An ‘innovator for women’s health’

Dr Carol Ann Thomas, MBChB, FCOG, MMed (O&G), gynaecological specialist, advocate and innovator for women’s health, has died, at the height of her professional career, of complications following a double lung transplant.

As the tributes pour in from devastated friends and patients, it’s clear that the labels used to describe Dr Carol Ann Thomas, who died on 12 April 2019, are neither exaggerated nor clichéd: role model, trailblazer, warrior woman, mentor, innovator, dynamic leader, mould-breaker, dynamo, brilliant scientist, compassionate doctor — she was all these and more.

She was my gynaecologist. She was also my friend. She held these two things in perfect balance, demolishing the protocols used by many healthcare providers to distance themselves from their patients.

She entered into not only the joy of pregnancies and new babies, but the anxieties of infertility and premature deliveries and female cancers, the heartbreak of miscarriages and stillbirths. She was loving enough to care, and tough enough not to need to hide behind professional screens. Dozens of medical professionals around the country (and indeed the globe) who encountered her when they were interns or junior doctors still marvel at the example she set.

Funny, raunchy (many patients will remember her proclaiming “Nat is lekker!”), and endlessly fascinated by a job she loved, she was never daunted by the challenges of a transitioning and troubled healthcare system, not even when she came up smack against the HIV-Aids devastation of the grim Mbeki-Manto years. She constantly sought ways to bring basic yet decent reproductive healthcare to all South African women, including the poorest. She was a tireless activist for women’s health all through the 80s and 90s, and made significant contributions to policy development on contraceptive care immediately after democracy.

Impressive achievements

The impressive list of her degrees, qualifications, honours, awards, citations, publications, international and local professional associations runs to more than a page. Picking from it almost at random, her Master of Medicine dissertation won the SJ Behrman Prize for excellence; she was awarded honours for “Selfless Dedication and Commitment to Reproductive and Sexual Health and Rights” by the Planned Parenthood Association of South Africa. I mention that she was Chair of the South African Menopause Society if only because it is mind-boggling that as late as 2016, she was the first woman to hold this position.

“She developed iMobiMaMa, with the goal of using mobile tech to connect pregnant women in rural and underserviced areas with the information they needed to stay healthy and give birth in safety.”

She loved gadgets, and embraced every new technology and app, investigating how it might be adapted to meet women’s reproductive care needs. She developed iMobiMaMa, with the goal of using mobile tech to connect pregnant women in rural and underserviced areas with the information they needed to stay healthy and give birth in safety — and to create local jobs. In the words of her website: “[My] passion remains exploring cost-effective, quality health service delivery models for women… especially those that are mobile, cell-phone based and capable of expanded reach.” Hence she established the WomanSpace, which offers tiers of services, including the more inexpensive options of consulting nurse-practitioners. She was particularly attentive to the fact that reproductive healthcare for black women did not necessarily fit or acknowledge their needs and context, and worked hard to address this at many levels.

Her compassion was monumental. Her patients all tell of that moment just before surgery, when she’d hover like an angel, promise to take care of us, kiss our foreheads: the essence of who she was both as a doctor and a person. Yet she was never sentimental, never gave false hope.

She and I were at UCT together, and although I didn’t meet her then, we all knew about the young star rising through medical school: the phrase “first black woman to…” was repeatedly heard. A decade after we graduated, we worked together on the South African Women’s Health Handbook — still the best grassroots and feminist research on the health of this country’s women — and I asked her if it would be weird if I became her patient. Both feminists who swore like sailors, the same age, both survivors: we never looked back.

With hindsight, my luck was extraordinary. Carol specialised in PCOS (polycystic ovarian syndrome) and menopause: I had PCOS and early menopause (the fertility equivalent of being hit by lightning twice). It’s impossible to explain how critical a role a good gynae plays in the life of a woman battling infertility, along with female organs ultimately intent on assassinating their host.

Life-saver

She saved my life when, during marathon surgery in 2016, she removed massive amounts of scar tissue choking my organs to death. While removing what seemed like half my innards, she carefully left the nub of one ovary behind because of research showing this was protective against Alzheimer’s.

“I’m not putting your brain at risk,” she said. The surgical techniques she performed on me were so innovative, my medical insurers didn’t have codes for them (it was no small crime that they forced her to waste time writing them multiple letters).

“I don’t get tired. Before I start, I go off into a corner and focus on my patient until I’m completely in the zone. And then I go out and solve the problem to the best of my ability.”

After she reconstructed me internally from the chassis up, I asked her how she coped with five hours of painstaking surgery (with serious consequences, including the risk of peritonitis, if she made the slightest mistake), when it was her fifth operation of the day.

“I love it,” she said. “I don’t get tired. Before I start, I go off into a corner and focus on my patient until I’m completely in the zone. And then I go out and solve the problem to the best of my ability. There’s no high like it.”

Some of the most painful conversations of my life were with her. She was the one who had the thankless job of raising my hopes and dashing them, over and over. The day came when we ran out of options, and the infinite gentleness of her voice telling me “this we cannot fix” will always stay with me.

When, to my great amazement, I fell in love after decades in a glacial glass coffin, she was my aide and advisor. And when the wheels came off, she held me as I sat on her table, and told me the same thing had happened to almost all her patients whose careers had outstripped those of their male partners. When I defended my ex, she said: “Feminist men sincerely support equality. But nobody prepares them for eclipse.”

She brooked no nonsense, either: once, after surgery, I refused to let nursing staff take away my morphine dispenser. I heard the clack of approaching heels and knew I was in trouble: “Helen! Are you giving my nurses a hard time?”

Yet through all the many D&Cs, cancer scares, the hormones that drove me demented, the tears in her office, the impressions that remain are of joy, subversion, bubbling ideas, generous hugs; the time the ultrasound showed good news for once, and we both danced around her examining room, me half-naked. When she had to perform an excruciatingly painful endometrial ablation on me without anaesthetic, she instructed me to drink half a bottle of champagne first (much more pleasant than painkillers).

Apartheid education

It is worth remembering that Carol received her entire education under apartheid, and her extraordinary successes were in spite of it. She was even first barred from UCT’s medical school because of the quota system designed to keep blacks out of “white” universities, and had to register for a BSc before transferring.

“Her achievements owe much to her parents, icons of teaching excellence in the desert of inferior education prescribed by apartheid.”

Her achievements owe much to her parents, icons of teaching excellence in the desert of inferior education prescribed by apartheid. Part of why she was able to attain so much was because she had a not-so-secret weapon in her sister Gail, who consistently supported her personally and professionally.

She adored her close family, and spoke of them often, especially her son, Adam, always with affection and pride. She was unfailingly honest and vulnerable about her own personal issues: her struggles with pregnancy and parenting, the end of her first marriage, the health crises that forced her to “retire” from the obstetric side of her practice, the joy of finding her life partner, Alison.

She leaves behind her father Gilbert Thomas (she died on the birthday of her late mother, Madge Petersen), Adam Thomas-James, Gail Thomas, and Alison Gray, along with scores of devastated family members, friends, patients and colleagues.

We mourn with them this shattering loss, not just to everyone who loved her, but the medical community of South Africa, and indeed all its women. Her legacy lies not only in her healthcare contributions and scientific feminist innovations, but takes the form of flesh and blood: women all over social media keep saying: “She saved my life. She saved my baby’s life.” She is utterly irreplaceable.