Tuesday, June 05, 2018

"We Don't Give Bad News On Friday"

Thank you, friends, for asking about my trip yesterday to Hope Breast Cancer Center. It is timely that this happened as I was gazing at a deadline for a grant for a conference on Narrative Healthcare--because these past three days have been vexed by an experience that shows me just how badly we need narrative training for doctors. In the end: I'm fine. It is, as I suspected an infected spider bite or an infected blister from a Canon camera strap. Because some bites can be very poisonous, I went to a GP on Friday afternoon to get some nice antibiotics so I didn't slip into a coma in my sleep as the worst stories go. I left with a worse worst story.


My regular GP wasn't available so I went to another. Seeing the infected bite, she was taken aback and immediately said it could be inflammatory breast cancer then left the room to make an appointment for ultrasound and mammography, leaving me there with my phone which I immediately googled IBC on: presents at stage IIIb, highly aggressive, rare, basically really hard to treat. Doctor came back into the room and was surprised I was crying, "Oh, you're crying." She handed me an appointment sheet for Monday. In three days. She said it might not be cancer and left. As I drove to meet my mom at the steps of All Souls Cathedral, I went through the details of dying in my head: will is done, power of attorney is done, daughter's trust is done, I can jump off the bridge over the French Broad to save everyone the trouble. . . these thoughts. Thoughts that perhaps come with every possible Stage IIIb (line from WIT comes to mind, "there is no stage V") diagnosis or possible diagnosis. I spent the weekend holding my daughter close and fading in and out of naps and Parks and Rec episodes. Not thinking about double mastectomy and head-shaving (both of which I'd do in a heartbeat if Monday came back positive). On Monday, I made my first trip to the breast cancer center. I am third generation, that we know of, so I felt that this was my natural progression of events, only more aggressive and challenging than my mother and grandmother's. Maybe this was my turn.

It wasn't. But here's the narrative side of things: in medical school people learn to diagnose, but they don't learn how to share that diagnosis. It gets delivered like the answer on a multiple choice test (because it once was), not like the incredible life change that, in cases like cancer, it is. Cancer was the first reaction. In narrative training, that first response is a quiet starting point then the "reader" inquires more. Practitioners learn that the diagnosis is a plot-twist and that plot-twists challenge a character on every level. Reading more about inflammatory breast cancer and seeing the actual oncologist on Monday, I learned how many more questions there were to ask, and how telling my story about photography and the possible spider bite directed his attention to polysporin and bandaids, a much more welcome treatment.

Yes, the GP ought to have considered cancer, yet the way she revealed it (first impulse--surprised outburst) and the way she managed the situation at 4:30 p.m. on a Friday were damaging, difficult beyond belief, even traumatizing.

I am still reeling.
That GP is part of my story now forever, the story of the Friday I heard I might die. She could be another character in another story: the story of the Friday the doctor asked me about what I had been doing lately, suggested bandaids and polysporin, and then gently suggested that I call back on Monday as my other medical office does because "we don't give bad news on Friday."


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