What I did for love

Last week a very special patient came to see me. I'll call her Angela (all names are changed for obvious reasons). Angela is 33 years old and 36 weeks pregnant with her first baby--a boy that she's named Michael. Two weeks ago she discovered a lump in each of her breasts. As she's pregnant, no x-rays or mammograms were done to protect unborn Baby Michael from radiation. She did however have an ultrasound and a biopsy of these breast lumps and was found to have breast cancer in each breast. She showed up for her appointment with her distraught husband, sister, and parents. We talked for over an hour and a half about her breast cancer and her treatment options. She had already decided to have a double mastectomy given the size of the tumors. She would also need several CT scans and radiologic tests to see if the cancer had spread beyond her breasts. But first, Baby Michael would have to be delivered to avoid exposure to anesthesia or radiation. Angela was calm and decisive through the entire meeting, but her husband and family were clearly fretful and anxious. So before the appointment ended, I told them about my friend Laurel.


I met Laurel in my first year out of residency. I was a young surgeon eager to apply my technical skills in the OR. The long hours and years spent in residency is very much focused on management of surgical diseases and honing of surgical proficiency. Laurel showed up one afternoon during a busy clinic with a red rash on and a 20 cm mass in her right breast. Her family doctor had prescribed an antifungal cream for the rash that didn't make it go away. She had something far worse than fungal skin infection. I did a biopsy of the mass and of the skin on her breast with the rash and scheduled her to come back to see me in 2 days for a discussion of the biopsy results. I told her to bring her family with her to that appointment as I thought that the results might reveal a cancer. I'll never forget how I squirmed in my chair as I told her these things, how I stumbled over my own clumsy words, how I hoped she couldn't tell how badly I was sweating. She seemed like such a nice person; and I simply didn't want to ruin her day with the spectre of breast cancer. And when the hell during residency were we taught how to compassionately deliver bad news?


Two days later I sat with Laurel, her husband, and 22 year old daughter in my office. The breast biopsy indeed showed a breast cancer. The skin biopsy revealed breast cancer cells in dermal lymph channels. She had inflammatory breast cancer, a rare but extremely aggressive type of breast cancer. Compared to non-inflammatory breast cancers, the survival rates are quite lower--in fact, they are dismal. She would start chemotherapy and radiation first. If she survived and the cancer shrunk, she would proceed with mastectomy.


Laurel's daughter was the first to cry. She didn't hold back any of her sadness. Soon everyone in the room was in tears including me. I cried for their grief, fear, and anguish. I cried because I wanted so much to help them, take away her cancer with one swift and dexterous operation but I couldn't. Before they left, Laurel asked if she could give me a hug. I thought, "Who hugs a surgeon? Do I look that pathetic crying that I need a hug even though she's the one with cancer?" I said, "Of course." She hugged me with her whole heart.

Over the next few months as she was getting chemotherapy then radiation, Laurel would stop by my office to see me. She insisted that she give a hug at the start and end of every visit. She also insisted that we address each other by our first names. Against everything I was taught to believe about being a medical professional, I found that to be comfortable and comforting. She told me about a book, "Love, Medicine, and Miracles" by a surgeon, Bernie Siegel. I read it and have re-read it several times. She told me how she changed her job--quit listening to people complain all day. She told me how she would visualize her immune system attacking and defeating her cancer. Rubbing her breast mass, she would say, "Laurel's white cells, do your thing!"

When her chemotherapy and radiation was finished, she came to my office for an "official " appointment. Though our meeting was scheduled, we still started with a hug and greeted each other by our first names. On examination, her breast mass had shrunk to a quarter of its original size. At 5 cm, it was still large but small enough to make a mastectomy possible. We talked about the operation including the dissection of her lymph nodes in her armpit. I wanted so badly for her to do well, but didn't want give her false hope because the prognosis of inflammatory breast cancer was so poor. She hugged me before heading off to do her pre-operative testing.

Laurel's operation went perfectly. She recovered quickly without complications. 3 days later her pathology report came back: Lymph nodes clear of cancer---excellent! No cancer found in the 5 cm breast mass---Wah! It couldn't be!! I called up the pathologist and made him review my biopsy result and do more sections of the mass. How could he miss a cancer in a mass the size of a small orange? How can there once be cancer and now none? He did more sections THREE more times (because I pestered him incessantly about it)...there was NO CANCER to be found. When I finally told Laurel of her results, I knew I had witness a miracle. The chemo docs high fived each other and claimed victory with their drugs. The radiation folks patted themselves on the back and marveled at the power of their radiation. I believe with my whole heart and the entire fund of my medical knowledge that Laurel cured her own cancer.

That was 8 years ago. Laurel is alive, happy, and cancer-free today. We send each other Christmas cards every year with updates on our lives. She told me I could tell anyone who had cancer about her story. I think about her alot and am so thankful to have the priviledge and honor to know her and have her friendship. She taught me that the most important part of my job was to give people hope and empower them to take control of their health. She taught me that the best part about my job was how much I could love and care for my patients.

So with her story, I hope that I passed on Laurel's hope and courage to Angela and her family. She has so much to live for: a new marriage, a new family, Baby Michael.

In a few days, I will go to court as a defendant in my first malpractice trial. It seems like business as usual for the lawyers and an opportunity to collect on more money for the plaintiff. I'm the only one who is taking it all so personally. I could've settled and walked away, but I felt that I had to fight for myself. I did nothing wrong and would defend myself in an imperfect judiciary system with the distinct chance of losing. I've thought about what I'm fighting for: my innocence? Justice? I'm fighting for the doctor I became after I met Laurel. I didn't want to become embittered by law suits. I didn't want to continue to be a doctor and be devoid of hope, caring, and love because I was so paranoid and hateful from this litigious environment.

Perhaps I'm being naive or overly idealistic about it, but I don't want to lose the person I was before this suit. That person is worth fighting for.