Saturday, August 27, 2011

Skin cancer everywhere!

We had a patient presentation this week on skin cancer. A 65 year old woman candidly told our entire lecture hall about her experience getting a local excision, a sentinel node biopsy and eventually radiation. She had no family history of skin cancer.

Hey-oo! Talk about hitting home.

Her doctor found the mole, and before she knew it, she had an appointment with an oncologist. Stage II, and treatable. She has been cancer free for several years now, but it haunts her a bit. She described to us:
Cancer is like the mafia. You live, but you're always looking over your shoulder.
I'll be coming back for your lungs.
That is honestly the best description of having cancer I've ever heard.

Her emotional experience dealing with cancer was much different than mine. She was terrified waiting for the initial biopsy results. And then she was terrified again waiting for the sentinel node results. She doesn't remember anything from many of her doctor's appointments during her ordeal. Her family took notes so she could read them over later.

I didn't have the same worry. I remember the most minute details from my doctor's appointments. I posted about this before; as I get older, I find myself worrying more. Maybe her age makes her more susceptible to worry? Or maybe I felt a bit invincible, so it just didn't worry me? But our stories are remarkably similar. So why was she so recognizably scared and I wasn't?

And after listening to this lecture, I realize that I probably did have something to be scared about. I mean, after all, what if it had metastasized?

It's weird hearing your ordeals being clinically described:
"It's possible that sentinel node biopsy is too optimistic. We may find out in several decades that we've gotten too confident. It is possible we missed some of the cancer with this technique."
Tell me more about the risks of sentinel node biopsy. I'm all ears.
Yes, that's exactly what I wanted to hear. And I use my sarcasm, but actually, I'm still not worried. Is that strange?

The woman went on to tell us that she had no interest in getting her doctor's opinion. Even though she had no medical experience, she had educated herself about skin cancer. She even corrected the physician who was interviewing her several times.

But then I wonder, as a doctor, how does it feel to be asked by a patient: "What would you do?" And worse, you know they will take your advice. Is the responsibility ever overwhelming?

Which brings me to my next point: is it every okay to cry in front of your patient? I've heard fifty conflicting opinions on this during the past week alone. Some physicians feel that patients really feel touched that physician can be so emotionally involved. Others feel it communicates compromised ability to view the patient objectively.

But it's only a matter of time before I run into something that triggers something from the myriad of health crises my family and I have had. As my husband says, "You need to work on that." Yes, indeedy.

I'm not a crier normally, but I can imagine nothing worse than crying when your patient is not crying.


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