Therapeutic couple Amélie Gession-Paute, plastic surgeon, and Malika Kacel, double mastectomy

MALIKA KACEL

I am a private nurse, and I am on duty in the emergency room of the Bordeaux-Nord clinic in Bordeaux, where Amélie works… We had never met, we met during my first visit.

It was a first contact in consultation, I knew that she worked in the clinic, and then we went through all the examinations for the treatment.

MALIKA KACEL

The day I had my first ultrasound mammogram, the radiologist asked me if I was pregnant. It turns out that I had stopped using birth control to get pregnant: third pregnancy.

I didn’t feel sick right away. I didn’t feel sick. I felt like a mom, but not sick.

So, it was complicated, I didn’t want to have an abortion right away, I wanted to be sure that something could be done and it’s true that Amélie helped me to make my choice: either I continue the pregnancy and we do what needs to be done afterwards, or I have an abortion because it’s dangerous for me and I do a treatment afterwards.

The hardest part for me was that I found out I had this breast cancer when I was 35, and my sister passed away from breast cancer at 34. So, it was complicated.

We make a “debrief” on our life in fact, and we try to choose the best of the solutions, without thinking about ourselves! At this moment, we don’t think about ourselves, we think about those you will leave in fact. We know how hard it can be to stay, the one who left is gone. But the one who stays, it’s more difficult for them. So, I was thinking more about my children and my husband, and I absolutely did not want them to go through what I went through with my sister. So Amélie helped me. A lot, yes…

AMÉLIE GESSON-PAUTE

So of course, we always have multidisciplinary meetings, the decision was not just mine. From a medical point of view, we always care about the patient, and so the decision to treat her was reasoned. We were able to authorize her to continue her pregnancy after a first surgical step since it was a rather risky lesion at the beginning, and then finalize the treatment. Therefore, a surgical intervention in the first trimester of her pregnancy.

MALIKA KACEL

I had a lumpectomy when I was two months pregnant. Afterwards, I gave birth on April 19, I had a total mastectomy on the right on June 19. And six months later, so seven months later, I went through a mastectomy again with a change of prosthesis on the right and a prophylactic mastectomy on the left, which I had also requested. I couldn’t live with one breast not being mine.

During a consultation, for us in any case, we didn’t just talk about the disease, we talked about all sorts of things because we are the same age, we have a family life, so it puts us at ease, I think it also puts the patients at ease by talking about something other than why we are here. And we were talking about sports.

AMÉLIE GESSON-PAUTE

Your husband was also very present during the consultation, as he is also a sportsman, and so there were little things that happened. And in the context of his breast reconstruction, which did not consist of a single operation, we saw each other often.

MALIKA KACEL

Yes.

AMÉLIE GESSON-PAUTE

Until the day I was preparing for the first women’s polar race, which took place in January 2018 in Finnish Lapland. I was preparing for this race and that was when I saw Malika in consultation, three months before the preparation of this race. I was supposed to do it with a friend but she was not sure. And subconsciously I had always said to myself, but without verbalizing it: it would be nice to do it with a patient. And I remember, it was in October 2017, so in those three months before my departure for Lapland, I saw Malika in consultation, everything was fine, we were to meet again I think six months later.

MALIKA KACEL

That’s right.

AMÉLIE GESSON-PAUTE

And then the door closed, and then 24, 48 hours went by, and without thinking too much, I took my phone, because I had talked to you, that I was going to Finland and I had probably seen stars in your eyes! I took my phone and I spontaneously proposed the race to her.

MALIKA KACEL

I saw Amélie Paute pop on my phone, I thought, “what’s going on?”. I saw her two days ago, everything was fine, what is she going to tell me? So I pick up the phone and she says, hello, this is totally unprofessional, I’m calling you [laughs] privately.

Here’s what I have to propose to you, the race in Lapland. We were still on first-name terms at the time, so she said to me: would you be interested in coming with me to do the Lapland race duo? I didn’t think about my family, my children, or my personal work organization, I am a freelance, I need replacements, and three months before is very short! Fortunately for me, I had a small base in terms of physical preparation because I am a sportswoman, I had put it in brackets but I had resumed a little because I was one year away from my last operation, almost, and I said yes!

