Cancer 1, Doctor 1 (Part 2 of 2)

I left work after my dermatologist broke the bad news that I did indeed have cancer. He had said that my type of cancer wasn’t so deadly that I should drop everything and find the nearest qualified surgeon; however, he added he wouldn’t wait too long. He gave me two names to look up, experts he’d trust with his own face. I appreciated how he fed me the information in digestible bits, and then gave me a straightforward task. It distracted me from thinking about how we don’t really have a cure for cancer.

At home, my partner and I set to work decoding our insurance coverage. We searched through hundreds of network physicians and learned that none of them performed the surgery I needed. In fact, none of the health plans available through my employer – HMO, PPO, POS, union-run – would cover the treatment. So, we called up the two specialists recommended by my dermatologist and asked for quotes. Would it be hundreds, thousands, or tens of thousands of dollars?

At the university hospital, no one could answer the question. One friendly nurse philosophized that our hospital should be offering comprehensive insurance for its own providers. I wish one could assume, but I wasn’t in the mood to ponder the capitalist, for-profit nature of our health care industry. Imagine going into a store and being forced to buy something for the sake of your life. What incentive do suppliers have to keep products accessible and prices low, when consumers have to make a purchase regardless? I just needed to be cancer-free, ASAP. I didn’t have time to wait for health system reform.

The private office we called next connected us to their billing person, who briskly listed the costs, line item by line item. Encouraged by the office’s efficiency, I requested the earliest available appointment...four weeks away. A good friend of mine confirmed from people who had worked directly with this surgeon that he was among the best in his subspecialty. My parents agreed to help me with the bill.

I attempted to relax as I counted down the days. In preparation for my treatment, I reviewed the latest literature on my cancer and informally consulted colleagues to make sure I was making the right decision. I wrapped up loose ends at work. I purchased a wide-brimmed hat. The weekend before, I stocked the refrigerator with fruits, vegetables, and ice cream, and cooked a large pot of chicken soup. I bought the recommended list of wound care supplies. All in all, I was ready. The goal was to stay in control, keep everything predictable. My cancer didn’t have to be any more disruptive than getting my car washed.

My surgeon good-naturedly obliged my need for order. While I laid stiffly on the operating table, he gave a detailed timeline of how the surgical site would change over the next weeks. Even when the affected area turned out to be much larger than expected, he explained that the gaping wound could be hidden with a special skin closure technique. I stole glances at the vital signs monitor and was pleased to see my blood pressure and pulse remain normal. My surgeon finished by commenting with satisfaction that my case was done on time. I liked him precisely because he was a skilled technician who didn’t get too caught up in the emotional messiness of illness. He affirmed my desire in that moment to believe in “magic bullets” – cancer => cut => cure.

My cancer experience thus far had been running like Swiss clockwork. So, it was an unwelcome surprise when my methodical façade broke down only hours after the procedure. At home, resting with an ice pack on my face, I found myself spooning rum raisin ice cream into my mouth as if I were in an eating contest, all the while fighting back tears. What is going on, my brain raced in confusion. The cancer is gone. Everything went smoothly. Why the drama now?

I replayed the events of the day in the doctor’s office. At one point, a nurse had come in, put her hand on my shoulder, and stated that my surgeon was confident he had gotten all the cancer. I should do “just fine.” Her smile was warm and sincere. I wanted to believe her, but I had seen healthy women almost bleed to death from routine vaginal deliveries. I had dealt with minor office procedures that turned into ICU stays. I have had to admit to patients that we have no explanation for their diseases. Doctors can’t give guarantees. Most of the time, we don’t have cures, just symptomatic remedies. Rather than comfort, the nurse unwittingly reminded me that science, technology, and medicine have more questions than answers.

So, it was not in the doctor’s office, but at home when my healing truly began. Twice a day, I cleaned and dressed the incision that started in the middle of my forehead and ran into my hairline. I carefully washed over the small stitches with saline, applied antibiotic ointment, and taped down the large white bandage. The wound started off angry and inflamed, causing swelling down to my cheeks until I looked like the cross between a Klingon and Frankstein. I hid from the outside world, mortified by the blatant sign of illness on my face.

But in the quiet and in my embarrassment, I slowly came to acknowledge my physical limitations. I sought calm in daily rituals. I sipped nourishing stews and ate fresh fruit. I napped on the couch with my dog at my feet. I replied to emails and texts from family and friends. I took medications as prescribed. I listened to birds chirp and watched the sun light stream through different windows throughout the day. I took deeper breaths and just closed my eyes from work whenever I wanted to. I started playing with Twitter. I let myself cry.

The vulnerability was awkward, but therapeutic. I thought about the disconnect of expectations that can occur between doctors and patients. I think most doctors realize the shortcomings of our craft. We have a set of tools that sometimes work and sometimes don’t, and we try our best to do some good. In the end, we are not someone’s parent or best friend or spiritual guide. Many patients, though, demand more. They want to be healed. They seek meaning, connection, and hope, when they are sick.

I didn’t ask my own doctor for such existential reassurance. But then, my illness has a defined, effective treatment. The cancers I deal with at work are usually mysteries, filled with uncertain disease courses and treatment responses. They cause patients to question their essential womanhood and values. Who am I if you take out my uterus? Will my partner still find me attractive? Am I more afraid of never being a mother or dying of cancer? I listen to the stories patients tell about themselves, because in there, are the clues to how they see their bodies, how they make sense of their lives, and ultimately how I can best contribute to their healing experiences, if they want me to.

I think my doctor picked up on my pragmatism and knew intuitively that I just wanted to get out of there as soon as possible. He mumbled during the initial consultation that doctors have a hard time being patients, that illness is extremely humbling. I have not made peace with illness, but I have gained a new respect for the process of healing. There are no magic bullets.