Diagnosed with pancreatic cancer, which she left under the radar for too long, Dr Tania van Avendonk moved from professional carer to also being cared for; to a patient, not just their doctor… Having moved also between anger, fear, regret, calm and living for the moment, she tells Kristina Chetcuti that patients should take ownership of their treatment, express their wishes and question their doctors to be sure they are not being treated as a statistic.

A burst of explosive energy – that’s how I describe her. For the last 10 years, every time I’d meet Tania van Avendonk, she’d be brimming with stamina, overflowing with liveliness. I’d be in awe of her multitasking: stethoscope in one hand, pen in the other, her shoulder cradling her phone to her ear, and all the while listening extremely attentively to what I’m saying. To be like that, I’d need four pairs of hands, two brains and no concept of flopping on the sofa.

Tania, 52, from Rabat, is one of those doctors – she has been a family practitioner with a special interest in women’s care for 30 years – with a long list of regular patients who would only want to see her, and who would trust her no-nonsense advice before anyone else’s.

When we meet for this interview, however, it’s a very different Tania. The tour de force has been rebooted, so to speak, and replaced by an aura of calm and tranquillity. The perfect juggler of tasks is instead enjoying her quietude, and all those surrounding her are basking in it.

“Sometimes we get a break in our lives and it shifts our energy,” she says. There is a long pause and she is smiling. “It had to be this thing that transformed me.”

‘This thing’ is cancer.

Two and a half years ago, after three years of ignoring worrying symptoms, she was diagnosed with pancreatic cancer. Stage 4. As a doctor, she knew what that meant. It meant a bleak prognosis of six to nine months.

“When I got the news, I was very angry. First of all, at myself for leaving it so long to go to the doctor, and secondly, I was angry at the world – why me? But this is a question you can never answer; if you keep dwelling on it, it rots you inside,” she says.

When her anger subsided, she was overtaken by fear.

We talk for a while about her “carelessness”. As a doctor, shouldn’t she have been more sensitive to her body’s alarm bells?

“I suppose yes. Two other colleagues of mine had been diagnosed with pancreatic cancer and passed away and I just said to myself: ‘Tania, it can’t be!’ I mean what were the chances of it happening to such a small cohort of people?”

Her most severe symptom was back pain. “It was so bad that I could not even sleep at night, and during the day, I needed painkillers to carry on. At one point, the pain was so agonising that I lay flat on the floor and told my daughter to step on my back.” But she put it down to stress. “I lived a stressful life. Like everyone else, I was juggling many things, but I am not one to make a fuss.”

For months, her husband of 29 years, Frans, and their two children, Jan and Tessa, now 22 and 25, went along with it. However, when three years down the line she started going to bed early and having afternoon naps, they started worrying. “If a patient had come to me with these symptoms, I would have sent them for tests immediately,” she says.

It was her daughter who finally persuaded her to go to a doctor. “I owe it to her,” she says, whispering. Her eyes well up as she explains how Tessa insisted she visits a consultant because she was going abroad on an Erasmus exchange and wanted to put her mind at rest.

It was November and the consultant suggested a CT scan – “just so that we don’t get bitten, Tania,” he said to her. Even he thought it highly unlikely that yet another colleague would have pancreatic cancer. With Christmas round the corner and her daughter going abroad, she did not want to disrupt festivities and so she went for the scan in February.

The result was what it was. “It was very difficult for my colleagues to face me and tell me certain things. It’s not easy giving bad news to a friend. They could not bring themselves to say it. They were counting on my being able to read between the lines,” she says.

But she knew the statistics. For doctors, Stage 4 cancer is inoperable and, according to medical guidelines, for a case like hers, the only option is palliative care: pain killers and chemotherapy to ease the pain, and support. There aren’t even support groups for pancreatic cancer sufferers – it is such a mercurial killer that there are usually no survivors to share their stories.

“I could not accept it,” she says matter-of-factly. It is in her tenacious character never to take no for an answer. It’s not for no reason that friends consider her to be as hard as nails. If she believes in something, there’s no backing off. “Now, it was the time to fight for the most important thing: my life.”

