Prof Lynette Denny, Living in the Body of the World

The late Professor Lynette Denny was one of medicine’s foremost trailblazers in the field of cervical cancer research. A world-renowned gynaecological oncologist, distinguished scientist, and passionate advocate for women’s health issues around the globe.

In this episode of Awakening Doctor, recorded a few weeks before her passing, Lyn talked candidly about her lifetime of public service in South Africa, her unwavering dedication to her patients, and her own experience of living with advanced breast cancer. Medical errors, illness narratives, institutional and systemic failures, confrontations with death, and the challenges of navigating both sides of the doctor-patient divide were all in the mix as we contemplated the delicate balance between providing care and receiving it.

Her story is both a celebration of the extraordinary commitment of medical professionals and a confrontation with the complex and layered realities of healthcare - a nexus of personal battles, societal challenges and systemic inequities intertwined with the relentlessness of the human spirit.

Join us for a compelling and poignant reminder of the human side of medicine and the enduring legacy of a woman with an unwavering dedication to cause and calling.

Chapters

• 0:00 Introduction
• 13:27 A Journey Back to Medicine
• 17:27 Disappointment and Dedication in Healthcare
• 26:49 Navigating Cancer and Denial
• 35:33 The Experience of Living With Cancer
• 41:20 Views on Death and Illness
• 50:08 Understanding Women's Health and Empowerment
• 59:09 Preventable Disease and Medical Error Impact
• 1:08:23 Challenges in Medical Education and Compassion
• 1:19:54 Challenges in Medical Practice and Reflections
• 1:33:10 Healthcare Challenges and Personal Growth
• 1:40:55 Closure and acknowledgements

Transcript

Prof Lynette Denny Guest 00:00

I don't feel afraid of dying. I don't think it's the worst thing in the world. I think there are a lot of things much worse than death. Such as being alive in this world. No, but I think there are things worse than death and I think things like war, which causes death, and the othering of people, and the disrespect, the way in which people are harmed by bad human behaviour, some of the aspects of cancer. There are aspects of it which are very humiliating and I have been really tortured by the side effects from a lot of the chemotherapy and really, in ways that are just too even embarrassing to discuss and can be mortifying. I often say you know, put one step in front of the other and get up, move on, but sometimes it is hard to do that. 

Dr Maria Christodoulou Host 00:56

So what keeps you going? 

00:57

I was really struck by - because I didn't know that Lyn was in hospital and then you let me know that you'd been in hospital, had this near-death experience, that there were six days of your life you had no memory of, and that you then sat up and said I've got work to do. 

01:13

And I thought that is Lyn, no matter what, the work comes first and this incredible resilience actually, Lyn, that has had you survive some of the most horrific things. We were also talking a little while ago, before we sat down to record, about the fact that someone like yourself, who has such a long history in the medical profession, who has such an illustrious career. There's very few people in our profession, certainly in this country, who won't know who Professor Denny is, and then your own doctors have often let you down, disappointed. You've often been on the receiving end of some of the worst kind of experiences in the hospital setting and even as you sit here today, I know you're in some discomfort and I don't want us to pretend that it's all rosy right now. So, how are you feeling in this moment and how is it to be talking about this? 

Prof Lynette Denny Guest 02:09

I've become accustomed to being uncomfortable in my body, and it used to be that I just couldn't stand it. You become accustomed to it because on one hand you have to, but the other side of it is there is something remarkable about being human. In all of us. I feel that there's a part of me that wants to honour what is. I mean, I've watched so many people suffer over the years and from cancer, from incurable cancer, from terrible cancers much worse than mine. The experiences that my patients have been through and particularly because I'm in the public sector and many of my patients are working class or not even working class, who present with advanced disease and have very little real support, and some of the stories that patients do tell are so remarkable. And the number of women who, for example, said to me, I just have to stay alive until my granddaughter gets her matric, or their commitment to their community is so strong. 

Dr Maria Christodoulou Host 03:29

Welcome. I'm Dr Maria Christodoulou, and this is the Awakening Doctor podcast, a space where we discover the personal stories of those who work in the medical and health professions. Join me as I explore the hopes, the fears, the aspirations, and the real-life challenges of those who carry the title, responsibility and privilege of being a doctor.

 My guest today is Professor Lynette Denny, a world-renowned gynaecological oncologist whose groundbreaking research in the field of cervical cancer has saved the lives of thousands of women around the globe. Lyn is a distinguished scientist, a global humanitarian, a very passionate activist and a fierce advocate for women's health. She has received numerous awards, both locally and internationally, for her outstanding contributions to cancer research and prevention, particularly among disadvantaged communities, and most recently she received the Order of the Baobab, South Africa's highest accolade for citizen excellence. 

 I've come to know Lyn as a leader with an unwavering commitment to excellence in healthcare, teaching, training and research, and an extraordinary life of service in South Africa's public sector. A woman who has given her heart and soul to the medical profession, and a human being who is as private and vulnerable as she is outspoken and passionate in her professional life. It's a very rare privilege to be granted a window into Lyn's personal story, not only because she's an incredibly private person, but also because she's recently had some health challenges of her own. So, Lyn, thank you. 

05:09

This is the second time we are doing this. Our listeners know that we had to record one of our episodes again because we had issues with the audios. I'm really grateful that you're with us today. Thank you for joining us and I'm looking forward to where our conversation will take us today. Thank you Maria. Welcome. Also with us is Amy Kaye, the producer and editor of the Awakening Doctor podcast. So hi, Amy. Hello. So, Lyn, where do we begin? Where do we tell the story of Professor Lynette Denny? 

Prof Lynette Denny Guest 05:43

I think it begins when I was in standard seven, when I had made a choice not to do science because I was going to be a nurse and my grandmother was a nurse and I was going to follow in her footsteps and something happened in that year. Lots of things happened, one of which I discovered feminism, and I discovered that women could be what they wanted to be and I thought no, I'm going to be a doctor. And I had to really fight the school to allow me to now do physical science. I had to catch up a whole year of physical science so that I could prepare myself for the correct matric, and even in those days, this was 1975, getting into medical school was still highly competitive. It still is, but different dynamics. So I think it begins then, and it was a very much a committed, passionate journey for me and I really wanted this. I got accepted into actually all the medical schools, but I chose UCT. It had always been my dream. 

Dr Maria Christodoulou Host 06:40

How did that shift in your thinking happen? How did you go from I'm going to be a nurse to actually wow, maybe I can be a doctor. 

Prof Lynette Denny Guest 06:47

I think actually at the same time I started reading and up to that point I'd only read what I'd been forced to read at school and I absolutely was fascinated by literature. And that became the first of many hundreds and hundreds of books that I read. That is what made me think I could be more than just a nurse. It awoke in me the sort of interest in science, the why things are that they are, created curiosity. It was a very, very important turning point for me and to this day, I'd say, literature or reading remains my deepest source of comfort and enrichment. So that, I think, is what gave me the courage to think I could be a doctor. 

07:37

I also had a mother who had not had the advantage of decent education. She was sent to boarding school at the age of five, to a German Ursuline Convent, as was my father, also at the age of five. So these were two very unparented people. And Mom left school in standard eight and went to work at the bank and she was determined that her daughters - because there ended up being two of us - would be the greatest, the best, the most educated, the prettiest, the most prolific, everything she could imagine that we could be. She was passionate about justice and she had very little education. 

08:21

She really pushed very, very hard for me and she kept saying to me why are you going to be a nurse? You can be a doctor, you can be a professor. And so she really pushed me to reach further. She had this thing about women being educated. Her whole life, I know I've only got standard eight, used to be her standard comment about everything. If you criticized her, I know I've only got standard eight. When I was thinking about us doing this conversation, I remembered the day we got my matric results, and when my mother got my results she went whooping around the house screaming and shouting at the incredible joy that I had done so well and she just kept coming and hugging me and hitting me and saying, oh, you're so brilliant. And it was a very passionate time. 

Dr Maria Christodoulou Host 09:20

And your grandmother, what was it about her that made nursing appealing? 

Prof Lynette Denny Guest 09:24

Actually not very much. To be honest, I never found her a particularly emotionally intelligent woman and she used to regale me of stories of her husband, my mother's father, who was a very ill man and an alcoholic and bipolar, and she always said he used to assault her. She used to tell me these terrible stories when I was seven and eight years old and I really never knew what to do about it. My mom always said Nana is such a wonderful woman and how lucky we were to have her, so I believed that for a little while, but then I undid that belief. 

Dr Maria Christodoulou Host 10:01

And what do you think it was about being a doctor that appealed to you? 

Prof Lynette Denny Guest 10:06

I think it really has been a vocation for me. It really has mattered to me and I learned this again from my mother, to take care of other people. She made us very aware of people who had less. I can just remember during those apartheid days. In Durban, we were absolute beach maniacs and we were always on the beach. Black people were not allowed to go into the water and she used to go up to the police and scream and shout and throw sand at them, and she didn't stand for it, and she said this is wrong. But it's always given me immense pleasure to take care of people. I've loved it. I love stories, I'm very curious and the relationship that happens between a doctor and a patient can be very beautiful and very enriching. It can also be very terrible. 

