I worked as a breast physician in a breast clinic for seven years. We screened women at high-risk of developing breast cancer, investigated those with breast symptoms, and followed women up after their treatment for cancer. We met the women in the morning, took a history and performed an examination, then sent them off for their tests. They returned to us later the same day and we told them the results.
Despite the pathology at the centre of this job, I enjoyed it — due in no small part to the fact I was dealing only with women. Sometimes I felt as if going to work was more like coffee with girlfriends than a job — except that the girlfriends had to strip-off mid-conversation.
During the seven years I worked in this field, breast cancer treatments evolved and improved, even in that relatively short time. For example, the Women’s Health Initiative discovered the link between long-term Hormone Replacement Therapy and breast cancer; geneticists became able to test for the BRCA – 1 and BRCA – 2 genes; and drugs like Aromatase Inhibitors (e.g., Arimidex) and Herceptin became routine treatments. I’m sure there have been many more advances in the three years since I stopped working …
Part of my job was breaking bad news — that was never easy. I tried to clear the waiting room before I called the patient in so that I could spend as long as needed with her. I prepared the room so it looked comfortable, not intimidating or frightening, and I had to prepare myself mentally, too. Sometimes, it was the third or fourth or even the sixth time that day I’d told someone they had breast cancer, but I tried to treat everyone as if they were the first, to be with them and them only. My words didn’t always come out how I wanted, but I tried at least to show that I cared, and, I hope, my patients felt that, and forgave my sometimes clumsy words.
No two women reacted the same, nor could I predict how someone would react. The woman I thought might not cope, would be stoic, and immediately say, ‘Okay what’s the next step?’ Others would say they were relieved — after days or weeks of wondering and worrying, they now had a diagnosis and could make plans.
Many thought the diagnosis meant certain death, and were surprised to learn that nearly ninety per cent of women survived their breast cancer these days.
Sometimes, we sat in silence while the diagnosis sank in. Some started talking and filled the room with chatter while their minds absorbed what I’d said. Very few burst into tears and only a handful showed anger.
Many times, a patient’s immediate concerns weren’t for herself. I remember more than one woman turning to her husband and saying, ‘I’m so sorry to do this to you.’ Often, a patient’s first tears came with the words, ‘How am I going to tell my daughter?’ If they were with their daughter, sometimes they’d turn and say, ‘I’m sorry to be a nuisance.’
The elderly ladies never failed to amaze me. They often came on their own, and after hearing their stories of war and widowhood, I’d have to tell them they had cancer. They took it as if it was the next step on the pathway of life. ‘Well, I’ve had a good long life,’ they’d say, and I’d remind them that they weren’t looking down the barrel yet.
Occasionally, a breast cancer would present during pregnancy or while breastfeeding, and instead of being able to celebrate the birth of a new life, a mother would be starting chemotherapy to save hers. I carried these women in particular home with me, and sometimes my husband’s eyes would fill as I told him the story. That evening, we’d hug each other and our kids a little tighter, knowing it was the luck of the draw and could have been us.
Sometimes, I had to deliver the really bad news that the cancer had spread and was incurable. I felt a kind of survivor-guilt as I sat opposite them, cancer-free and healthy, telling them that their lives would be shorter than they’d hoped. I felt like they knew that although I was trying to put myself in their shoes, I really had no idea, no idea at all what it was like to be facing death.
Some people mistrusted us or were too frightened to see a doctor, and came in too late. I remember one lady who presented with a year-old cancer that she’d watched grow until it took over most of her breast. When I asked her about other symptoms, she said, ‘Yes, I have a sore spot at the back of my head.’ The bone scan showed secondary deposits. We did what we could, but she eventually declined all treatment.
Some patients sought alternative therapies. I put the information I knew before them, but the decision was ultimately theirs and I had to respect that: it was their body, their life, and their choice. I told them that I would support whatever decision they made, as hard as that was at times. It was especially hard when I knew their cancer was curable, if only they’d let us try. Some went off and tried shark cartilage and vitamins, and returned months later when the cancer had spread, when it was too late, when all anyone could do was try to eke out a life as long and as comfortable as possible.
I’ve said this before in a blog post but I’ll say it again: I always felt it was a privilege and an honour to be a doctor and to share some of the most intimate moments of people’s lives.
To all the ladies I met during those seven years — I haven’t forgotten you.