‘I now know that I actually knew very little’
“Why me?”
It’s a question I often hear among my patients when I share a new
diagnosis of cancer. People want to know why. Is it their fault? Did a family history catch up with them? Did they smoke or drink too much, should they have exercised more, was there a genetic component? Cancer is a common disease, and yet it never makes sense when it’s happening to you.
On Sept. 13 — just nine months ago — I awoke after a colonoscopy to my wife leaning over my stretcher railing, sobbing. My wife, a radiologist at Harvard, is the rock of our family. I’d never seen her cry like that in our over 20 years of marriage. She broke the news to me: They discovered colorectal cancer during my colonoscopy.
I am only 48. I am healthy and have no risk factors. “Why me?”
I’m a breast cancer surgeon working in Boston at the renowned Brigham and Women’s Hospital and Dana-Farber Cancer Institute. I’ve dedicated my entire professional career — and plenty of my life outside of work — to treating women, and quite a few men, with breast cancer. I like to think of myself as an empathetic physician, and my track record confirms I’m a talented surgeon. I’m focused on identifying the best ways to treat people with early-stage breast cancer, and I’ve become an advocate for taking a less invasive approach to avoid overtreatment. Over the last 16 years of practicing, I estimate I’ve cared for several thousand people, and I always learn something about the cancer journey from each one. Yet since receiving my own diagnosis and starting treatment, I’ve realized I actually knew very little.
On the day of my colonoscopy, the nurse asked me questions about my medical record:
Have I had surgery before? “No.”
Do I take any medication? “No.”
Have I ever been hospitalized? “No.”
On and on, all my answers were no, and in some cases, I wanted to say, “Of course not, I practice what I teach.” Yet, there I was for a colonoscopy two years earlier than someone my age is supposed to. I should’ve known something was wrong.
Over the summer, I began having diarrhea and lost weight without trying. I was feeling fatigued, and I would lose steam on our usual weekend hikes. I love tennis, and yet I couldn’t run the balls down anymore. Sometimes I even needed to take a nap after exercise. I blamed it on working full-time and the fact that I had just begun my second year as an MBA student at MIT Sloan School of Management, one of the most rigorous MBA programs in the world. I blamed my symptoms on everything possible but an actual medical condition. I, more than anyone, should have known better.
Finding out you have cancer, I can now personally attest, is a unique kind of fear.
When the symptoms didn’t improve, I arranged a colonoscopy, but I put it off until the end of the summer. Because my wife and I are both busy physicians, we needed to plan our vacations well in advance, and we already had booked our vacation traveling with our boys, ages 19 and 17. In retrospect, this was a good decision because we made a lot of great memories that summer.
Finding out you have cancer, I can now personally attest, is a unique kind of fear. It didn’t matter how much I knew about cancer in general; I was scared. And so was my wife. When it came to my diagnosis, I didn’t know the exact steps of my treatment or what the treatment involved or the risk of cancer spreading or recurring after complete treatment.
The gastrointestinal doctor was terrific but very frank. We would get the full results back the next day, but it was definitely cancer. Colorectal cancer is not my expertise, and I immediately found myself in the position of so many of my patients after I share such news with them. What’s the plan? Who will treat me? How will we tell our children?
Being a cancer surgeon at one of the world’s best cancer hospital systems is mostly a blessing but also a small curse. I knew right away who I wanted on my team: I picked my surgeon, my oncologist, and my radiation oncologist — all my colleagues of many years. They ordered “staging” scans to see if my cancer had spread, just as I would do. And I was told to try to go about my life until I heard back. How many times had I told my patients the same?
I went to class as usual at MIT the weekend that followed while we waited for the results. I thought of all the times patients waited for me to call them. I don’t remember anything from the class, and I probably should have stayed home. My wife couldn’t wait any longer, so she called my surgeon herself. He said my cancer was not metastatic — meaning it hadn’t spread to different areas of my body — and so it was considered curable, but treatment would require several steps and many months. My wife shared the news with me as soon as I came home that day. I felt relieved that it had not spread, but I still felt angry. My wife told me I was going to be all right. “I know it,” I responded. Why couldn’t I feel the same way?
As many people do, we tried to “act” normal that weekend, but we were cracking. We had to tell our kids because my 17-year-old had suspected something was wrong and kept asking my wife if she had been crying, which she kept denying. My wife called our oldest son and said she missed him so much and wanted to see him. He came home from college for what he thought was family time and watching the Patriots play; instead we sat the boys down in the kitchen and shared the horrible news with them. We all cried, except our oldest son, who looked at us the way I try to look at my own patients and said, “Dad, you are going to be okay.” How could he know? And how could he be so strong?
We cried a lot that day. I don’t remember much else besides the crying and watching the Pats lose badly to Jacksonville. The Patriots don’t lose often, but they did that weekend, and I felt like I was losing too.