10:55

And then, of course, I did get into medical school and I chose to come to Cape Town. It was an extraordinary experience because I had to leave home. I had to come live in another city. I had two little brother and sister who were aged five and three when I left and it was a big separation for me and quite painful. But the actual study of medicine was so fascinating and I so loved it. I had lots of fantasies about universities in those days as being institutions of learning. I'm not so sure I believe all of that still, but I was committed and I made my very best friend to this day, was in the room next to me and she was a Zimbabwean art student and we became very close. We supported each other through that and I'm godmother to her daughter and it's been a very long association. 

11:47

But medical school was tough on many levels, not that I took it very personally because I was very driven, but it was very much a white male domain, as it is still and as the years have gone by, for me, white male is not really a biological construct, it's a cultural construct and it is sort of white male supremacy, capitalism, extraction, damage the earth way of thinking. So I grew up in that environment. We women were in the minority. Black people were an even more minority. It was both exhilarating and harsh. UCT had an aura. I grew up in Durban which is very anti-Afrikaans. One had to live with lots of prejudice. I was an activist. I started a newspaper called Pulse, which I co-edited with a colleague of mine, and we were really out there. We challenged everything. It was a wonderful time of growth and pain. However, in my third year, I suddenly had had enough, and up to that point I had always aimed for excellence and never believed I was excellent. 

Dr Maria Christodoulou Host 13:04

What do you think the turning point was? How does one get to third year level and then go, I'm done with this? 

Prof Lynette Denny Guest 13:09

I don't, even to this day, understand what happened. Something just snapped inside me. It was like two weeks before third-year exams, I just left. I called my mother and said I can't do this anymore and I'm leaving, and she was completely and utterly hysterical. It had terrible consequences. My parents were not wealthy and so I lost all my bursaries. I had about four of them that were paying for everything. The Dean of the Medical School at the time, he never asked me why, what's going on? He just said, if you walk out the door, you're never coming back. And he never asked why? He never said, what's the matter? What's going on? I said that's fine, I'm never coming back. 

13:51

I left. I went back to my digs in Harfield Village and I told my partner and told my housemate and they just all looked at me like I'd lost my mind and maybe I had. All I remember it was a Saturday morning and I was swotting for the final year exams and I put my pen down, just kept saying to everyone, I can't, I can't. And I didn't know what was wrong. I was just shut down inside and then I wanted to immediately get rid of all my textbooks, my microscope, everything. I just wanted it all out of my life. My mom was beyond angry and a lot of her friends phoned. You spoilt brat. How dare you? Do you know how much your parents have sacrificed for you? So there was a lot of anger. No one said, what's going on. 

14:40

I decided I was going to be a journalist. So I applied to The Argus and I got selected to go to journalism school, which was in Johannesburg. I went for six months. They paid you basic junior salary and I love writing and I did very well and I won the prize. So this was my year of letting people down because I won the prize and the prize t was, 

15:06

you got sent to London and my teacher, the head of the journalism school, he said to me, Lyn, you don't let me down, I'll never forgive you. I said no, no, no and planned and everything to go to the London office and I was actually put on the Weekend Argus, and I was doing a lot of really nice things, like I did a series on autism, a series on the abuse of women in advertising. 

15:29

I was all now geared up until I read An Unfortunate Man, just forgotten the author, and it was the story of an English general practitioner who worked in rural areas for 30 or 40 years, and he travelled and looked after people and he made diagnoses through incredible sort of detective work and I was so moved by the story that I thought, no, I'm not going to London, I'm going back to medical school. And so we now had a new Dean and I made an appointment to see him and I walked in with a speech this long prepared. Why I'd done what I did and I know I can't come back and I've burned my bridges and I walked in and just as I started giving this big speech, he said, it's okay Lyn, we'll take you back. Just like that. 

Dr Maria Christodoulou Host 16:16

I'm also struck by the power of a story. So you read this book.. 

Prof Lynette Denny Guest 16:20

Is the author, John Berger? John Berger, oh, thank you. I became a devotee of this man because he changed my life. So I missed third year and I had to repeat it because I didn't write the exam. But I went back with absolute passion this time. I got medals. You know, I did incredibly well. My mother, took her a long time to forgive me. Even though you went back? It took her six months after I went back and then I lost all my bursaries. They had to pay my fees and couldn't manage the fees, so I took out a student loan. So I left university with a huge debt. It took her a long time to forgive me because she felt that I'd betrayed everything she believed in an educated woman. 

Dr Maria Christodoulou Host 17:03

Right. Interesting that education trumped freedom of choice. 

Prof Lynette Denny Guest 17:06

No, there's no choice. There was only one way to behave or expected us to behave. Her adage was, I'm never wrong. I had to go through all of that again, but I was absolutely thrilled to be back and I felt the vocation and to this day I have felt that way about practicing medicine. 

17:27

Although in many ways I have, particularly as I've become ill and I'll mention that a bit later but I found our profession often very disappointing. With this dedication to humane practice and compassion and respect for vulnerability and otherness, I actually often find my profession very insensitive, very narrow. I often feel very angry about the way we - and I'm putting myself there because I'm part of the system - the way we treat people and our limited capacity often, not always, to listen. Right. And the limited capacity to really see and to really be there for our patients. But I think that for me part of the service has been I've been a teacher, I've done research and I've been a clinician and I've had opportunities to be a role model to other people and people have been a role model for me. It's a complex labyrinth. 

Dr Maria Christodoulou Host 18:40

What's it like to have spent your entire career advocating for better quality healthcare and then to still, at this stage, despite all the input on teaching, research, clinical care, say I am disappointed with our profession. 

Prof Lynette Denny Guest 18:57

It's painful and then one witnesses unbelievably wonderful behaviour from doctors. 

19:06

So, for instance, you know, during COVID it was amazing how the profession and that's not just doctors, it's everyone from the security guard, the whole team that makes the provision of healthcare possible, and it was amazing to see people's dedication and their concern about saving people's lives. 

19:26

It's a mixture and it's not one thing only. And there are many wonderful doctors who, I mean, if you just look at the world today and how many people are being murdered on a daily basis, and doctors are very often at that crossroads and yet don't have the political power to actually change things and to stop things from happening. So we in Cape Town at the moment, or in South Africa, for a number of reasons, we're in a major financial crisis in the whole country, but also in healthcare. So we know for a fact that people are going to be dying from preventable as well as unnecessary deaths because of lack of resources. As a doctor, to actually live with that is very uncomfortable and you feel furious towards the politicians or to those human beings who have had a wonderful time stealing from the national fiscus and that's what's caused this lack of resources. It's really unforgivable. 

Dr Maria Christodoulou Host 20:33

So we could easily go down the trajectory of focusing on what's wrong with this country. I'm certainly, at this stage, more interested in your story. I'm curious about, like, what was it about his story (John Berger) that made you think, no, I'm going back to that environment. 

Prof Lynette Denny Guest 20:49

It was his relationship with his patients and the way they received him and these very remote people. It's that trust, it's that cleanness, it's that there's no mess here, it's not dirty, it's what you see is what is. 

Dr Maria Christodoulou Host 21:07

Say more about that, because I think there are many who would argue that medicine is messy and complicated. 

Prof Lynette Denny Guest 21:13

Well it is. But when there is trust between you and a patient and the patient allows you to use your expertise, together with the patient, to bring healing - not always healing, actually. We're not such great healers. We're kind of fixers. We're more like plumbers and mechanical. I mean, I think really good doctors are doctors who are curious, who want to know why and really want to listen to what a patient has to say. Pretty difficult to get doctors to really look at what it feels like. There is this need to whitewash things and I've had some experiences where I have just not been heard and I've just not been seen and it's very disappointing. 

22:02

And having been a cancer doctor myself and having spent the last nearly 30 years looking after women with gynaecological cancer, I have a very acute sense particularly what women go through, and for me it was, I had to do a lot of digging inside myself. I had to get rid of my denial. I kept putting on this armour of I'm okay. When I first felt this lump in my breast, I felt it at about six in the morning. I thought, oh, I'd better go and do something about that and actually six weeks later I'd forgotten. Gosh. And then six weeks later I felt it again and I thought, oh my God, I need to do something about this. So I phoned my colleague who was the head of breast cancer surgery at my hospital and he said. Lyn, I want to see you now, and he knew I was going to fight him. 

22:59

And it was a Monday and Mondays were very busy days. We had a morning clinic, we had a ward round. We had an afternoon clinic. He said you have to come in at lunchtime and get this biopsy. And I said no, it doesn't suit today, I'll come tomorrow. He said now. And he did the biopsy, and then he came to my office the next morning and he said Lyn, you know you've got cancer. I said yes, I know. I knew exactly what I was in for, but I had booked to go away that weekend to Gansbaai resting, because two of my colleagues were going to be at a conference and I was going to be on my own and I needed to rest. So I didn't change that and I did what I normally do. I took my wine, I took my books, and then had to come back on the Monday for all these tests and things and I just went into a kind of, just wasn't happening and I had better things to do and I didn't really have time for this. 

23:54

And then a week later I had the operation. I had a double mastectomy. I didn't feel anything about it and the next day, actually, a woman came in. I'll never forget her. She had like a beanie on and she had this bag and she smiled at me and I said well, who are you? And she said no, I work with the cancer association, something like that. 

24:15

She said I'm here to talk to you about a wig and getting breasts and things. I said no, I don't want a wig and I don't want any false breasts. Thank you very much. And she said can I just show you? I said no, I don't want them. And I was quite rude to her, poor woman. I mean, all she was doing was doing what she was told, and I thought, you know, what a cheek to tell me I'm going to wear a wig, what kind of a wig. 

