The First Visit

After He Said Cancer | A Memoir

“I didn’t choose to have breast reconstruction, so I was swimming in the Sea of Cortez within a month of the mastectomy,” she said with sparkling eyes.  

A patient advocate was telling us her story of success and triumph over breast cancer while we were waiting for the team of breast cancer doctors to enter the room. Her white hair was closely cropped, and her white blouse covered her flat chest. She had a lean physique with dark, energetic eyes. It wasn’t hard to imagine her doing the crawl stroke in the turquoise waters off a beach in Mexico. Hell, if she told me that she swam the length of the Sea of Cortez one-month post-op, I would have believed her.

Sea of Cortez, photo credit to Sam Beebe

The cancer had been a blip in her life, she explained. It wasn’t going to steal her happiness or occupy her thoughts.

“Just get through the treatment”, she said. “Things will get better. Stay positive.” She added a quick apology that they didn’t have a man with breast cancer, who could act as a patient advocate. There were simply too few of them. We nodded in silence to show our understanding, and she left the room.

Neither my husband nor I said a word to each other after she left. What was there to say? If we had any words for this experience of shock and despair, they would have been sucked into the black hole that seemed to follow us.

Stay positive? The words were jarring to me. There was nothing good about my husband’s rare diagnosis or his armpit with cancerous lymph nodes. The horizon before us was either dark, bleak or had no shape at all. Her positivity didn’t uplift me. If a breast cancer survivor couldn’t understand how difficult this was, then there must be something wrong with me. My feeling of isolation was growing. 

I looked at my husband, who shot me a glance with a small nod of his head and a weak smile. He seemed to appreciate her story and was grateful for her visit. She had a good outcome, and he was happy for her. Period.

Depression had poisoned my thoughts and taken away my ability to be happy for anyone or about anything. I was doing the best I could to fight for my mental health. I was taking medication and speaking to a grief therapist, but my uncomfortable grief companion seemed to always be with me murmuring one terrible thing or another. 

You should be strong for him, but look how you are falling apart, my grief monster whispered. You aren’t the one with cancer, so why can’t you keep it together? I shrugged off this terrible voice and looked for a distraction, but the room was painted white with only a single framed print.

I picked a spot on the wall to focus on for a moment to try and regain control of my thoughts.  The wall texture wasn’t completely smooth. Sometimes there was a tiny irregularity in the surface of the white paint. I stared at it for as long as I could to try and sweep away the dark thoughts. It lasted 5 or 10 seconds at the most, then the thoughts started coming back. I looked down and toward my left at my husband’s lap. His hands were folded. For some reason, they were completely still. They weren’t clenched or grasped tightly on the arm rests. He wasn’t even fidgeting with his fingers. Maybe he was frozen in place.

In my lap, there was a small notepad. It was blank.  Neither he nor I had prepared a single question. I hadn’t read up on breast cancer in men to try and predict the options for my husband’s plan of care. After seeing the miserable statistics for his survival, I was done with the internet. At some point I would figure out if there were clinical trials in which he could enroll, but that would need to come later.

The door opened and three physicians in long white coats came in. They introduced themselves one-by-one as a breast surgeon, breast oncologist, and a fellow physician in training. Then, the oncologist sat down at a small table next to my husband to begin the medical interview.

Once she began talking to him, she never made eye contact with me again. She asked about his disease, but not about his family. There were no questions about his children or his work, who might depend on him, whether I was his wife or girlfriend. By the end of the visit, I was sure they didn’t know I was a doctor, who had practiced for more than 20 years in the same hospital system.

I understood their strategy of focusing only on the patient. First, they needed to gain the patient’s trust and make them feel important. Secondly, they were in a busy clinic and had to be efficient to see all the patients with a new diagnosis of breast cancer. Hearing him briefly talk about his discovery of the lump and examining him quickly as a group was necessary for efficiency. If they took the time to talk to every husband or wife, they would be in the clinic until 8 PM.

My expectations were too high of them, I thought. In this high-volume breast cancer clinic, they needed to move through patients as quickly as possible. It didn’t matter that I was a physician and whether my husband was single or had seven children. He was a 54-year-old man with biopsy-proven breast cancer. He was a number (more or less) that needed to get moved through surgery and chemotherapy. And we needed to be OK with this.

Yet, whenever I failed to honor my patient’s family members by making eye contact with them and asking for their perspective, I regretted it. It had happened enough times that I always spent the extra few minutes talking to the spouse, parent, or partner. If I could address a family member’s concerns respectfully at the first visit, it would go a long way to solidifying the patient’s and family’s trust in me as a healer.  

“Now, we are going to examine you.  Normally, we leave the room when a woman takes off her top for the breast examination, but hopefully it’ OK with you if we stay in the room,” she said with a slight smile. A gentle attempt at sarcastic humor. I got the joke but didn’t smile.

He took off his shirt and sat down on the exam table. The physicians silently examined him one by one. Their hands swept over his chest…excuse me, breast. I was trying to replace the word ‘chest’ with ‘breast’ in my mind’s vocabulary. The male breast cancer advocates told me that this was important to emphasize the fact that men could get breast cancer, too.

The physicians maintained their pleasant, neutral demeanors throughout the exam, revealing nothing of their thoughts on his prognosis. This practice was designed to instill confidence, yet not make it difficult for them to pivot later towards a good or bad prognosis depending on the test results and their exam.

“Any questions at this point?” they asked, before leaving the room. The lead doctor said they would return later to counsel us more in depth about the plan.

We looked at each other and shook our heads. Then, I glanced down at the blank page of my notebook and the pen in my hand that refused to take notes. 

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