AMÉLIE GESSON-PAUTE

We had to anticipate a lot of things, especially in terms of technique and clothing, because we don’t run like we do at home, and we had the idea of going to train in cold stores, and so it was near Bordeaux, at the same temperature, at -25 degrees.

MALIKA KACEL

It helped us a lot. Particularly in terms of breathing, because it is a cold that seizes the nostrils, the breathing, so you have to learn to manage your breathing…

AMÉLIE GESSON-PAUTE

We were jogging in the giant freezer.

We left for five days, with three days of race. The first day was “run and racket”, that is to say that we ran in the snow with some passages with snowshoes. The second day was “run and bike”, a bike for two, it was very hard as an event, and the third day was “run and ski”, with cross-country skiing, and different events.

MALIKA KACEL

And the obstacle course to finish.

AMÉLIE GESSON-PAUTE

So I was very touched to bring Malika in this adventure because I think that the extreme conditions played a role. That is to say that it was very difficult, physically. Often, it was hard and, in this difficulty, I said to myself: what have I got her into? And I had a huge feeling of protection towards her. I really needed to protect her. Sometimes I would run – when you run, you think about a lot of things – and I often had images of block. But still! Still, what I did to her… She’s here with me and I really felt protective. I’m quite reserved in personality and there, I was overwhelmed. I really was.

MALIKA KACEL

She told me all this afterwards. That is to say that at the time, I didn’t realize it, and above all I wanted to be seen as a participant like everyone else, and not as the sick one. It was metaphorical with regard to my illness, because if I reached the end, it was… When I reached the end, I had the impression of being alive again. I felt like I was living again, and I thank Amélie, really, for taking me on this crazy adventure – because it was a crazy adventure! I needed to feel my body actually. To feel the hardness of all these challenges, but how good it was!

AMÉLIE GESSON-PAUTE

Sport, in relation to cancer, is very beneficial in many ways. It is beneficial before, during and after treatment.

Before, we know that it’s a healthy lifestyle and therefore we hope for fewer risk factors, it reduces the risks. During the disease, it also often helps to tolerate the treatments better, to be more active, to take things in hand. Afterwards, it’s not for everyone, I’m aware of that. And after the disease, we are in the example, in what we did with Malika, it is really important. And I have quite a few of my patients who have come back to see me for follow-ups, and who have almost said to me, raising their finger: I would like that too!

MALIKA KACEL

I am privileged, I admit…

AMÉLIE GESSON-PAUTE

It was only after the race that we realized that this doctor-patient relationship, what we had done, what we had created, had been very strong.

MALIKA KACEL

Very strong yes, we’re out of the consultations terms, but we’re still a therapeutic team, and it’s a form of therapy by the way. It was for me during these trials. Because sport, when you are sick, you keep your sociability, it is your escape, you unload all your emotions, and you think about yourself. Sport is the only time… I used to do a lot of running, and people often told me, “What are you running after?” But I don’t run after anything, I just keep my time for myself… These races, which are multi-sport races, teach me not to be afraid anymore. For example, we are going to Croatia, I like running, we are going to do mountain biking, I have never done mountain biking in my life.

AMÉLIE GESSON-PAUTE

Really?! [laughs]

MALIKA KACEL

I’ve been practicing, though. In fact, you go back to childhood and you really do things that you would never have done in life… Afterwards, it’s a lot of mental strength. It’s a lot of mental strength afterwards. That’s what illness is, it gives you another strength, and it helps you go further. If I had not been sick, if I had not had this cancer, I would have been in my little life, quiet, without going further, and here I force myself to go and look for challenges, objectives, and that puts a little spice in his life finally. So, I’m not going to say that I was happy to have had this disease but it’s a blessing in disguise, I’m different.

AMÉLIE GESSON-PAUTE

It’s getting you out of your comfort zone.

MALIKA KACEL

Completely, completely.