July 08, 2022
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No one can ever be truly prepared for a cancer diagnosis, even those in the medical field who confront diagnoses like breast cancer daily.
I remember the first time I was called Ms. Jackson. I was sitting in a waiting room with floral-framed photos on each wall. It was my first appointment with my breast surgeon, just days after receiving my breast cancer diagnosis.
Before that moment, I was Dr. Jackson, an emergency medicine physician. For the last 14 years in the making, I cherished my intensely desired and hard-earned title.
Prior to being Dr. Jackson (my married name), I was Ms. Srivastava. I had never been Ms. Jackson. I had never been a patient. My life experience with this name thus far was as a doctor.
I waded through a rigorous foundation of biology and chemistry, diligently studied each organ of the body, and learned about thousands of disease processes that affect the human body, including breast cancer. I memorized the breast cancer demographics, screening guidelines, recommended work-up, and treatment options.
Despite what insight I thought this gave me into what an individual with breast cancer may endure, I had absolutely no idea — until I was diagnosed with breast cancer.
The most challenging part of this journey was certainly the beginning. I discovered my diagnosis by reading biopsy results on the patient portal app on my phone.
Even though I couldn’t digest most of the technical pathology report and the various stains that were performed, I did recognize “invasive ductal carcinoma” to mean cancer.
“What?” I thought, “you’ve got to be kidding me.” I knew I couldn’t have cancer. I was a healthy 32-year-old female without a family history of any cancer or risk factors for breast cancer. Statistically, my breast mass was favored to be a benign tumor, like a cyst or a fibroadenoma.
Honestly, although I discovered my own breast mass, it was entirely by accident. I wasn’t performing self-breast exams.
I learned in medical school that research studies didn’t show a reduction in death from breast cancer in individuals who did self-breast exams. In fact, they often led to an increased risk of complications from more invasive testing without increasing the number of breast cancer found. Thus, self-breast exams were not recommended.
As an astute medical scholar, I heeded the knowledge and didn’t do them.
I happened to find my own breast cancer after I felt a sharp pain in my right breast. I instinctively grabbed it, somehow wrapping my fingers directly over the lumpy yet firm mass. On further evaluation, it was large enough to be noticeable when I looked at my profile in the window.
When I received my cancer diagnosis, I started to carry two contradicting labels: the healer and the “healee.”
I now grapple with the idea that I could’ve found it sooner had I been looking. I know I can’t prove this and perhaps it wouldn’t have changed the medical management of my breast cancer. But I do note this as a way that medicine — my own profession and life’s work — failed me.
As we learned in medical school, patients do not always follow the textbook. I became my prime example of this.
Furthermore, I struggled to understand how I could have cancer. I’m a doctor and doctors don’t get sick! I’m supposed to be healing the ill, not be ill.
What about the Hippocratic Oath I took in medical school, to do no harm, treat the sick to the best of one’s ability, preserve patient privacy, and teach the discipline of medicine to the next generation?
I realized that in taking this oath, I somehow believed that in exchange for dedicating my life to caring for patients, I was somehow guaranteed good health. So when I received my cancer diagnosis, I started to carry two contradicting labels: the healer and the “healee.”
How was that supposed to work? In an instant, I felt my identity was confused and lost.
As I entered the hospital as Ms. Jackson, the patient, the walls of my second home now felt cold, foreign, and intimidating. I was used to flourishing in my element here, but now I was confused by the hospital map and the signs pointing me in the direction of my oncologist’s office.
I was unsure how to answer the questions on the intake form and then how to put on the gown — was it supposed to open in the front or the back? And why did it have to be pink? The signature color of breast cancer seemed to invade my range of view everywhere I went, as a constant reminder that it’s supposed to mean something to me now.
In my first appointment with my oncologist, I heard everything she said. I recognized all of the words but I retained nothing. I was so terrified that I couldn’t make any meaning of what she said.
What I do remember is her sitting in a chair directly in front of me, face to face, knee to knee. Her blue eyes connected with mine and she simply asked me, “What are you feeling right now?”
I broke down crying, a disheveled blubbery mess. I’m not sure any of my words even made sense, but I conveyed to her my deepest fears about having received my breast cancer diagnosis, experiencing pain, and dying.
She responded by holding my hand and affirming, “We are going to figure this out.” A wave of relief washed over me.
It wasn’t what she was saying, but instead how she made me feel that allowed me to place my trust in her. I was seen and heard. This alliance continued through the rest of my treatment. She remained my number one ally, fighting my breast cancer with me.
As a physician, I feel the constant, gnawing pressure of time when I’m with my patients. I’m always trying to get through my checklist of questions to make clinical decisions and simultaneously document them in the electronic medical record.
I didn’t recognize the impact of simple and easy gestures until I received them from my oncologist. Body language, especially eye contact and facing patients, conveys a level of attentiveness and acknowledgment of a patient’s experience beyond just calculating the potential medical recommendations based on their symptoms.
Body language can facilitate a more aligned and therapeutic relationship between patient and physician. It can enhance not only perceived empathy by the patient, but also a more comfortable environment in which patients can express their concerns.
This instills a higher level of trust and confidence that patients have in their physicians, which has the power to influence their treatment experience, and potentially their medical outcomes.
You know yourself, your body, and your health goals best. Your medical decisions are yours.
As a patient, I advocate that all individuals with cancer deserve a relationship with their medical team like the one I had with mine. While medical professionals hold the expertise in cancer treatment, they are your guides and consultants who make recommendations based on their expertise.
However, you know yourself, your body, and your health goals best. Your medical decisions are yours. It’s within your rights as a patient to ask questions as many times or in different ways as it takes to get answers that satisfy your concerns.
If something doesn’t feel right, I urge you to say so. If you’re not happy with a professional or feel they are not a good fit for you (not all professionals are created equally), seek out someone new. You will always be your best advocate.
No one ever chooses to become a patient, and no one can ever be truly prepared for a cancer diagnosis — even those of us in the medical field who confront diagnoses like breast cancer daily.
My cancer journey has certainly been a learning process that prompted personal growth. It also ultimately aided my return to work as an ER physician.
To say I’m grateful for what I learned never sounds right because I can never feel grateful for being diagnosed with breast cancer.
But I’m appreciative of the aspects of my cancer journey that pulled me out of my textbooks and redirected my attention to my patient’s experiences.
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