Cancer Conversations

Medical folks get cancer, too. Just because they know more about it doesn’t mean they get a pass.

Miriam was one of my favorite doctors. She had an enviable ability to be sophisticated and perky at the same time. It was always a pleasure to see her for that yearly appointment. Then one day I went in and her normally long brunette hair was short and gray. She was both gaunt and bloated and had the unmistakable look of someone undergoing treatment. Nine months earlier she had been diagnosed with an aggressive form of breast cancer. She’d had a lumpectomy, chemotherapy, and radiation, and was only then returning to work.

Her diagnosis came into an abundant life that included a busy medical practice, a young son, two older stepchildren, a husband with an active legal practice, leadership in the medical and lay communities, and frequent, competitive tennis matches. She knew what a Stage 3 tumor was. Her pathology report did not need interpretation. She understood the prognosis, that her chance of surviving five years was 50 percent.

But she’s a doctor. Why wasn’t her tumor caught before it got to Stage 3?  Didn’t she do the self breast exams she told her patients to do?  Didn’t she have the yearly mammograms?  Yes, of course, unfortunately, being close to the chest wall, the tumor eluded earlier detection. “There are no givens,” she says.

How did she react to the diagnosis? “As a mother,” she says. “I realized I might not see my son graduate from high school. It was a water main of emotion breaking loose. I’ve had a great job, life, and marriage, but my thought was of how this would affect my child.”

Calling in Professionals

As a medical professional, Miriam knows the impact medical conditions can have on families. This made contacting a family therapist one of the first calls she made. “I knew there were immediate issues to tend to. It’s very hard for a child whose parent is suffering from a life-threatening illness.” The therapist helped the family recognize that each member approached the situation differently and each deserved his or her own way of dealing with it.

As to her own treatment, she knew the various protocols and was privy to their risks and benefits. One had potential for damaging peripheral nerves – a concern because she needed her fine motor skills for surgeries; another had less impact on cardiac function – a plus because of her love for tennis and biking.  Ultimately, after discussion with her oncologist, she chose an experimental regimen from Europe. Although this made her a bit of a guinea pig, it was a role she was willing to accept.

Such discussions, which can be quite graphic, were common for Miriam. They were not, however, for her husband. “In the medical community,” she says, “it’s called ‘the birthday cake.’ At one session, we go over one layer, then the next layer – rather than dumping it on the patient all at once. Well, my poor husband just got it dumped. And he turned green.” She credits her oncologist for sensing her husband’s discomfort, recognizing that he processed the medical jargon differently, and gently engaging him in the conversations. “It worked out and they got along well,” she says. “Sometimes I think the spouse and family are the ones who need to be comfortable with the doctor. That’s important, and that’s how I’ve made my own referrals.”

Other Issues

Another challenge: How to tell friends, colleagues, and family. Generally, it happens on the grapevine. “Did you hear about……?” But what about telling your parents – one of whom is dying? That was Miriam’s dilemma. Her father entered hospice care just as she began chemotherapy. How could she tell him and add to his burden? “What if it was your son who was ill?” a friend asked. “Would you want to know?” She called her father that evening. “You are my daughter,” he replied when learning her news. “You are very strong, and will be just fine.” With his confidence, her burden melted away.

Miriam-the-doctor often found being Miriam-the-patient challenging. Scheduling appointments, waiting for procedures, sitting in lobbies with old magazines, assembling medications (take this with food, that on an empty stomach . . .) could be overwhelming for anyone. Then there was the lying half-naked on cold tables while nameless technicians wandered in and out to peer and probe. It was enough to make her unleash lectures on medical manners and etiquette. “I’m sure they wanted to give me Valium,” she says.

Having endured the treatments through to a successful outcome, she finds she has gained a life lesson – whether from the experience or just from getting older she’s not sure. “If I had found the lump earlier it might not have been a big enough life change to get my attention,” she says. “I might have had the lumpectomy and radiation and gone back to my old life with an I Survived Cancer notch on my belt.” Now she values living with less stress, doing fewer things at once, and appreciating everything more.

Aside from one bike event, Miriam has not done the walks, races, or other organized activities for cancer survivors. “When you get to the finish line, the survivors are supposed to go to one direction and the others to another. To me, that’s a problem. I didn’t go through all of that to be by myself.  I did it to be with my family and friends.”

Final words:  When her son graduated from high school, Miriam-the-mom was there. She was there for his graduation from college, too, and for the birth of his entrepreneurial startup, and the births of three grandchildren. And, as often as she can she rides her bike and plays tennis – with family and friends.