24:39

And nobody had yet told me I was getting chemo. So I didn't know I was going to lose my hair yet. I developed sepsis in my one breast so they couldn't start the chemotherapy. It was delayed, and then finally they started the chemotherapy and they put us in this room where you had these big easy chairs and we were sort of all opposite each other. There was no privacy. All I wanted to do was hide behind the wall, and a friend of mine actually came in because of her mom and she was in the chair next to me also getting chemo and she was in her 80s and she kept saying I don't want this. 

25:20

I said, well, don't have it. And her daughter and her family were insisting that she had this chemotherapy and she didn't want it. And there's this thing like, if you don't accept the treatment then you just, you're full of shit, you know. And I remember saying to her you know, just boycott them. Fight back. Toyi, toyi. 

Dr Maria Christodoulou Host 25:47

Gosh Lyn. What's it like to be on the receiving end of medical care after you've devoted so much of your own life to being a clinician? 

Prof Lynette Denny Guest 25:57

It's much harder than I thought and I've been actually largely quite forgiving towards my doctors. I've spent a lot of time trying to make meaning out of cancer and make meaning out of chronic illness. To not see it as a punishment and to actually have an adult relationship with it, and a lot of the time my relationship has been one of denial. But as I've grown into the disease and I've lived longer with the disease and read more and more about it, people think of cancer as a death sentence, but it isn't. I'm definitely going to die from it, but it's not immediate. Right. It's not tomorrow. Right. And there's time to actually use it as a learning experience. And I realized not long into the journey that cancer is not my enemy. My enemy is my denial. My enemy is my refusal to feel the grief and to feel the pain. That is far more damaging to my being than having the cancer. 

Dr Maria Christodoulou Host 27:10

Well, my understanding of denial is that it's protecting something. It's almost as though that awareness or that insight can only come when you are ready to receive it and that, in fact, if we try and force people out of denial, we actually create more harm. I find denial is protective and I'm wondering what it was about finding out you had cancer that was scary, and why the attempt to make meaning? 

Prof Lynette Denny Guest 27:35

It's a good question and I think because I had seen cancer cause a lot of harm and a lot of damage in lots of women's lives, as well as very positive things. And I had grown up in the war against cancer, and you know in the 1970s when Nixon said, we've put these men on the moon and now we're going to get rid of cancer in five years, and I grew up with that. That cancer was an enemy and that we were going to be at war and we were going to win this war. And then I began to realize that if you characterize cancer as a war, war only has winners and losers, and it's not the way. Susan Sontag, who wrote the beautiful book about illness as a metaphor, she said cancer is the disease that doesn't knock before it enters. And that really struck me, as this is an opportunity to explore more about who I am as a human being, and so I started to really read about what other people had thought about cancer, and then I began to look into the war metaphor. 

28:48

And if you look, for example, in breast cancer, one of the great breast cancer curers was a man called William Halsted who designed the radical mastectomy, which was an operation that left women completely disabled. So they cut away the breast, they cut away all the chest muscles, they cut away their arm muscles. They couldn't move their arms. And as the evidence became available that there was no improved survival and it had no oncological benefit, the more people pushed for it and to me that was an incredibly masculine approach. So cut, burn, slash, whatever, and it took something like, I think it was 30 years for his approach to be discredited as unnecessary. And it was a woman called Louise Kutzner. She was a journalist who developed a breast cancer and she was told she had to have the Halsted operation and she said I don't want this and she objected and she couldn't find a doctor to treat her unless she was prepared to have this mutilating surgery. Eventually she found someone who just did a simple mastectomy and she turned out to have a one-centimetre tumour which was cured by that mastectomy and she didn't need any of that mutilation and she fought this all the way up to Capitol Hill and she was a real activist. Reminded me so much when I read that story about people like Zackie Achmat when they formed the Treatment Action Campaign and when the community rose up and said you're killing us with this disease, give us the treatment. I think that that war metaphor had a very profound impact on me. And then when you look at the development of chemotherapy, I mean the whole process of developing anti-cancer treatment was basically, you kill the patient to save them, okay. You make them as sick as you possibly can, and sometimes successfully. 

30:51

I had radical surgery. I got septic as hell. I was really ill, I stank, it was absolutely awful. And then I had my chemo and I was bald. And I think I may have told you the story before. I was at the Waterfront waiting in the queue to go to the toilet and this woman came up to me and said, excuse me, sir, this is the woman's toilet. And I was kind of seriously mortified and so I said well, I actually am a woman and I left, but still, no one would have said to me that that would be a way someone would react to me. Now, for example, I've once again had chemo so I've got no hair again, and I was walking to my car two weeks ago and one of the clerks at Groote Schuur, she goes, ag Doctor, have you got cancer? I said yeah, I said I have. She says, ag man, just live your life hey, just live your life. Just saying, live your life. So it was a little bit different from, excuse me, sir, this is the lady's toilet. No big deal. Just live your life. 

Dr Maria Christodoulou Host 31:54

Is it a big deal? 

Prof Lynette Denny Guest 31:59

It is on some levels because, as I've told you earlier, I had a near-death experience recently. The most painful part of it was what it did to my family, and I have 13 and 12-year-old nieces and they were just so brave, and Indigo, the 13-year-old, said, I was the only one who wasn't worried, Lulu. I knew you weren't going to die. But the others were pretty convinced that I was going to die, so it was painful. As were your doctors. Well, my doctors were the ones who made the decision, or made the diagnosis, that I was dying and told my sister and my brother and they were all absolutely broken. So that for me is hard. It's for the people who love you. 

32:49

I mean, I don't feel afraid of dying. I don't think it's the worst thing in the world. I think there are a lot of things much worse than death. Such as? Such as being alive in this world. No, but I think there are things worse than death and I think things like war, which causes death, and the othering of people, and the disrespect, the way in which people are harmed by bad human behaviour. Some of the aspects of cancer. There are aspects of it which are very humiliating and I have been really tortured by the side effects from a lot of the chemotherapy and really in ways that are just too even embarrassing to discuss and can be mortifying. I often say, you know, put one step in front of the other and get up, move on. But sometimes it is hard to do that. 

Dr Maria Christodoulou Host 33:46

So what keeps you going? 

33:47

I was really struck by - because I didn't know that Lyn was in hospital and then you let me know that you'd been in hospital, had this near-death experience, that there were six days of your life you had no memory of, and that you then sat up and said I've got work to do. 

34:05

And I thought, that is Lyn. No matter what. The work comes first and this incredible resilience actually, Lyn, that has had you survive some of the most horrific things. We were also talking a little while ago, before we sat down to record, about the fact that someone like yourself, who has such a long history in the medical profession, who has such an illustrious career. I mean, there's very few people in our profession, certainly in this country, who won't know who Professor Denny is, and then your own doctors have often let you down, disappointed. You've often been on the receiving end of some of the worst kind of experiences in the hospital setting. And even as you sit here today, I know you're in some discomfort and I don't want us to pretend that it's all rosy right now. So how are you feeling in this moment and how is it to be talking about this? 

Prof Lynette Denny Guest 35:00

I've become accustomed to being uncomfortable in my body. And it used to, you know, I just couldn't stand it. You become accustomed to it because on one hand, you have to, but the other side of it is there is something remarkable about being human. In all of us. I feel that there's a part of me that wants to honour what is. I mean, I have watched so many people suffer over the years and from cancer, from incurable cancer, from terrible cancers much worse than mine. The experiences that my patients have been through and particularly because I'm in the public sector and many of my patients are working class or not even working class, who present with advanced disease and have very little real support, and some of the stories that patients do tell are so remarkable. And the number of women who, for example, said to me, I just have to stay alive until my granddaughter gets her matric, or their commitment to their community is so strong. The thing about any chronic illness, but particularly cancer which in some senses has become more like a chronic illness, and certainly breast cancer. I've got advanced disease, if you looked at it statistically, but I'm going, still functional. And you don't have to see yourself as a dead end. Right.

36:45

2011, that was when I got first diagnosed and then I was discharged in August of 2020 by my doctor who was so happy with me and I was so happy to be getting out of that, and then, in November of that year, I suddenly developed this most shocking pain in my back and it was difficult to get seen because it was COVID and doctors weren't seeing patients face to face, and I phoned one of the orthopods. He said no, go and have an MRI. And then my doctor called me and she said, Lyn, don't move, you're about to get spinal cord compression and called my sister. So I was immediately put in hospital. I refused to go that day because I needed to go home and have a glass of wine. So I went in the next day and I stayed in for two weeks having radiation, and then I had this massive surgery and these two wonderful Afrikaans men operated on me for hours and hours and removed a lot of the cancer. So now I was in a whole new phase. There were metastases and different parts of my bone, and some of that was very painful, and I then had to have radiation, which is horrible. Don't let anyone tell you any different. It's horrible. Although modern radiation techniques are much better than they were, but it's unpleasant. 

38:18

And then I had this latest episode of reacting to the chemotherapy. I mean, I'm fascinated. The drug is made from a Japanese sea sponge which was discovered in the first part of the 20s. Somebody discovered this Japanese sea sponge produced a substance that had anti-cancer properties and it was converted into this drug that I was given and then nearly took me out. 

