“Hello, It’s Your Electronic Medical Record Calling”

I’m sitting in the waiting room at my hematologist’s office. Today is bone-marrow biopsy day—the day a drill will penetrate my hip bone to extract a sample.

The road to this moment began several months ago with a routine blood test at my annual exam. The test showed an abnormally high count for one type of blood cell. I was referred to a hematologist for further evaluation. The referral surprised me, but I wasn’t worried—yet.

I endured several more tests to rule out some conditions; however, my hematologist, Dr. Fawcett, has suggested that we move forward with the bone-marrow biopsy to get the full picture. The reviewing pathologist will look at the tissue and at other genetic markers to identify or rule out blood cancers like leukemia.

I’m eager to get on with it and find out what’s going on with my blood. Of course, I know it could be cancer, but I’m determined not to obsess over it.

I’ve arrived here on time, wearing my nerves on my sleeve. My anxiety finds its favorite place, in my chest. My heart beats a little faster. I try to derail my racing thoughts, thinking: Breathe, just breathe… I wish I hadn’t watched all those YouTube videos of biopsies!

In the videos, the procedure seems barbaric, and the patients either unusually calm or theatrically histrionic. Speaking for myself, I know I’ll be calm on the outside but anxious on the inside.

“Ms. Brooks?” the nurse says. She introduces herself, leads me to a room and takes my vitals. I’m escorted to another room that contains an odd-looking table; I don the dreaded clinical gown and take a seat.

Dr. Fawcett floats in—my caring hematologist, attractive, with dark hair and eyes, her kind demeanor and ready smile always reassuring. Her bedside manner is engaging and compassionate; she’s someone who cares about her patients. I’m thankful to be one of them.

“How are you?” she asks.

“Nervous,” I confess. “I watched YouTube videos of biopsies.”

Her soft chuckle conveys surprise that any doctor would ever have posted those videos, or that I would have watched them. Hearing the unspoken message—It’s not that terrible a procedure—I feel calmer. I admire the way she always makes me feel at ease.

She goes over the procedure again, and her nurse administers a mild sedative to help me relax, thank goodness.

I lie prone on the table, and my unsuspecting hip accepts a syringe full of whatever numbs the target area. After a few minutes, Dr. Fawcett makes a small incision for the drill.

The drill’s whir sounds familiar, like the drill I use at home to fix a loose screw or create a hole for a new one. I feel an odd sensation as the drill locates the target bone. Then my hip feels pressure and intense pain—but it’s not unbearable, and it’s over in just a few minutes.

The nurse bandages me and gives instructions for aftercare. I leave to start the long wait for the results.

It’s a torturous six weeks, with too much free time during which I immerse myself in Googling all the dreaded possibilities. My thoughts resemble an endless, unstoppable news feed: I look just fine…Did I cause it?…Who’ll take care of me?…Will I be able to work?…Who will tell me that it will be okay?

These ruminations reflect my anxiety about my future. I live alone, with no spouse or children. My small extended family lives in another city, and I have a demanding job. I relish my independence and freedom. My private nature convinces me not to tell my support network everything until I know more. The exception is my best friend of many years, who knows what I’m facing and can always coach me back to equanimity.

Now, back at the clinic and waiting for my hematologist to arrive with the pathologist’s verdict, I feel exhausted by my nervousness.

Footsteps, a quick knock; then she greets me with her warm smile.

“How are you doing?”

“Anxious to know the results,” I reply.

“Did you think it was cancer?” she asks, peering into my eyes with unexpected curiosity.

My mind races; there’s not time enough to convey what I thought during those six weeks of waiting.

“I didn’t know what to think,” I say finally.

“You have an iron deficiency, not cancer,” she says. “You don’t have any iron stores in your bone marrow. You’ll need to take iron supplements, and I’ll order periodic blood tests to check your progress.”

“I’m so relieved!” I reply, with a big sigh.

She explains the next steps. I’m not sure who’s more relieved, her or me; but I sense that she shares my elation. I leave feeling much lighter than when I arrived.

Several months fly by, and I’m sitting at home, checking on my latest blood-test results and feeling hopeful that my treatment is working. I’ve no reason to believe otherwise; there’s been no call from my doctor’s office.

Instead, the “call” comes from my electronic medical record (EMR). It’s right there for me to read.

No human voice speaks these words—they’re just letters that make words, words that make a sentence, a sentence that makes the message:

Many large and giant forms consistent with a myeloproliferative neoplasm….

Tears suddenly rush up—new tears, scared cancer tears. I want to see my doctor’s warm eyes, hear her reassuring voice—but the compassion that sat with me when I received the biopsy results is nowhere to be found.

Indeed, my biopsy ruled out cancer—at that given point in time. But our bodies are not static; they are changing every second. And sometimes, without warning, they fail.

I read and reread the test result, thinking, How can it be? Why hasn’t Dr. Fawcett called? Does she know that the test results were automatically released?

I’m so choked with hurt and shock that calling her office isn’t possible. I wait for her call, but it never comes.

Several days later, I head to her office for my follow-up appointment. I wait, then her pleasant nurse calls my name.

“How are you today?” she asks.

“I’m good….” the lie tumbles from my lips.

In the exam room, I hear the familiar knock, and Dr. Fawcett steps in and greets me with her usual kind demeanor.

I decide not to disclose that I’ve seen the test results; I want to give her a chance to explain the “call.”

She begins to read the test results—then pauses.

“It looks like you do have a myeloproliferative neoplasm,” she says.

Clearly this is the first time she’s viewing my test results.

“I saw that,” I reply.

She doesn’t attempt to explain the automatic release of my cancer diagnosis. Outwardly, I remain calm; inside, a sickening feeling of mistrust settles into my exhausted mind. The appointment concludes with a discussion of next steps, the details obscured by my inner fog of disbelief.

The EMR screen, cold, sterile, devoid of life, delivered this terrifying fact: The rare cancer has exited the realm of possibility and is now inside me. EMR has delivered the most agonizing health information I’ve ever received—information that begs for a compassionate voice—with laconic indifference.

After some time, I can reflect on the unseemly similarity between cancer and the EMR. Cancer methodically creates defective cells to replace healthy ones; the EMR efficiently communicates test results to the patient. Each does its job stealthily, persistently, without discretion or compassion.

Ironically, just as cancer finds ways to fool the immune system, the EMR somehow evaded human notice and became a virtual doctor, empowered to make its “call” with mystifying precision.

I’m still left wondering: How was automation allowed to hijack “patient-centered care,” modern medicine’s favorite sound bite? How on earth was that test result automatically released?

———-

Postscript: I’m humbly reminded that, with acceptance, we can resolve to transform the rough edges of our experiences into prosperity. Today, thanks to excellent care from a myeloproliferative-neoplasm specialist, I’m in remission, and I enjoy a full and active life.