Going against the doctor’s orders, she felt her best chances lay with surgery. “I wanted… I needed, extensive surgery,” she says. Tania did her research and contacted the most specialist clinic on pancreatic cancer in Germany. But even there, they refused to do it for her, citing the advanced stage of her cancer and encouraging her to stick to palliative care. But she would not give in. She kept researching, studying, talking to colleagues.

“In the end, a surgeon in Malta told me he was willing to shoulder the risk of surgery,” she says. Thanks to his pluck, and to the procedure carried out in the liver by another doctor – microwave ablation – her six to nine months have so far stretched to two and a half years, and with the advances in chemo these days, it has been a relatively “good-quality life”. She has continued to work, to travel, as it was important for her to maintain normality, and not to let the disease control her.

“In the process, I’ve gone from being a professional carer to also being cared for – and that role reversal was not easy for me,” she says. However, Tania could see that people who came to her clinic were relating more to her. “I was now also a patient, not just their doctor.”

And more and more, she found herself telling her patients to take ownership of their treatment, to express their wishes, to question her as their doctor, and to question medical practitioners so as to ensure that they are not being treated as a statistic.

Slowly slowly, she allowed this break in her life to help her become more self-aware. “It allowed me to understand myself better.” First and foremost, she learnt to let go, to live for the moment. “I used to live for tomorrow. I used to want to control situations. I used to plan my future to the minutest detail. I used to make plans weeks and months in advance. But plans can go wrong. Now I just live in the present,” she says, as we chat about her life today and how she enjoys even simply sitting on a bench in the garden.

And because she is so light about it, so at peace, we can joke about the contrast between a Tania then and now. “Can you imagine me sitting on a bench, observing life? And I am enjoying it so much!”

However, the stark reality of the present is sometimes too crude.

We see a young couple walk past us, hand in hand, and she cannot find her voice for a long time. Silent tears trickle down her cheeks. She asks rhetorically: “Will I see my children get married? Sometimes, I can’t help it; I feel jealous of people who can plan ahead.”

Although her husband and children are very supportive, and although they are all trying their hardest not to let the dynamics change, things have subconsciously shifted. “My daughter does not want to go and do her master’s abroad as she wants to be close to me all the time,” she says.

Together, they realised that family happiness is not based on what you manage to achieve financially, or your career, but on sharing the small things in life. “I count my blessings in the circumstances,” she says. One other colleague diagnosed with pancreatic cancer died recently, leaving behind three young kids, and that keeps her perspective in place.

“I now feel I have a meaning in life.” It is one of the reasons for her doing this interview. “I want to pass on the message that with the right care and attitude, we can shift something negative.”

As a doctor, Tania knows full well what will be happening to her body sometime in the future. But she does not dwell on it. Her plan now is just one: to enjoy life.

A doctor’s advice to doctors

“As doctors, we tend to practise medicine based on figures. People are categorised in boxes, slotted in stages. You’re Stage 1; the other is Stage 3; the other is Stage 4. Perhaps we should try and put aside statistics sometimes and give more personalised, individualistic care.

As long as there is life, there is hope. So what if I only have a two per cent chance of survival? I can be that two per cent! I can turn it around!

I have complemented Western medicine with acupuncture, reflexology, homeopathy, reiki and Bach therapy. There is nothing to lose; more to gain. Of course, you have to be careful; you have to ensure that people in alternative therapy are recommended to you.

I knew that if I wanted to achieve a form of healing, I had to work on certain issues: emotional, physiological and spiritual, and not just physical.

Scientific medicine just tackles the physical aspect. But doctors also need to acknowledge that healing comes from within and support it. Because it cannot be explained scientifically, then some tend to call alternative therapies ‘ћmerijiet’. Let’s acknowledge that, sometimes, healing is more than just a physical cure. A doctor’s job is to encourage the fact that life is worth living.

But most of all, I’d like to tell my colleagues in medicine: we focus on work, on career, on friends and family, but if we have to help people, first we have to take care of ourselves.

So please don’t do like me; check symptoms as early as possible. Listen to your bodies. Nobody is a super being.”

This feature first appeared in the August 2017 issue of Pink magazine. Dr van Avendonk passed away on January 24, 2018.

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