38:44

That is what you accept because you know that these are the side effects of cancer and you do accept it. It's not the doctor's fault that that happens, but it's the way we have treated cancer in the last say 50, 60 years. You treated it as the enemy and you blast it. One time. You kill the cancer dead. What's the alternative? 

39:10

At the moment there is a revolution happening in the treatment of cancer and it's fascinating. It's called targeted therapy and there's no doubt that they still have a lot of work to refine targeted therapy, but it causes much less damage to healthy cells. It's still not at the point where it's a panacea and it still causes a lot of damage. Six percent of patients get a rupture of the stomach and I'm like excuse me, six percent. Would I take that drug? Many people would, because we also have created - through Hollywood I think - this idea of live, no matter what. You just don't do death and you've got to fight it at every level. I was reading a story about a journalist in Delhi who went around interviewing cancer patients in six different cancer centres, and one of them, actually a very close friend of mine, works as also a gynae cancer specialist, and he was saying that the vast majority of people he interviewed did not even mention the word cancer. 

Dr Maria Christodoulou Host 40:24

Right. If you don't give it a name, it doesn't exist. 

Prof Lynette Denny Guest 40:27

Well, exactly, and that is why, that's the way in this particular group of women and men that he interviewed was, silence, and not giving it a name. 

Dr Maria Christodoulou Host 40:38

In the Greek community where I grew up, often they would say the person has, in Greek, the bad illness, and everybody knows what that is, but nobody will say it. If you say the word cancer, all the older generation will make the sign of the cross. Almost as though you might invoke it just by using the word. I had somebody tell me the other day that their relative has the bad illness. 

Amy Kaye Other 41:02

Some people still refer to it as the C word. It's almost like Macbeth. Superstition around it. Don't say it. If you don't say it, then it doesn't exist. Again, that denial. 

Prof Lynette Denny Guest 41:11

I mean, part of having cancer is dealing with people's reaction to the fact that you have cancer. I take a fairly non-dramatic approach, or it's maybe it is dramatic because I don't mind talking about death and I don't mind talking about my own death. In fact, my sister's now put me on the spot. As she says, we've had a rehearsal. A recent near-death experience. We've had a rehearsal, so she wants me to talk about how I want to be buried, and what I want when I'm dead. I keep thinking about it and I used to have all sorts of ideas like let's all go and have breakfast at the Mount Nelson or something ridiculous like that, but I don't know anymore. 

41:57

I went through a phase of thinking I wanted to go to the Catholic Church. I'm born Catholic but not a practicing Catholic. So I'm struggling to decide what I want to have done with my body, excepting I'm very sure I want it to be cremated and then send the ashes into the ocean. People get very shocked when I talk about it. They say no, no, don't say that. I say well, why not? No, but you're not going to die. 

Prof Lynette Denny Guest 42:30

I'm sorry. Actually I am, and in fact, so are you going to die. We have some really bizarre ideas around death. 

Dr Maria Christodoulou Host 42:38

I know Ken Wilber talked about the medical phenomenon that is cancer and the sociological or social phenomenon that is cancer, and that when his late wife was dealing with breast cancer, they spent 80% of their time grappling with the social phenomenon and 20% dealing with the medical. 

42:54

And the medical is the facts of the diagnosis, it's the medical understanding of its pathology and the various treatments that are offered to you. But the social phenomenon is all the ideas and preconceived notions that people have about what it means that you have cancer, the stories they tell themselves about what's going to happen to you, the image we all have of the emaciated patient who's lost their hair and is vomiting as a result of chemotherapy and, of course, inevitably the idea that it is an automatic death sentence and that those sort of images and stereotypes are true of some cancers or some cancer patients, but not everybody. And so, as you say, this thing of having to deal with other people's reaction and that often that's harder to deal with than the medical treatments and the things that you've got to go through. I mean, has that been your experience? 

Prof Lynette Denny Guest 43:41

I mean, in the beginning I used to notice somebody would say, oh, we've heard you've got cancer or it'll come up and they say, well, you know my sister-in-law's auntie, she had it and then she got this sepsis, and they tell you the most horrendous stories of what went on and you think, thanks very much, it's really helpful, you know. And then there's this look of tragedy. The tragic look. What I call the tragic look.

44:09

Oh gosh, how tragic. And I would get naughty and you know part of being a doctor is you've also got to have some gallows humour, and we all have it in one way or another. It often made me laugh and then sometimes I would feel a tremendous sense of abandonment that people couldn't bear the pain they imagined I was experiencing and the projection onto me of the pain they were feeling if they were to have cancer. 

Amy Kaye Other 44:46

What was that lovely phrase that you used the last time we spoke? Something like people are struck with a brick of stupidity or something. Yes, something like that. People are often very stupid and very insensitive and you assume they know more, but the things people say you just think, really? 

Prof Lynette Denny Guest 45:01

It is like that. It often is like that, but having listened to many patients tell their stories - many of my patients come from the Cape Flats and there's this kind of mix of tremendous community support as well as stigmatization, and there is this mix of, you're poisonous, you've got this terrible disease, and there's some fear of contamination and oh no, now there's this negative energy. I mean, I think that if we were all to think of illness as part of living instead of as a punishment, I think there would be so many better attitudes and outcomes. 

Dr Maria Christodoulou Host 45:45

Well, I guess it's the same thing about death. We go into denial about the fact that death is a part of life and that illness is a part of being human. I think in some ways there is something about this notion of punishment. You brought it up earlier in the conversation, well, when you said that you went on this journey to make meaning of your cancer, and I think this idea that it's a punishment of some sorts is quite endemic, but maybe even the idea that one has to make some meaning out of it and that it has to mean something, and that you have to grow from it, you have to learn from it. I'm not going to remember the author's name now, but years ago I read a book by a woman in the UK who had breast cancer. 

46:21

The book was called, It's not like that, actually. She basically just said having cancer is shit, the treatment is shit. I didn't learn from it. I'm not happy I got it. It didn't change my life in any positive way. I'm glad I'm done with it. And I think that we have to be careful to not assume that for everyone it has to be a meaningful experience or that there has to be some kind of well, I think, inevitably, we learn from every experience and we can make a choice about that, but the idea that there must always be meaning is one that I'm questioning. 

Prof Lynette Denny Guest 46:51

I think you're right to do that and maybe for me it's because I've just retired, literally 18, 19 days ago, and it's a kind of weird feeling because I keep saying to everyone, but just the other day I was 20. I'm about to turn 66 and I'm on a pension and I have to fill out all these forms and I'm no longer paid by UCT, I'm paid by my retirement annuities and pension etc. And there are two deaths that happened in my faculty that have a very profound effect on me, and the one was Bongani Mayosi, who committed suicide by hanging himself, and there's a complexity to that which many of us still don't understand. And the other was a woman called Brenda Klingenberg, who was the faculty manager for 30 years and then she retired. When I started coming up towards my retirement I thought of her, because she had three months where she was painting and she was doing all kinds of wonderful things, having lunch with friends, living a life that she hadn't been able to live because she worked so hard and then she killed herself and we were never given any of the details of why that happened. 

48:08

But it felt to me that without her work she didn't have meaning and it's worried me how I was going to react to no longer being a professor of gynae oncology and going every Monday to this clinic, every Tuesday to theatre. For 30 years I've done the same thing every day in the clinic and I've worried a lot about that I would wake up and just feel emptiness within me. I haven't thanks God, not yet, but it's a concern for me that what I have seen take people through painful life experiences is meaning. And again, you don't want to manufacture it and I'm certainly no good Catholic, but when you're working, the way we work in the west, is very defined. Your identity is defined by what you do, and I so realize now, all those accolades, all those things that you achieve, they are not what's important. What was important was resilience, staying power, trying to understand, having curiosity, trying to understand the meaning of life, without claiming to understand it ever. So that's when I said to you about the meaning. It's somehow important to me. 

Dr Maria Christodoulou Host 49:43

So what does it mean for you that you have cancer? 

Prof Lynette Denny Guest 49:46

It's a good question. I don't have a direct relationship to the fact that I have cancer. What it does mean is my mortality has become very close and it's, in a way, it's been quite nice because it's been de-mystified and especially just having a nice rehearsal. You know we learned something. For example, the first thing we learned was that when you die, they close all your bank accounts. So now my sister has access to my bank account but I had changed my pin code so she couldn't access it. Did they close your bank accounts? No, not yet. 

50:27

One of my colleagues who is also a gynae onc. She said, Robin, when Lyn dies, and she's going to be dying in the next few days, they're going to close all her bank accounts so you'd better go and raid her accounts so you can pay the bills. We didn't know that. So now we know. So she did. She raided my account. We found out that we must always pass on our pin codes. I've got all my paperwork together. The beneficiaries I discovered were wrong on this one and they were wrong on that one, so those are all fixed. There's a lot of paperwork to do. Death is not a quick business and it requires attention, a lot of attention, especially for your loved ones. So now we know how to raid my account, so instead of it going to the Master of the Supreme Court, because it can take two years. So she took a whole lot of money out and I said, now you can give it back. 

Dr Maria Christodoulou Host 51:19

I'm not sure she was maybe too happy about that. How has it changed the way you worked with patients? Because, as you say, you only retired very recently. You've had cancer for a long time. You, I think, have always been a very compassionate, very caring doctor who listens to her patients, and you've fought really strong and hard for women to get access to equitable healthcare and good quality healthcare. What changed about how you treated patients? 

