, she rushed Marilynn to the hospital and she ended up in theatre.

“Seeing all these lights and the doctor no longer in a white coat but in scrubs, created an interest in medicine but it was not until later in life that it became a decision,” she explains.

In high school, during the 90s, they were placed in a hospital where she had to do community work every weekend and that was when a medical career became more established for her. “I think this might be my thing, this was it,” she thought. She had never struggled with Science and Math as much as her favourite subjects were biology and history because she enjoyed reading.

Coming to the end of her undergraduate training in medicine, Marilynn realised surgery was more straightforward for her. She went back for masters and did work in all arms of surgery. “I found there was not enough being done in breast disease,” and that was how she had developed that interest.

“Just getting told you have cancer, breaks you,” and female surgeons tend to look at the smaller things in the bigger picture, for example, who is going to be supporting the patient back home, explains Marilynn.

“We have come together as a group of both female and male doctors and having put the patients journey at the centre, one of the roles we have created is the patient navigator,” Marilynn talks of this role as the bridge between the doctor and the patient. A doctor may have a schedule that may not give enough time for constant communication with all their patients. The navigator walks with the patient through that journey and also schedules times when the patient can have conversations with the doctor about their fears and hopes. This could be as simple as knowing if they can push a treatment a week forward when their children are on mid-term break at school.

The team of doctors are from multiple disciplines: four surgeons, three oncologists, two nurses and two patient navigators. The result is reduced dropout rates and treatment time.

Marilynn explains the dynamics in diagnosis

Worldwide, lung cancer is the most prominent form of cancer. Breast cancer is second on the list. In Africa, the most prominent was cervical cancer until vigorous preventative campaigns took place. Cases were picked early enough. The superseding numbers in breast is attributed more to improved diagnosis rather than an increased rate of the cancer. Now the two have been combined and women are advised to get their breasts checked as they get their pap smears.

Nonetheless, this poses a further challenge. If a lump has been found in the breast, the investigative diagnosis comes at a high cost, unlike with cervical cancer. Many women put it off as it may not bother them until much later and by then the cancer has become advanced. NHIF coming in has helped to subsidise this but for many women from the lower socio-economic backgrounds the cost they still need to incur is high. In remote areas it is an even bigger challenge.

“Doctors are seen as next to God,” and one may come across a doctor who may decide it is nothing to worry about, something a patient would gladly believe.

“We now emphasise during our lectures to upcoming doctors that any lumps must always be investigated. One cannot tell with the eye if it is something to worry about or not. It would be unethical for a doctor to tell you not to worry before further investigation, it is our duty to minimise error,” says Marilynn.

Next for Marilynn to pursue her training for registration as a breast surgical oncologist and to keep embedding the multidisciplinary holistic approach to the treatment of patients with cancer.