‘I felt her arms around me, firm and strong’
An oncology nurse faces a diagnosis from the other side of the exam table
The diagnosis of cancer, when it comes, is like having a bucket of icy cold water thrown hard into your face. Fine one minute, in the next the vision blurs from the smack of fluid, and the pain from the cold is so sharp the skin feels pierced. There’s a sense of injury, the asking of why, the realization that this unbearable soaking wetness defines the new normal of one’s life.
I’ve worked as an oncology nurse and as a hospice nurse for more than a decade, and even though I’ve only been a bystander when other people were diagnosed with cancer, I thought I knew how getting a cancer diagnosis felt. I was wrong. It was the middle of September, and I’d come to the hospital for a follow-up to my routine mammogram. I might have been worried, but I wasn’t because I had promised myself that I wouldn’t worry until I had reason to. I’ve had several followups to mammograms over the years, including ultrasounds that turned out normal and even a breast biopsy that was fine. So when they called to schedule the follow-up and I felt a clench of anxiety in my stomach, I told myself: No.
And I kept that “no” with me at the screening, while I changed into a pink gown and afterward stored my clothes in a locked cubby, while I sat in the quiet waiting room reading the book I brought with me, while I casually glanced at the informational handouts for breast cancer patients, thankful they were not relevant to me.
The follow-up screening was for the right side only, and the mammogram seemed to go fine. Next came the ultrasound. The tech did her part, and though it seemed to take her awhile I still wasn’t worried. As a nurse I know that the most ordinary things in health care sometimes take much longer than it seems they should.
When the tech finished she told me she would have the radiologist come in. That also seemed normal. I went back to my book, unconcerned.
When the radiologist came in she said, “It’s good you have a book. It’s always good to have a book,” which seemed oddly offtopic, although maybe that’s only in hindsight. She said nothing else during the exam, and it took so long that I got annoyed at her silence. I’d just been reading how provider-patient communication is so important for good health care, and that’s exactly the kind of health care improvement issue I focus on in my own writing.
What those arguments in favor of constant open communication miss, though, is that sometimes the doctor has to tell the patient something she absolutely does not want to hear, and in those cases the physician needs to be silent until she is sure.
Looking back, as a nurse, I can see so clearly how the situation played out. The tech saw ... something ... and took her time with it while remaining very calm. Then she quietly left the room and, most likely, explained her findings to the radiologist. Then the radiologist came into the exam room and talked about something, anything — in this case, my book — that had nothing whatsoever to do with the subject of the screening. And then, after silently completing an extended ultrasound exam, she told me, “We see a mass here, at 9 o’clock.”
Just like that. The bucket of water, the pain from the icy cold, the wetness, the feeling of being blinded, of drowning.
I can picture what happened so well because I have been on the other side. I worked in outpatient oncology for a few years taking care of, among others, patients who had received stem cell transplants (formerly called bone marrow transplants). My patient that day must have come in for a transfusion, because we “typed and crossed” her: verified her blood type and checked for known antibodies. That’s standard procedure, and it usually feels pro forma, but this time was different.
The lab called with the patient’s blood type, and it was the blood type she had been born
with, but not the blood type we wanted to see. Her blood type had actually changed after her stem cell transplant. That happens. If the stem cell donor’s blood type is not the same as the patient’s, the patient will convert to the donor’s blood type. I knew that a reversion to original blood type tends to mean that someone’s cancer has returned, but this was the first time I had confronted it in real time, happening to a patient I was responsible for.
The problem was, the changed blood type was a single data point — significant but still singular. More work was needed to say definitively that this patient’s cancer had returned, and sharing our partial information with her would have been irresponsible, even cruel. Plus, I was not the right messenger for such horrible news since I barely knew her and she didn’t know me.
I took care of her pressing needs that day, but the hardest work was done behind the scenes by one of our physicians and the inhouse physician assistant, who had to verify whether the patient’s cancer had come back. What I remember most is how bad it felt to have this terrible secret, a secret the patient deserved to know much more than I. I remember being very polite with her, calm, slightly distant — exactly the way the radiology tech was with me. I remember that at some point the doc determined the patient had relapsed, and he broke the news to her. I felt relieved that taking care of her no longer required me to tacitly lie to her, but I also understood that the care we took with her secret was a form of caring for her. We needed to be sure of our facts and we needed the right person to deliver the news; someone who knew enough not to let the patient shatter.
That’s what the radiologist and the tech did for me — they made sure I didn’t shatter.
The radiologist told me about the mass and explained further while she finished the ultrasound. I lay there, saying nothing, as tears trickled out of my eyes. As soon as the radiologist left the exam room I started to sob, really, a hard ugly crying of a kind that I thought I had outgrown.
I didn’t even hear the tech come back into the room, but I felt her arms around me, firm and strong. And then she spoke: “This is treatable,” she said. “They can cure this.”
The splash of icy water on my face, the momentary blindness where I thought only of my children, my husband, the fear so powerful it was painful: cancer, cancer, cancer.
And then two hands, two encircling arms, and the voice of someone expert enough to contain my fear telling me, you can survive this. You can. Then the radiologist showing me the mass on her computer screen, setting out the first stages of a plan for treatment, giving me a structure for containing my terror of the disease.
The diagnosis was confirmed with a biopsy, and the rest of my care included genetic testing, lumpectomy, radiation and then the drug tamoxifen, which I will take for the next five years. Through it all I worked to put into practice what I had learned from working as an oncology nurse, and then relearned as an oncology patient. That is, in order for a cancer patient to at least approximate regular life she must contain the fear that a cancer diagnosis inevitably stimulates.
Like so much of life, this was all trial-and-error. I binge-read murder mysteries and binge-watched Netflix. I spent a lot of time with our dog and very little time on cancer websites. I wrote a column for The New York Times called “Breast Cancer Is Serious. Pink Is Not,” because I found the inescapable pink of October (Breast Cancer Awareness Month) irritating and insulting. I ate chicken noodle soup from Everyday Noodles in Squirrel Hill at least once a week and had Belgian frites from Point Brugge for dinner when the going felt especially rough.
I rode my bike the 2.5 miles to and from 15 of my 20 radiation treatments. I did that, not to impress people or prove that I’m tougher than cancer, but because it reminded me that I’m a vigorous able person, not a disabling disease.
And now I am, mostly, on the other side of treatment, and writing this piece, to say, once more, that after the initial shock of diagnosis, the challenge was to keep my fear, as much as possible, in check. The how of that is of course what’s tricky. Ideally, people in health care step in at the hardest moments and demonstrate containment by facing the fear with you and then offering hope in the form of treatment. After that, for me it was one day, one bike ride, one Agatha Christie novel, one bowl of chicken noodle soup at a time, until I learned, despite the diagnosis of cancer, to fully live again.