Prof Lynette Denny Guest 51:51

You know, I think the first thing that I remember changing is that patients don't just need information, and I've watched doctors do it to me and to one another, telling as nth detail. I remember when I was diagnosed with - I won't say because it will expose the person and I got this like three-hour lecture on all the things that could and couldn't, and I was so bored and so exhausted that I took none of the information in. And information isn't so much what you need. What you need is to be heard, and that can just be a way of saying hello. It can be a way of greeting you. Yes, empower a patient through knowledge. That's really important. But doctors use it as a mechanism to not communicate and they just load you full of all this information and you think, oh, shut up, I really don't need this amount of information. So that was number one that changed. I started being more like, to the patient, what would you like to know? What are the thoughts that you have? What have you been told? What did your neighbour next door actually say about this? So what information are you getting out there? What does Die Son say? Because they do. They write lots of articles on disease and they write such rubbish, some of them. So I think it made me more conscious about the need to really understand what the patient is seeing and experiencing. And they come in with their own eyes and their own experience. 

53:22

And for me to have a double mastectomy, others would like, oh God, no, I couldn't possibly live without my breast. And I said, no, well, I can't live with asymmetry. I didn't want to have no breast here and then a big one here. I wanted symmetry. So when I said that to my surgeon, his response was oh, I never thought of that. I had quite sizable breasts, so he'd chop this one off and then you're going to have this big thing there and then you're going to have to use something else. I said, no, I like symmetry. 

Dr Maria Christodoulou Host 53:52

But don't you find that there's also quite a strong push now for women to automatically have an augmentation, so they wake up from their mastectomy with fake boobs, and for some women I think that's important, but for others I'm not so sure that they're ready or that they've even be prepared for that. 

Prof Lynette Denny Guest 54:07

Absolutely. I said don't you even think about touching me with any augmentation. And thank God he didn't, because I got really septic so it would have ended up being a really bad story. The gendered view of cancer, the fact that cervical cancer kills more women. It's less common than breast cancer but it kills more women than breast cancer, because it's down there and it's dirty and it's part of the woman's intimate being. And if you think about how, in Western society, how many swear words use the female genital tract. Every time I hear that I want to go completely mad because it's part of what makes it impossible for those women with symptoms to go to the healthcare profession and say I've got a smelly vaginal discharge. 

54:58

And, whereas breasts are beautiful. The woman who has inherited the L'Oreal wealth, the richest woman in the world, they pour millions into breast cancer, not a cent into cervical cancer. There's all those issues. In my research, we've been working in Khayelitsha since 1995. And one of the things I noticed is that when we examined women in the genital tract, so we put their legs up, it's called lithotomy, we pass what we call the speculum into the vagina to visualize the cervix, and I noticed from the beginning women going like this, and, to cut a long story short, we ran these workshops where we gave women newspaper and pens and glue and scissors and we said let's talk about this thing called 'down there'. 

Amy Kaye Other 55:51

I just want to put into context. You visually showed us, but obviously the listeners don't know. So when you did that to the women, they put their hand up over their face so that they couldn't see. They didn't want to see their own bodies. 

Prof Lynette Denny Guest 56:02

Ye, so they covered their eyes and they were ashamed. So that's why we tried to do this intervention, because I wanted to understand, why would a woman have such a disdainful attitude to such a critical and important part of her body and a beautiful part of her body? We did this process and what came out of it was the women, together with a prayer singer, created a poem called The Sacred Pathway and it went like this, the vagina is beautiful, the vagina is an apricot, the vagina is like a strawberry. Kings, queens, graduates are born through the vagina. Even Nelson Mandela was born through the vagina. 

56:47

The process of creating that poem was very liberating for those women, and we created a health festival, we called in the traditional healers and we got them to sing this. It was such a powerful experience for me, because it was the observation of shame in these women because of a disease that I'm an expert in and that we're trying to prevent, and this terrible shame because it's part of her genital tract and that is just too awful. And that is one of the reasons that so many women die of cervical cancer and more than die from breast cancer, although breast cancer kills literally millions of women. So there's a whole gender thing around cancer and something like 40% of women with cervical cancer, their partners leave them because of their cancer. They can't have sex with them. They don't want to have sex with them. And it's been shown that of all the cancers in women, cervix cancer causes the greatest degree of suffering amongst women. 

Dr Maria Christodoulou Host 58:01

What took you into that field of research? In fact, if we go even a little bit further back, so you finished medical school. What led you to study gynaecology? 

Prof Lynette Denny Guest 58:10

I wasn't going to, actually. I was going to be a paediatrician and then I was going to be a GP, and then I decided to be a gynaecologist and it was the draw of both the fact that it's a surgical, practical discipline and it was women. Actually, I started by doing a lot of research into social issues like rape. We documented 1200 cases of rape that came through our unit and we did work on domestic violence or intimate partner violence. And then I joined the gynae cancer unit and we saw 10 women a week with advanced cervical cancer who were all black or so-called coloured, and we virtually never saw a white woman with cervical cancer and that's because white women had access to pap smears. 

Dr Maria Christodoulou Host 59:03

Right. And private hospitals, so you may not have seen them in your setting. 

Prof Lynette Denny Guest 59:07

Exactly. We wouldn't have seen them in our setting. And when you looked at the fact that this was a preventable disease, I felt such a sense of outrage and the suffering that we saw. I mean, these women suffered, really, still do despite all my efforts, and women are still dying. But that was the draw, was that this was preventable. You could relieve suffering. 

Dr Maria Christodoulou Host 59:29

So how is it for you that, despite all your efforts, and I mean your efforts have been notable, globally, women are still dying of a preventable illness? 

Prof Lynette Denny Guest 59:40

It's frustrating, but we are making progress. So I think anyone who gets involved in oncology we all have an unreasonable sense of hope. It is changing and the WHO has now put out a global call for the elimination of cervical cancer. One of the reasons I had work to do was I was appointed to - this is after the near-death experience - 

01:00:02

Yeah, I was appointed by the WHO to help write the South African Strategic Plan for the elimination of cervical cancer. So we've made a difference over time. And if you go back historically, when did we find the means to cure pneumonia and when did we find the means to cure tuberculosis? And yet people are still dying of TB. It's the same thing. After the second world war, I think everyone thought now we're done. And here we are again with major wars going on, and we know war benefits no one and we know that, but we carry on doing it. That's why, in a sense, one does need to have a feeling of meaning, the meaning of life. 

Dr Maria Christodoulou Host 01:00:47

I know you have many very powerful stories of your experiences as a doctor, as a surgeon, as a clinician, as a teacher. Are there any particular ones you'd like to highlight for us today? Anything that stands out for you about your career that was memorable in some way or another? 

Prof Lynette Denny Guest 01:01:07

The greatest meaning for me has been my work in Khayelitsha because it took me into a community that as a privileged white South African I would never have entered. And I learned so much by immersing myself in that community of women and it was enriching and it remains a constant teacher for me. But I mean, at the other side of being a doctor is error, and we kill people. Not intentionally. I have one experience where we had a complication during surgery and she bled to death under my face and I always say under my face, because that's how close it was and that is an enormously painful experience. It's not possible to get over that pain. So there's that side. Making error, missing things, trying to be the best you can at all times and you can't be. A lot of doctors don't want to admit that we make mistakes but we do and I think that's been a hard part for me. I mean when I was at medical school black doctors weren't allowed to examine white patients. 

Dr Maria Christodoulou Host 01:02:26

Same. In fact, white patients would often refuse to be examined by black people. 

Prof Lynette Denny Guest 01:02:31

So apartheid affected everything. But it also is what, by working in the public sector, I was not so cut off from people from other ethnicities and class. I was given the opportunity to enter people's lives, which I'm so grateful for. And I'm so grateful that I did work in the public sector and I was able to give to people who couldn't afford private insurance. 

Dr Maria Christodoulou Host 01:03:04

I want to come back to this idea about the reality that doctors make mistakes, because I think it's not often talked about and I think that there is so much fear of medico-legal consequences that doctors are discouraged from talking about the fact that they make mistakes. 

01:03:21

I remember a very powerful session with your registrars one year where we created a space for them to talk about mistakes and yourself and your associate colleague at the time shared a story. In your case, this particular one patient that you had lost. For me that was one of the moments in my career that stands out. Incredible vulnerability in the room, the real raw emotion around the fact that there are times where our actions result in somebody's death. And then, if one really grapples with the idea that much of what we do, in any other context, you know, if we didn't carry this title of doctor and wear a white coat and do it in a particular setting, would be labelled criminally insane, or homicide, or we would end up in prison, or in a mental facility for doing these things. What do you think makes it possible? Because I'm one of those medical students who keeled over in theatres and kind of felt every sort of knife cutting into somebody and I could never have been a surgeon. What made it possible for you to be a surgeon? What's it like cutting into somebody? 

Prof Lynette Denny Guest 01:04:31

It is quite a beautiful process that unfolds because it begins in your second year when you dissect a cadaver, and I always had a great love of anatomy and the logic behind it. And what I loved about surgery is, first of all, your intention is good and you believe you're going to make a difference. Right. And sometimes you come out of an operation and think, wow, that was great, I've done the right thing, I got the right planes, I didn't make errors. The patient is alive and well because of the intervention. And there's something very satisfying, and I was one of those surgeons who liked silence in the room. I was very focused. I was teaching a lot of the time. I was sometimes a bit of a monster and would hit my registrar's with a scissors and say, uh uh uh, but mostly not. Mostly one was there to show people the right way. 

