By Jonathan Edwards
Again and again, Hannah Catton told doctors something was wrong with her body. Again and again, she said, the doctors dismissed her concerns.
They didn't listen in late 2018 when she told them about her frequent urinary tract infections. They didn't listen months later when she returned to tell them she was having irregular periods. And they didn't listen when she complained of bloating, constipation, diarrhoea and extreme pain.
Catton was telling them her body was in rebellion. Almost a dozen physicians told her otherwise: She was young and healthy, so it was probably nothing - just a little too much stress. One told her she was overweight and losing a few pounds might ease her symptoms.
Almost three years passed after Catton's symptoms first emerged, during which she saw about 10 doctors. Then, in October, she collapsed in pain and took herself to the emergency room. From one of her ovaries, surgeons pulled a cancerous blob stretching nearly eight inches (about 20cm) and weighing roughly 4½ pounds (about 2kg).
After her years-long crusade to be heard, Catton, now 24, wants other women and doctors to learn from her experience. Women should learn the warning signs of ovarian cancer and forcefully advocate for themselves, she said, while doctors need to become better versed in recognizing the symptoms. More importantly, Catton said, physicians need to listen to patients instead of dismissing them.
Starting in 2018, Catton said she went to multiple doctors, but they all brushed off the possibility of a serious ailment. They told her to monitor her symptoms and come back months later if she still felt ill. Several gave her antibiotics.
In the middle of it all, Catton in February 2019 moved more than 10 000 miles away from her home in Kent, England, to Melbourne, Australia, where she planned to work as a veterinary nurse.
Catton didn't have to pay for her medical care through the United Kingdom's National Health Service and, when she headed south, most of it was covered by Australia's government-funded healthcare system, she said.
After the move, Catton's symptoms got worse, and so did the pain. As in England, she sought the help and advice of doctors. Again, they brushed her off at multiple appointments, she said. When Catton went to get help with a particularly bad UTI in May 2021, the doctor referred her to a gynaecologist and a urologist, which at the time felt like "a massive, massive relief."
"Someone's finally listening to these symptoms and taking me seriously," she said.
The gynaecologist performed an ultrasound and diagnosed Catton with a uterine fibroid, a non-cancerous mass that grows in uterus, often during childbearing years. Although Catton was put on a waiting list for surgery, the procedure kept getting pushed back because of the global pandemic.
Finally, one day in October, Catton collapsed in pain after dismounting from her horse while riding. She balked at going to the emergency room since she'd been told the uterine fibroid was benign. So she took some pain relief medication and slept it off. A couple of days later, the pain roared back, forcing her to the ER.
At first, doctors suspected an ectopic pregnancy, which happens when a fertilized egg implants and grows outside the uterus's main cavity. But scans revealed that what had been growing inside her was ovarian cancer.
After nearly three years, Catton knew what had been wrong with her body.
But she still didn't know how wrong it was. Until doctors surgically removed the cancer from her ovary and did more tests, they couldn't tell her how far it had spread, if at all.
That meant making a tough phone call to her parents back in England.
"That's really hard because your parents obviously are really concerned, and they keep asking me these questions. And for the first couple of days, all I could answer to questions was, 'I don't know. I don't know. I don't know.' And that's really quite . . . hard."
Catton broached the biggest unknown with them.
"It was an extremely hard conversation to have with my parents over the phone, to tell them I didn't know if I was going to die," she told the BBC.
The coronavirus complicated matters. If Catton had been diagnosed before the pandemic, her parents would have dropped everything to fly thousands of miles to care for her, even if it was just for a week, she said. They would have taken her to appointments, run her errands and cuddled her. But with Australia's strict Covid-19 restrictions barring almost any outsiders from travelling into the country, that wasn't an option.
"My parents - they just feel helpless. Like, what can you do over the phone?"
Two days after her diagnosis, doctors removed the tumour. Testing it and receiving the results took another three days.
When they came back, the result was a relief. The cancer hadn't spread, and Catton's prognosis was good. Because the tumour had ruptured, she needed to go through chemotherapy to "mop up" any cancer remnants. She started on Dec. 6 and went in to start her fourth round on Monday, which will be her last if tests show she's in remission.
While ovarian cancer appears to be done with Catton, she's not done with it. Catton started researching and discovered her case wasn't unique. Ovarian cancer is hard to detect because of its vague symptoms - bloating, constipation, frequent urination, back pain and feeling full quickly when eating - especially during early stages, according to the Mayo Clinic News Network. There are no reliable screening tests for ovarian cancers, unlike other gynecologic cancers.
Catton said that she's gone back to her doctors to tell them they got it wrong and, in the process, made her feel voiceless. This time, they listened. Catton said they've been responsive to her criticism and agreed to go through ovarian cancer awareness training to help them spot symptoms in the future.
"I felt like they needed to know so that they could do better," she said.
Catton said she thinks she might have better advocated for herself early on if she'd heard from someone like her and hopes her experience spares others from what she endured. Catton knew early on that something was wrong, that it wasn't just stress. Despite that, she acquiesced to the doctors because she didn't "want to be a patient that wastes time."
She's not alone, doctor Bella Grossman said for the Northwell Health Katz Institute for Women's Health article "Gaslighting in women's health: No, it's not just in your head." Men tend to be more persistent with their doctors when they have concerns about their health, Grossman said.
"Women may have a harder time pushing back and advocating for themselves," she added. "They feel like they need to be good patients, which means accepting what their doctors tell them. But by doing so, they're stripping themselves of a voice."
Catton said she wants women who might have ovarian cancer - and all patients - to find their voices.
"As a patient, we should feel comfortable and confident enough to advocate for ourselves," she said, adding, "If I'd have seen a story like this a year ago, two years ago, maybe it would have made me be a bit more forceful in how I was approaching it with doctors and saying, 'No, listen to me.'"