My surgeon, in customary manner, breezes into the room. She is going away for the weekend but has stopped in to see me, as promised. After checking the fluid levels, she announces that the tubes can come out. “Yes,” I tell her, “the resident said he’ll do it later in the day.” “Well, I can do it now,” she offers.
I am happy to see the drains go, but not prepared for what she says next. “Here’s what we can do. I can take the drains out and leave the bandage on for as long as you want. Or I can take the bandage off and replace it with something smaller-you don’t have to look. Or I can take it off and you can look at it.”
I knew the big swatch of elastic that encircled my upper torso had been put there “for my protection”-more psychological than physical. There would be no real pain at the mastectomy site as the nerves that had brought sensation to my breast were gone.
But I was struck dumb by the choices I had not been expecting to make. Perhaps sensing this, my surgeon plopped herself in the chair by the bed. “You don’t have to look at it now. I have one patient who hasn’t looked at herself in 20 years.” I knew I would not be like her. I would be one who wanted to accept this alteration to my body with grace and pride and defiance. Single-breasted women would have to make their scars visible to demonstrate the magnitude of this epidemic. No, I would not shy away from looking at my body. But now? Right this minute? I felt numbed by panic.
“That’s what I like about you,” I tried to joke in a desperate bid to buy some time. “You offer me choices so undesirable that there’s only one option to choose. You know I don’t want to walk around with this bandage on until I see you again in 10 days.” But my attempt at humor was short-lived. “What will it look like?” I asked meekly. “It will look fine,” she assured me. “What does that mean?” I wondered, but didn’t ask.
How does one prepare for the loss of a breast? Over a period of about two weeks, I had read books, joined a support group, sat for “before” photos, consulted with two therapists, talked to a mastectomy patient, talked to God, exercised, visualized, fantasized. “I’m not ready yet,” I wanted to scream.
My more rational voice said, “Now is the time.” The sooner you confront it, the sooner you can accept it. “OK,” I said, “let’s do it. But you look first and tell me if it’s OK to look.” I was 43, talking like a 5-year-old.
She left the room and returned with a handful of supplies. We were mercifully alone, she and I-no nurses, medical students, interns, residents, loving family and friends. just my doctor and me. As she removed the drains and snipped off the bandage she was helping me heal through a procedure probably not mentioned in any medical text. Make the patient feel safe, make the patient feel cared for, and most important, make the patient feel in control of what is happening to her.
The road to this doctor’s clinic had not been an easy one. Over the past five years, I had told an assortment of doctors about a suspicious thickening in my breast. “I don’t see anything,” said four different radiologists. “I don’t feel anything,” said three internists. “I wouldn’t worry about it,” said two surgeons. But I worried every day.
Things only got worse after the biopsy. I listened to the surgeon who did the needle aspiration and misled me about the results. “Atypical cells,” he said, when, in fact, it showed cancer. He was the man who announced without discussion, “I want to do a mastectomy and I like to do reconstruction at the same time.” I persisted with the internist who, when asked if he could get me an appointment with the prominent female physician, replied, “I don’t know why you need to see another surgeon.” I was rejected by the oncologist who refused to make an appointment with me when told I would also be meeting with another doctor in his office. “If you’re seeing her,” his assistant relayed sheepishly, “he said he doesn’t need to meet with you.” “But how can I choose the right doctor for me if I can’t talk with him?” I asked. “Keep the appointment with the woman and maybe he’ll pop his head in and say hello.” I met with the plastic surgeon who, when I said, “I’m not sure I want reconstructive surgery,” replied incredulously, “Why not!?”
After all of this, I sought out the surgeon who, with her medical team, reviewed my records and said, “I can do a lumpectomy; here are the pros and cons. I can do a mastectomy; here are the pros and cons.” I took it all in and when I asked, “Do you have a recommendation?” she Offered it. She is the surgeon who, at the time of my initial evaluation, had me meet not only with an oncologist and a radiologist but with a psychiatrist who assessed my emotional adjustment and offered support of varying kinds. This is the surgeon who believes fervently that the more information a patient has, the better able she is to cope with her circumstances.
As the bandage fell away, I snuck glances down, waiting to be shocked by some unimaginable horror-a vision of my body-raw, wounded and bloody. Instead, I saw clean, healthy skin and a thin band of steri-strips covering a neat incision. It was nothing. And it was everything. I looked for what seemed like a long time and felt myself begin to breathe again.
“I’ll put some gauze pads around this for your protection,” she told me. “But you can take a shower tonight and these bandages can come off.” As she left to go off for the weekend we smiled proudly at each other acknowledging our accomplishments.
That night, alone in my room, I stood in front of the bathroom mirror and took off the remaining bandages, They provided protection I didn’t really need. They covered a scar I did not want to hide. They represented a level of medical care which should not be so difficult to find.