Dr Maria Christodoulou Host 01:05:29

I have heard people say that Professor Denny mellowed over the years. 

Prof Lynette Denny Guest 01:05:34

I was terrible sometimes because I really wanted the best for my patients, so I did go overboard and I was very intolerant of people who didn't take a decent history and a decent examination, and that has been one of my biggest experiences as a cancer sufferer. We were taught, and it's to this day, in my opinion, the only way to practice medicine is, you take a history from the patient which uses all your senses. At the end of that, you examine the patient. At the end of that, you have a differential diagnosis and you say, well, based on this and based on that, I think x, y, z and then you do tests that will support that diagnosis and then you do the intervention. So nowadays, what would happen is, you'll go in and you'll say I've got a pain down my shoulder. Okay, CT scan. Do an MRI. So now we go, patient - test. We don't go patient - narrative - story - test. That's why I keep saying to people where are all the good doctors? Where have they gone? Why don't we do this anymore? 

Dr Maria Christodoulou Host 01:06:48

I was going to say to what extent do you think AI.. 

Prof Lynette Denny Guest 01:06:51

AI hasn't even hit the roof yet. But to the point of technology, and suddenly, instead of the pathologist being in control of the flow of profit, it's the radiologist, or it's the people who control the operating theatres, et cetera, et cetera. And to me there is that old-fashioned history, examination, differential diagnosis, and I never tolerated anyone taking shortcuts on that. I would suggest to them that they went home, got changed and came back with a different attitude. 

Dr Maria Christodoulou Host 01:07:29

And later you were a really strong advocate for reform in terms of teaching and quite vocal against teaching by humiliation. So what shifted for you? 

Prof Lynette Denny Guest 01:07:40

Well, I can remember sitting once with one of our famous gynae obstetricians who everybody thought was just the greatest teacher out, and we were at Peninsula maternity hospital and he used to - you go around and you present each case and then he would stand against the wall and he would, with a monotone, he would lecture us about the condition and I was sitting there listening to him one day and I thought you know, you're a stupid idiot of a man. I couldn't believe how stupid he was and I couldn't listen anymore and I walked out. And as I walked out he said where are you going? I said I'm going to go and have some tea. 

Dr Maria Christodoulou Host 01:08:24

At what level of the hierarchy were you? 

Prof Lynette Denny Guest 01:08:32

I was in the registrar stage. I just couldn't stand him. I couldn't stand his way of teaching. It was didactic, it was rigid, it did not encourage curiosity and that kind of, I am a white male wearing a white coat and I know what's right and I know what's wrong. Don't think he ever really forgave me, but I didn't really need him to, because I just felt so strongly that this approach was so wrong. 

Amy Kaye Other 01:09:03

How did the other people react to you doing that? 

Prof Lynette Denny Guest 01:09:07

A lot supported me. Funnily enough, bad people tend to pull together. So we were always the bad element and my group throughout all those years. We were a mixed group racially, religious-wise, in terms of sexuality. We were all very left-wing and you tended to come together, people with a similar way of thinking, and the medical profession is very, very conservative. Many of the gods, when they walked into the ward, we stood up to attention, we were scared of them, but we were a rude bunch and we didn't take it that easily. They didn't manage to reduce us to gibbering wrecks. 

Dr Maria Christodoulou Host 01:09:53

Do you feel like you ever reduced people to gibbering wrecks? 

Prof Lynette Denny Guest 01:09:56

I did sometimes. I must admit that I did. Especially, there were a couple of things I just couldn't stand. One was not making decent notes and that would just put me in a rage. Or being late. I've always had an issue with lateness. The other thing I had an issue was not getting the paperwork done, because when you work in an institution like Groote Schuur, it's clockwork. So if you don't get your discharge drugs ready by 11 o'clock, the patient's now going to have to sit there until seven or eight o'clock at night and not get their meds. And they now have to take a taxi. So it's not like there's a Rolls Royce waiting for them to go home. Then people would say, don't do this with her, and then they didn't. So a little bit of fear was a little bit helpful when you were trying to get standards up, trying to get things to be of a higher quality of care. 

Dr Maria Christodoulou Host 01:10:53

One of the things I found interesting in my research with young medical students was how, when they start medical school, the majority, maybe not everyone, but the majority come in with the right intention. There is a real sense of wanting to make a difference. They're altruistic, there is incredible compassion. There is often an awareness of the suffering. They come from disadvantaged communities. They have witnessed the sort of situation in the public sector hospitals, and then they go on to become doctors that are described as lacking in compassion, lacking in empathy. What do you think that's about? 

Prof Lynette Denny Guest 01:11:26

You've mentioned it to me a lot and I've tried to pick your brain to understand it. I think that the whole concept of what drives us, and I'm just looking at the Western paradigm. We are driven by the desire to acquire. So acquisition. There's a lot of greed. Generating capital is a very important function. Having the best car. These materialistic, capitalistic, patriarchal approaches, I think, are what break altruism and those kind of feelings. 

Dr Maria Christodoulou Host 01:12:07

But it seems to be particularly in the culture of medicine that this happens to people. I mean, you know this has been my area of interest is because I would often feel really frustrated that by the time people are in fourth or fifth year, there's now this whole drive to teach them empathy and to teach them mindfulness and to teach them compassion. Have we ever stopped to consider that it's the culture of medical education or the medical hospital environment that is actually cultivating this inability to demonstrate empathy and compassion in people who, actually, were motivated by that to begin with, and we keep pathologizing the individuals who are not displaying these qualities rather than saying, what is it about our system that perpetuates that? And I've told the story on a previous podcast conversation before, but what always comes to mind is a young woman who emailed me because she'd fallen apart on a ward round and she was in third year. 

01:13:01

It was the first time she was exposed to any kind of physical trauma to a patient through the act of domestic violence and she was overwhelmed at the bedside of the patient and she ran out of the room and she was in the corridors crying and the registrar went up to her, or whoever, the consultant, went up to her and said pull yourself together and take yourself down to student health and you can never be a doctor if you don't get this under control. 

01:13:25

And she was present enough to her own emotions to say surely there must be a way that I can feel what I'm feeling and stay present to the patient that I don't have to run out the room when this is happening. But she went down to student health and they gave her a prescription for an anxiolytic. Nobody said, so what came up for you in that moment? What was that about? Let's talk about what you might do next time that happens. The over-identification with the patient's pain and suffering, which I know that, certainly for someone like you, has been a powerful motivating thing. That identification with the patient that you've done things like drive to the hospital in the middle of the night to do surgeries you operated with your shoulder actually in need of surgery itself. All driven by that empathy and that understanding of suffering. 

Prof Lynette Denny Guest 01:14:10

Listening to this young woman's story, I would find it disturbing if I was running a ward round and she ran out because, she is abandoning the patient. There needs to be a way in which she could say, excuse me, I'm distressed, I'm going to come back and see you, and not to pull all the attention onto herself, because that, to me, is part of the problem. 

Dr Maria Christodoulou Host 01:14:44

I know the young woman, she isn't. But at the same time, for me, it's why is a third-year medical student exposed to that sight for the first time without any preparation? Why is there an assumption that a 19-year-old should be able to contain their emotional reaction to something traumatic? I'm more concerned about the medical student who stands at that bedside witnessing for the first time and has no reaction. 

Prof Lynette Denny Guest 01:15:07

I can give you an example from my own experience, which was my first night as an SHO (Senior House Officer) at Groote Schuur Hospital, and I was on for theatre, so in paediatrics. So the babies would be born and the responsibility of the SHO was to make sure the baby was fine, because the mom's just had a caesarean section and I was on my first night of call. The baby was born what we call flat. I had never resuscitated a baby. My registrar had gone for a jog, the anaesthetist who was there, he said I can't go and intubate this baby. So I tried to intubate the baby and I failed. Had you ever intubated a baby? I'd never intubated, I'd never been shown, but I knew it needed oxygen and I intubated it's oesophagus. So the baby was then denied oxygen for a significant period of time and, of course, by the morning the baby was fitting and I had to watch this every day, for six days, until it died. 

01:16:09

The consultant called me aside and said, why didn't you call for help? I said I did and he said well, that's not the story I got. And I said well, you can call me a liar, but I can tell you, I did call for help and no one came, and nor did the anaesthetist, who did know how to intubate. I went home every day via that baby, its mother sitting next to it watching it fit its way to death. And I came home and I just sobbed every night. I would never have done it at work and even now that I remember that story, that mother, and her sense of loss. Oh, it was just, just unspeakable, and she used to look at me with this deep accusation and I had to accept that. It was extremely painful. And that's the profession that, at the same time, I've had colleagues who've gone the extra mile to help one another at two in the morning, regardless, and then others who just don't give a damn. So it's so mixed. 

Dr Maria Christodoulou Host 01:17:20

It is. What do you think it is that makes it hard for the public to accept that we also make mistakes? When I say the public, for the layperson, someone who isn't in the profession. There's a whole profession around suing doctors, lawyers who specialize in suing doctors and then the story you've just told, where it's almost out of your hands that you didn't know how to intubate a baby in that moment. It's a system failure. What is the equivalent of 911 for that senior house officer who's alone in that situation and that happens a lot, those kind of situations. But what do you think it is that makes people look at the medical profession and say, you're to blame, this is your fault. 

