From medical skeptic to grateful and compliant: My recent patient’s transformation

When I first met her, I perceived she was nervous. I could sense the ‘doctor skepticism.’ To my absolute non-surprise, she declined all screenings and preventative care that I offered.  No labs. No pap. No mammogram. No flu shot.

I wondered why she had even come to the doctor.

I think she wondered that too.

I proceeded with the appointment in my usual manner, attempting to keep the encounter warm, inviting, welcoming. I explained what we were testing for, protecting against, and how tons of studies and science had deemed the benefits to far outweigh the risks. Ultimately, I reassured her that I wasn’t there to force anyone to do anything. Patients can choose to take my advice. Or not. I take no offense.

A small win

One year later, almost to the exact date, she arrived in my office again. Same air of anxiety. Same negative aura. This time, she accepted the lab testing. She still refused or wavered on the other recommendations.

“The last time I had a mammogram, it turned into a whole ordeal. Another imaging test, a biopsy, and a lot of medical bills all for nothing.”

We discussed risks and benefits a little more. She said she’d think about it.

I considered that a win.

Five months later, results of a mammogram came across my desk. To my surprise, she had gone, and the results were abnormal. My MA called her. Despite our best efforts, the patient refused further imaging. She was sure this would end with more bills and the same result.

Instead, I suggested she at least come in for me to examine. She obliged.

‘My stomach turned over’

When I am examining other patients and trying to reassure them about lumps or bumps or all the things that Dr. Google has informed them is likely cancer, I usually say, “Trust me. I’ve felt cancer. It gives me an immediate visceral reaction. I feel sick to my stomach.” Cancer looks and feels completely unnatural. Inorganic. Wrong. I would then usually be able to say, “I didn’t get that feeling. It’s fine. We can just watch it.”

When I felt the lump in her armpit, my stomach turned over.

The eventual biopsy confirmed my suspicions. It came back invasive, stage three, breast cancer.

I sprang into action. I set up her appointments, I got her in within days to see an oncologist. And I called her. A lot.

“Are you ok? Who is your support system? Do you need help getting to your appointments?”

“Yes. My cats. No, I’m fine.”

This patient had no one. Her parents dead. No siblings. No kids.

I was stunned and stressed for her. I reached out to other patients and contacts to find her a partner, a group, or some sort of support. But she quietly went on her way through therapy on her own.

I watched her progress from afar. As doctors, we have this unique ability to follow the clinical course on patients through the medical records and notes of others. Standing right next to them at every appointment, but invisible. I thought of her often. It always seemed to me that cancer needs to be surrounded by strength, warmth, and love to be destroyed. I worried her cats weren’t enough.

Nine months later, she appeared on my schedule again. This surprised me, as my cancer patients generally migrate to their new medical home during the course of their treatment and no longer see me for visits.

A transformation

I quietly knocked on the door and stepped in to find a bright woman wearing a warm brown wig and a beaming smile. Her eyes were blue and shining.

I hoped she didn’t notice my barely concealed look of shock.

I smiled and shook her hand.

“You look great!” I remarked. “Tolerating treatment OK?”

She smiled again and proudly said, “Why yes. I even started rowing while on Adriamycin!”

I was even more surprised, knowing that Adriamycin is a notoriously awful chemo drug. She went on to describe how well she’s tolerated all treatments, and that radiation is still an option.

I was just blown away. In front of my face, I had watched a stage three, dire and life-changing cancer diagnosis actually bring someone to life. She had completely transformed, her aura bright and airy.

An awakening

“Doctor, thank you for calling me that day, and for explaining to me that sometimes things in life are too hard to do them alone. That it’s OK to find help, and that there are people out there who want to help. After this diagnosis, I realized how miserable the last 10 years of my life have been. I wrote down my regrets and realized I didn’t want to keep them anymore. I am going to cancer support groups, I’m sleeping better. I even made a friend! I hope to one day help people in my same condition. Is it weird to say that this diagnosis helped awaken me to a better life?”

At that moment, I nearly cried.

Then I smiled at her and replied, “That’s not weird to say at all. Cancer provided you with your silver lining … to life!”

I hugged her, told her to keep up the good work, and we parted ways.

I’ll see her again.