Last week, one of my favorite patients was diagnosed with breast cancer. We all have favorites, don’t we? We shouldn’t, but we all do, so don’t pretend you don’t.
I delivered her diagnosis, though I had missed it.
She is one hell of a hardworking woman, a middle-aged mother who has earned a very high position at her super-well-respected-and-important company. I didn’t catch on to her status for the first two years she was my patient. Maybe that’s why we hit it off: I couldn’t be self-conscious or nervous at all about taking care of her, because I was clueless. She was one of the first patients I had seen as an attending, I would have been a dork around her if I knew who she was.
I have always enjoyed her visits, which were not infrequent, for some low-grade chronic medical issues. She’s funny, like, makes you laugh funny. She’s got great wisdom and life experience, and is highly educated. She doesn’t mince words, or waste time. She’s just an enjoyable patient.
She has her annual exams on time every year. And at her most recent annual, on a review of her healthcare maintenance, I saw that her last mammogram was three and a half years ago.
I said something like, Wow, you are way overdue for your mammogram.
She said something like, Yeah, I keep putting that off. Got to do that.
And I said, I’ll order it, you can schedule it on your way out.
As a matter of fact, that’s the same conversation we’ve had every year about her overdue mammogram, for the past 3 1/2 years. She has a history of obesity, and a distant history of smoking, but other than that, no real risk factors for breast cancer. Her breast exam was benign. I never pushed it.
This year, she did the mammogram. It showed an abnormality. She had a biopsy done same-day. I called her and reassured her: You don’t have alot of risk factors. This may be benign.
I checked for those results every day. Every day praying: Please don’t let her have breast cancer, not on my watch, because I wasn’t really watching.
Then the report came back- Invasive carcinoma.
I called her and told her. She’d been prepared. The radiologist who did the biopsy had sat down and told her that she thought this was very likely to be cancer. So, she handled it very well.
I still felt like such an asshole.
I feel very responsible, I told her. I let you go three and a half years between mammograms. I am so, so sorry.
I feel awful about it too, she said. But I’ve thought about it, and I decided, I’m not going to go there. I’m not going to look back and wonder what if. I’m moving forward.
OK, I’ll still feel guilty. I said. But what can I learn from this, what can I do differently to make sure that this doesn’t happen again to someone else?
She paused. Then: Tell them my story, she said. Tell everyone that a busy working mom put off this test, put everything and everyone else first. She didn’t take care of herself, and then she was diagnosed with cancer. Tell them she never in a million years thought it would be her. And it could be them too.
And so, there it is.
*Obviously I had her permission to tell her story. The story and conversations have been simplified; Details have been omitted or obscured to protect her identity.