Amy Kaye Other 01:18:11

Before you answer, I just want to say that, as a layperson, I think people forget doctors are people. I really think that's the first problem, because I was at work recently and over the December holidays, we had to work straight through, I'm working in education, and quite a few of the educators were complaining about the fact that, why do all the doctors take leave at this time of year? I can't get a medical appointment anywhere. It's December. What if something goes wrong? And my question was, so when would be a good time for them to take leave? What months of the year would work for you? Everybody has to take leave at some point. I now know, having heard all these stories. I knew doctors worked hard. But wouldn't you rather the doctors take the leave so that they can help you when you have a problem, rather than them all being burnt out? It was amazing that the assumption was, how dare they? How dare they take time off at the busiest time of the year? 

Dr Maria Christodoulou Host 01:18:59

Would you have picked up on that before participating in these conversations?. 

Amy Kaye Other 01:19:04

No, I probably also would have been a little bit, what if something goes wrong during December? December is the most stressful, chaotic time of year and so much goes wrong and there are so many accidents and drunk driving and trauma, and so that's when you want to know that there's somebody you can call, but then the whole country shuts down. So what do you do? 

Dr Maria Christodoulou Host 01:19:19

It's a known phenomenon that there are certain times of the year that one shouldn't get ill or end up in hospital, either because there's less doctors on call, or because the first crop of newly graduated doctors are starting work that day, or at the time of day when the nurses are changing shift, there’s many different statistics. 

Amy Kaye Other 01:19:33

There have been a few instances lately where I've kind of been on the doctor's side going, actually, doctors are humans too. Trying to fly the flag, and then people kind of look at me and go, what's your problem? We all need leave. 

Prof Lynette Denny Guest 01:19:45

But it's also recognizing that we provide an essential service and it's not like someone else can do it. I do think it requires a broader view. It's Christmas, I need time off with my family, but who will cover the orthopaedic injuries that are going to happen because people drink too much? It does require more than, I'm human. You have chosen a profession that requires of you to be of service, and particularly when there's whole practices, they all go, the whole practice goes. It’s not right. They need to make provision for that. In the public sector, we close down surgery for that last two or three weeks of the year and we don't make money during that time, and the private sector, where practice is motivated by profit, there's a different dynamic, a different way of thinking, but it really does distress me. I mean, for example, there were just no psychiatrists available in private over the Christmas period.

 Amy Kaye Other

 That same thing of therapists taking leave over Christmas and New Year's Eve. 

01:20:56

That's the worst possible time. That's when people are the loneliest, most suicidal. Just wait till the new year. 

 Prof Lynette Denny Guest

 I just find it so stupid and selfish. And there were no psychiatrists. I was looking for, not for me, for someone else. I could have needed them, but thank God, I don't, but there was no one around and I know somebody who has having a major breakdown and your alternative is to go to the state where the services provided in state psychiatry are so dreadful because of being under resourced and not enough people. 

Amy Kaye Other 01:21:26

It really isn't the worst thing in the world to work over the festive season. I worked straight through the festive season this year and it was fantastic because I didn't get the blues. Normally I get incredibly depressed over December and I was working so much that December came and went and I didn't have to deal with all the chaos outside in the world. I went to work, I went home, that was it, and it was fantastic. There are ways around it. 

Prof Lynette Denny Guest 01:21:45

I've never taken leave over Christmas. I used to love it. It was time. I could clear up my rubbish, I could get work done, I could pay attention to a lot of things that need attention and don't get it.

 Dr Maria Christodoulou Host

 So it's interesting. I find myself getting yes, and... There is a piece around my original question, which was why is it that people struggle to accept that we make mistakes and that we're human? And I think part of it is because we also have this idea that we can continue to work, that we should be available to work and to serve, because there is a calling, in ways that are often detrimental to our own health. I'm not sure how we challenge that culture, but when you gave the example of so who's going to deal with the orthopaedic injuries that are going to happen over this time because people drink too much? That's exactly it. Why has that social issue become the doctor's problem? Why is it the doctor that should be on call or the nurses be on call to deal with the consequences of what is a much broader issue? Then we have the whole phenomenon of the God complex in medicine, and there's no doubt that a lot of narcissistic people are drawn to the profession. But I think the public also project this idea onto doctors that somehow we are God, we are almost inhuman and deified in some way that it should be possible for us to work in this way because we have this calling, and I think we walk a very delicate line. 

01:23:05

On the one hand, yes, it's a calling. There is a need, and often a compulsion to be of service that may not always be motivated from the right place. It's one thing to be called and it's quite another to feel good about yourself because you are working in this way and helping people or derive your self-esteem from that.

 Bad things happen in the world and we all have a shared responsibility for how we manage those. And, yes, we provide an essential service. But the service we provide is often at the tail end of a whole host of other complex social issues.

Prof Lynette Denny Guest

Exactly.

Dr Maria Christodoulou Host

 We saw the impact on our hospitals when alcohol was banned during lockdown. The minute alcohol was allowed again, the hospitals started filling up again. 

Prof Lynette Denny Guest

It was extraordinary.

Dr Maria Christodoulou Host

Yeah, so doctors are burning out, dealing with the consequences of social issues and being held responsible for the outcome of that in ways that I think our politicians should be held accountable.

Prof Lynette Denny Guest

Exactly, completely agree with you.

 Dr Maria Christodoulou Host

 Lyn, I feel like we would need to spend a week together. 

01:24:07

Maybe even that wouldn't be long enough to really tell your story. We haven't talked about your work with Rape Crisis and the incredible contribution you've made in that arena, your art, your painting. I mean, there's so many different dimensions to your story, not only the contribution you have made, but you as a woman. When you look back on your career and on your life thus far, having had a near-death experience, what are some of the high points for you and what are some of the low points? 

Prof Lynette Denny Guest 01:24:35

In terms of high points, I have really… I’m one of those people who is really privileged because I loved my work, and I think it really makes a difference. Not that it wasn't hard and not that there weren't times when I was frustrated, but I have loved being a doctor and I've really loved my patients and colleagues and the environment has fed me in many ways, and having had the experience of cancer, in some ways is also a highlight, because it's given me access to parts of myself and other people that is more vulnerable, much softer. I think that it's made me actually, a slightly nicer person. One of the strongest feelings I've had since I've had cancer has been gratitude, and I don't mean to be all goody two shoes, because I'm so not. 

01:25:31

I'm so not, but I do have a sense of gratitude and when I think about this rehearsal and Robin running out to go and raid my bank account and trying to hold everything together, I think that's an extraordinary experience. I think the downstream for me has been much more the lack of social justice. Politics have been incredibly disappointing. A child of apartheid and where we are today in South Africa are not pretty places. But then there's also, when I think of the French Revolution, for instance, and Hilary Mantel who wrote this extraordinary story about it, they were also a complete disaster because liberators are not governors, don't know how to govern, and they just feel entitled, and I’ve suffered so now I can take. 

01:26:19

Life is incredibly interesting in its mysteriousness and I've become much less needy of certainty and thank God, because living with cancer is very uncertain. And I went through some periods last year when I was as sick as a dog, really awful and tremendous pain. Beside myself actually, with discomfort. Physical, really feeling bad, and then recovery and I kept recovering. I keep saying to people it's your fault, you mustn't make me recover like this all the time.

Dr Maria Christodoulou Host

You have been known to call it the Lazarus effect.

Prof Lynette Denny Guest

Yes! I think I was very lucky to have found a profession I love. 

01:27:06

I actually wanted to study law. That's what I was going to do, and my head mistress, who was a very interesting woman. Miss Christians. She said to me, you can't possibly do the law. You’re far too soft. And I was not known as soft as a child. I was known as a bit of a wild rebel. And she said you must just study medicine. I remember her saying that so clearly.

Dr Maria Christodoulou Host 01:27:26

And if you could go back and do anything differently? Is there anything you might do differently in your life? 

Prof Lynette Denny Guest 01:27:36

It's something I've only recently thought about. I might have focused more on interpersonal relationships. I might have tried to create more intimacy. I've always been a bit allergic to intimacy but, except in my relationship with my patients.

Dr Maria Christodoulou Host

Which is a different kind of intimacy. 

Prof Lynette Denny Guest 

It's completely different. So I think, were I to think about life differently, I think that would be one of it, and an alternative profession, in retrospect, I'd love to have been a writer. 

Dr Maria Christodoulou Host 01:28:11

Well, you are an academic writer and you've been quite prolific in your publication.

Prof Lynette Denny Guest 

So now I paint and I do calligraphy, but I would like to write.

Amy Kaye Other 01:28:23

Well, you are retired, so it's the perfect time to start. That's the beauty of writing is you can never be too old to be a writer. Actually, the older, the better the writer you usually are, because now you have a wealth of experience to write about. Maybe you can start now. 

Prof Lynette Denny Guest

I don't know what to say!

Dr Maria Christodoulou Host 01:28:32

So what advice would you have for a young colleague who was - maybe let's have different levels - thinking about entering medical school and then for a colleague who is thinking about doing obstetrics and gynaecology, or particularly gynae oncology? What advice would you have? 

