Breast Cancer: The Unwelcome Guest
About a month ago, an unwelcome guest came knocking at the door of my healthy, happy, professionally successful life. It started with the discovery of a lump near my right armpit which I discovered while showering. At first, I thought it might be a cyst because it was round and painful; however, I had the presence of mind to call my breast surgeon colleague, Dr. Michael Schultz, to ask him to see me. The way breast cancer runs in my family, I had already figured that it wasn't "if" but "when" in terms of getting breast cancer. Last summer, I had my first mammogram scare, but that had been cleared up at the time.
Dr. Schultz fit me into his going-out-of-town-busy schedule and saw me at 6:45 in the morning on the day he was flying to Barcelona with his wife to celebrate his twin sons' 21st birthday. After noting the suspicious characteristics of the lesion on ultrasound, he "shot me" with a biopsy gun. Less than 36 hours later, I received an international call during my afternoon clinic hours. Mercifully, the schedule was light. He opened, "What are you doing at this moment?" At that moment, I realized that it must be bad news. I went to a private area in the office and heard words that I would have to own. "You have breast cancer." Much of what followed coagulated in my mind and became unintelligible; thus, I had to ask a number of questions over and over in the week that followed. Anxiety medication was called into the pharmacy, and I thought I lost it. I misplaced my hospital ID badge. My keys were harder to find. I finally let my family know what was going on but was advised not to tell my staff right away.
The night after discovering my diagnosis, there was a prayer meeting at our church. Many people gathered and surrounded me with love and support. It was such a comfort to be in the midst of a supportive community, with so many immediate offers to help. I also decided to post on Facebook, as well, which is a private space for me where I can interact with family and friends. Telling patients and staff would be another matter. Since practicing medicine is what I love to do, I began thinking of ways that I could preserve my practice but still take care of myself. I wanted to be sure not to scare my patients or staff away, to find a way to reassure them of the lasting quality and excellence of care that I would still be able to provide. Lots of thoughts flooded; however, I was still feeling joyful and hopeful, because every woman in my family who has had this has survived for many years. I felt God's peace.
When Dr. Schultz called me the following week to let me know that my breast cancer was ER/PR negative, I was relieved to think that I would be spared of early menopause by not having to take tamoxifen, but then the other shoe dropped. I would have to undergo chemotherapy! I'm not sure Dr. Schultz anticipated this reaction, because I was just in his office to have him draw my blood at the time that he told me this news. I simply burst into tears. My hair was all I could think of besides all of the other untoward side effects plus my strong sentiments against chemotherapy that developed during medical school and residency. Watching my sister endure chemotherapy for ovarian cancer 5-6 years ago had also created a more personal and lasting impression. Dr. John Fetting, my future oncologist, called a couple of days later to discuss the timeframe of about 6 months of treatment and also to advise me that I would need to temper my expectations of my energy and professional output during treatment. Recovering from surgery this past week, while back at work, was a reminder of my limitations. Thankfully, the tumor was smaller than expected (1.3 cm) on final pathology, and the sentinel lymph node was negative for cancer. Therefore, this is Stage I.
The matter of keeping my medical practice running well is one that I still have to solve. I intend to solve it smoothly, even though there are variables I can't control. I am a small business owner and a primary care doctor in solo practice, with fixed overhead and lots of patients who need me. I also have 2 of the best front office/medical assistant staffmembers I have ever had working for me. Lately, I we have made so much progress with Green Spring Internal Medicine, and I have finally enjoyed more financial security after the very lean start-up years; thus, I am hopeful that I will be able to preserve what we built by a strategy of working fewer hours during treatment weeks, having other doctors cover when needed, and not taking new patients. I am grateful for the electronic medical record which has made it so much easier to practice medicine, and which allows me to do a lot of work from home. I will just need to carve out the time to eat healthfully, to exercise, to have emotional recovery, and to stay spiritually strong.
In the end, if there is good that will come from this unwelcome arrival, it is certainly humbling. Already, I have realized what a wonderful community I have here in Baltimore. I am also hopeful that this trial will make me a better physician. I have already become familiar with many tests and procedures that I had never experienced before. I am hopeful that, with the help of rest and exercise and funny movies as well as a whole lot of prayer, I will be able to keep my sense of humor. I have also found that pouring my heart and mind into the care of others brings me a deep-seated joy and sense of purpose that little else could replace.