On that following Monday, my wife and I went to the cancer center where I work and where I am now a patient. I got off on the seventh floor, the GI oncology floor, instead of the ninth, where I usually see my patients. I didn’t know what to do with my doctor ID — should I keep it on or take it off? Getting my first patient wristband was a humbling experience. Shouldn’t they know who I am? Now I am one of many on the medical team’s list. My wife and I were ushered into an appointment room, where I had to do a double take and avoid sitting in the “doctor’s” seat.
My medical team told me the plan: I’d undergo chemotherapy for 16 weeks, followed by six weeks of chemotherapy and radiation together, then surgery. It was to take up the next 12 months of my life.
When I meet my own patients for the first time, I’m always spewing statistics: the prognosis, the therapy with the best survival rate, the complication rates with the different types of surgery, the percent chance of recurrence. But as I listened to my own treatment plan, I didn’t want to hear any numbers. I didn’t want to hear the prognosis or the five- or 10-year survival rates. Regardless of the stats, I would get the same treatment and live the same life. All I needed to hear was the words “curable.”
Maybe some patients aren’t ready to hear statistics at the first meeting, or maybe they just want to know — in layman’s terms — whether they are going to be okay. Sometimes doctors want to share all the possible outcomes to fully inform the patients. When I get back to practicing again, I will ask patients what they want to know.
I began asking the doctors how I was going to manage my patient load, school, and my research and coordinate these with my treatment. “Mehra, you have to put yourself first now,” my wife said. It’s so hard for a surgeon to hear that he should stop being a surgeon. It was painful to hear I couldn’t continue treating people with cancer because I needed to battle this disease myself. Couldn’t I still operate with a chemo pump? Or at least see patients in clinic? But everyone advised, “Mehra, you have to stop.”
I was told I could start treatment the next week.
For me, one of the hardest parts of getting this diagnosis, I think, was who to let know. I decided I had to tell my work colleagues in breast oncology, my family, my close friends, and my fellow MIT classmates and professors. People reacted to hearing my diagnosis in different — sometimes disappointing — ways. But I learned how much so many people cared about me, and that allowed me to ignore the reactions of those who let me and my family down.
Many patients were already scheduled to have their surgery with me. Until I started treatment at the end of the week, I operated on as many as I could. The rest I had to call and share my news with. These were some of the hardest calls I have ever made. I was letting my patients down. After my “last” case, I let some members of the operating room team know about my diagnosis. The news spread like wildfire. Everyone knew I had cancer now.
A few days later, it was time for my port-a-cath to be placed for chemotherapy to start. The port-a-cath is inserted under the skin so that drugs can easily reach a person’s veins. So many of my patients have this done, and I’ve always thought of it as such a minor procedure. Well, it turns out I hated it. It became a badge of sickness for me, something that constantly reminded me that I had cancer. I could see the port, and I constantly felt it. When I get back to practicing, I will remember the feeling.
I was told the hospital would call me to let me know what I should do to prepare for the port-a-cath placement. I waited, but no one called. So I had to call them, twice. How could they forget? So often we hear about the need for patients to take charge of their own care; it was strange to experience it on the other side. As a physician, I just assumed the systems work.
When I arrived at the hospital a couple days later, my provider went over all the pros and cons of having a port-a-cath placed. I couldn’t help but think, “Do I really have a choice to say no?” The procedure went fine, and when I awoke from the sedation, I was craving a cup of coffee. It was one of the last cups of coffee I’d enjoy for awhile. For 20 years, I used to drink a cup a day, but during the many months of receiving chemotherapy, I couldn’t stomach it, not a single cup.
The day after the port placement, despite the pain and still recovering from the procedure, my wife and I drove up to Maine. I had accepted an invitation to give a presentation at a major cancer conference there a year prior to my diagnosis. I sat through a panel of esteemed cancer surgeons who spoke about various treatments for lung cancer, breast cancer, and, of course, “my” cancer. When it was my turn, I stood in front of the audience and began my usual lines of how great we are at treating cancer — all the data and statistics. No one knew I was sick, but I couldn’t move my head to the right. Each time I tried, I felt the port-a-cath, and it hurt. I was trying to hide my cancer, but it was sticking its ugly head out. Despite covering my bandages that stretched to my neck and biting through the pain, the cancer was winning that day.
As fall turned to winter, I started to notice things I hadn’t seen when I had been busy studying for exams, training to be a surgeon, or working. I noticed the leaves change color and fall as we took walks in the neighborhood. I found myself wondering if I’ll experience the seasons change again next year. Of course I will, but sometimes it’s hard to believe much of anything in those moments when all you know is pain and helplessness — and I will never forget that.
Today, nine months after my cancer diagnosis, I’ve completed all treatment, and I am cancer free. I’ve managed to complete my MBA program, and I graduated June 7. I’m making many promises to my future patients and to myself, including to always remember what this was like. I will not forget how terrifying it was to be told you have cancer. How painful each needle and catheter felt, how chemotherapy ruined my appetite, what it was like when my providers forgot to call.
I’m still learning so much as a physician, now in a new way.
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