Prof Lynette Denny Guest 01:28:53

Measure yourself and know what you are actually capable of handling. So that means know thyself. And spending time getting to know who you are, what triggers you, what makes you feel strong, what makes you feel weak, is worthwhile time. Obstetrics and gynae is a very, very physically demanding profession. I don't recommend that you go into it if you have a lot of physical issues. It requires often being up for 24 hours, no break, high levels of stress, and labour ward is an emergency room 24-7. Gynaecology is painful because it affects women, and everything from rape to domestic violence to women's diseases are associated with a lot of suffering. 

01:29:40

It's really important, when you make a decision to go into medicine, to really know what your strengths are and what your weaknesses are, and what needs to be worked on, because you may not have everything you need, but if you can commit yourself to an inner journey. Somebody once said to me, the unexamined life is the only life worth living, and I think that I would change that. Examine your life and examine what impact. And I did. A lot of the time in my careers, I overworked and I overcompensated. I did a masters, I did a PhD. I don't know how I did all that and I worked flat out. I didn't really have a life other than my work, and that's not good. 

01:30:27

I wouldn't encourage that. I'm not a good role model on that level and I think symmetry, some sense of balance…

Dr Maria Christodoulou Host

Some acknowledgement of humanity…

Prof Lynette Denny Guest

Vulnerability. Just saying I feel shit, I'm tired, I'm exhausted. I can remember when that patient died under my face, I walked out of the operating theatre, been in there since 7.30 in the morning, it was 10 at night and the entire family were waiting there and all looked at me as I walked out and I just had to walk away and I went home, got into bed, I somehow managed to sleep. I went to work in the morning. Not one of my colleagues said anything. Everybody had their head down.

Dr Maria Christodoulou Host 01:31:11

And that's a common story. I hear that a lot.

Prof Lynette Denny Guest

And nobody was going to do anything about it and I was so mortified.

Dr Maria Christodoulou Host 01:31:17

And if you do end, up talking about it, it's in an M&M meeting.

Prof Lynette Denny Guest

When you least want to talk about it.

Dr Maria Christodoulou Host

And then it's actually a criticism of you and what happened. It's not an exploration of the impact it's had on you.

As someone who has contributed to women's health issues around the world, someone who is still contributing. I mean, you're writing papers for the WHO literally a week after being out of hospital now, what's your vision for healthcare? If you could wave a magic wand and really create the ideal vision for women's health care…one that's realistic in that suffering and disease are a part of the human experience. What would you like to see healthcare move towards? 

Prof Lynette Denny Guest 01:32:02

It's about really understanding the context in which women are living. So a woman in Malaysia is going through a very different experience today versus a woman living in Peru versus a woman living in London. We don't recognize context and we try to have one size fits all and one way of approaching all problems, and that's not right, because the context varies so profoundly. I was listening to something yesterday about food insecurity and how we approach it in South Africa, which is i.e. we do nothing, versus what they do in Peru, where the government actually compensates women for feeding their children nutritious food. The electorate have decided that food insecurity is unacceptable and we need to decide that the beating of women or the death of women giving birth is not allowed. There has to be zero tolerance. What is most relevant in this particular context needs to be understood profoundly. 

01:33:10

Funny enough, today I was doing some research for an article I have to write by tomorrow about breast cancer and Gaza. Now there's a war going on in Gaza. This was in 2009. Breast cancer was the most common cancer amongst women in Gaza, and they had teamed up with some groups from other Middle Eastern countries and they’d set up a breast cancer prevention program. And then, at the bottom of this article, which I was reading this morning, was that the whole cancer program in Gaza is now cancelled. It's gone. It doesn't exist. So even in Gaza, all those years ago, they identified this as a major problem. It's now no longer a problem because the cancer services have been cancelled. Context is everything in terms of healthcare. I think context is really important and we need to stick to it. We do a lot of lip service, we do a lot of yada, yada, yada, but not much follow through. 

Dr Maria Christodoulou Host 01:34:08

What keeps you awake at night? 

Prof Lynette Denny Guest 01:34:10

Ooh well, I have physical things that keep me awake, but what keeps me awake is injustice. It really distresses me. It breaks my heart actually, when my colleague in Eastern Congo calls me about a woman he's operating on and she dies while we're talking to each other because there's no proper care. And what goes on in Congo also, that keeps me awake at night. It enrages me because it's all about greed and it's all about theft and the creation of violent militia. I mean those are the kind of things that really wake me up and upset me, because it's not necessary. It's just so painful. With this new latest financial crisis, they're cutting services in all the provinces, but including Western Cape. So I was asked to comment on a document about prioritizing cervical cancer prevention. I said don't do that, because we're going to pick up early disease and there's no theatre to operate on them. I mean I didn't mean to do it, but I was saying that's the consequence. We're going to do something that will save lives, but we can't save the life because there's no money. 

Dr Maria Christodoulou Host 01:35:22

So this is the moral injury. 

Prof Lynette Denny Guest 01:35:26

Moral injury. That’s the word I was looking for. So I find it very painful when, as my society has educated me and trained me to be a competent medical health professional, but I can't do that because there are other people stealing the money and making it impossible for proper healthcare. 

Dr Maria Christodoulou Host 01:35:48

And when patients are dying, people are saying doctors are to blame. Waiting lists in the hospitals are too long. We need more doctors. 

Prof Lynette Denny Guest 01:35:57

And there are also many bad doctors. Believe you me, I see them. I had a patient, a wonderful case the other day. She came with her folder from the day hospital and it was, date, B-O-M, tick, Amoxil. So date, B-O-M is burning on micturition. In other words, she had burning urine. Tick i.e. that's a symptom. Treat, Amoxil. No examination, no history. And she actually came because she had increasing pain and the first thing I did was take a history and the second thing I did was examine her and she had a pelvic abscess. Now, that's healthcare. That was a UCT graduate who saw her at the primary healthcare clinic, so that's why I can be a scratchy bitch. 

Amy Kaye Other 01:36:55

That's one way of putting it. 

Dr Maria Christodoulou Host 01:36:57

Maybe that's a good note on which to hit the pause button, because I think we could talk for hours. Anything else you want to ask, Amy?

Amy Kaye Other 01:37:02

I just want to say, as somebody who never, ever wanted to be considered soft or feminine. A lot of my life I thought it was such a weakness. 

Dr Maria Christodoulou Host 01:37:14

Well, that's part of the problem that we all sit with. 

Amy Kaye Other 01:37:16

I haven't known you very long, but just in a few months from - and obviously a lot has happened in a few months - from your previous conversation to this conversation, you've softened so much. It's so wonderful. It's not like having a different person in the room but the difference between the conversation previously and the conversation now. 

01:37:33

Remember, in the first conversation I said, it's like you've been the soldier in a war and now, there's still that strength and there's still that resilience and there's still that power behind everything that you're saying, but it's just such a different energy coming from you. It's really, really lovely, and I just want to acknowledge that and say, without being condescending, well done. 

Prof Lynette Denny Guest 01:37:55

Well, I mean thank the doctors for nearly killing me, because I think that has had a major effect. 

Dr Maria Christodoulou Host 01:38:03

I think I'd be more concerned about you if you hadn't had some effect. 

Amy Kaye Other 01:38:06

The denial is gone. Yeah, it felt like in the previous conversation you were just to hell with it. If I die, whatever, I'll sleep when I'm dead kind of an attitude. Now you are looking at life very differently. It's really beautiful to witness. So it's nice to meet you here. 

Prof Lynette Denny Guest 01:38:22

It’s true. It is different because I don't even get up to an alarm anymore. I can't bear the sound of an alarm, so I've abandoned it. So I sleep late and I have a huge need for sleep, which I'm loving because I'm allowing myself to do that. It was good to have a near-death experience. Well, thank you, I really appreciate taking the time to do this a second time and I just hope it works. It gives you the response that you look for. 

Dr Maria Christodoulou Host 01:38:55

I'm not looking for a response. I'm looking to share stories and I'm always so incredibly touched when people are willing to share their stories and to do it in an authentic and vulnerable way. I've said that before, but I think I echo Amy's sentiments that there is something quite different about this conversation to our last one. I think in the last one you and I had not had any interaction for a really long time. It feels like, I said recently when Amy and I had a chat about the journey of the last year with this podcast, that one of the things that I'm learning is to really just surrender and to not even be attached to the outcome of... There must be a podcast episode as a result of this meeting that we have with someone. 

01:39:35

I remember when I listened to our last conversation and after the last conversation I thought we'd had a profound conversation. It was very powerful. You were really raw and honest and vulnerable. You shared a lot of really powerful things. Are we ever going to capture this story again? And now I'm sitting here today so grateful that we've had the second opportunity, because I think people are going to hear and see or witness a very different side of Lyn Denny, that encompasses all of that that was here last time, but also it feels like there's an openness today. 

That you're less guarded and that… you’re talking about your cancer more openly than you did last time, and there's definitely a softening, which is beautiful to witness, and I'm just so grateful that, in the midst of everything you are going through and dealing with right now, you made the time to come here to sit with us to share the story, and I'm curious to see what life brings you next. 

01:40:35

Thank you, Lyn. People don't know all of the story or the history and it isn't the place to talk about it here today, but I've been part of your journey in many different ways over many different years and it feels like there's a beautiful coming full circle to that place of vulnerability where we first met each other all those years ago.

I'm Dr Maria Christodoulou and you've been listening to the Awakening Doctor podcast. If you enjoyed this conversation, please share it with your friends, follow Awakening Doctor on Instagram, Facebook and Spotify and go to Apple Podcasts to subscribe, rate and give us a good review. Thank you so much for listening.