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Under the Microscope

I was walking into my kitchen with an armful of groceries when my cell phone rang. It took a second to register the caller’s name: Dr. James. The surgeon I’d met two weeks earlier.

I wasn’t expecting this call. My biopsy had occurred only a few days ago, and I’d been told that, because of the Christmas holiday, the results would be delayed.

Why is she calling?

I answered. She greeted me briefly, then said: “How did the biopsy go?”

I set down the bags and dropped into a chair, every muscle tense.

“Why are you calling me now to ask that?” I asked.

“You’ve got high-grade cancer,” she said curtly, as if trying to move the conversation along, or maybe just get it over with.

I couldn’t believe my ears—and I didn’t understand her words: What exactly does “high grade” mean?

“Here’s what you need to do right away,” she said. “You need to find a surgeon, get an oncologist and schedule an appointment for genetic counseling—”

“What? You’re telling me it’s malignant?” I shouted.

What kind of doctor starts a call that way? protested an inner voice. Shouldn’t she say, “We got your biopsy results. I’m sorry to say that the news is not good”?

Maybe I’d watched too many TV shows where a white-coated physician gently breaks the news. Or maybe my own training as an oncology social worker had taught me to value a kind, calm manner.

“Slow down, and listen carefully,” she said matter-of-factly, then resumed the to-do list.

“Wait!” I screamed into the phone. “Stop talking, please! I have to call my husband.”

My heart pounded. How is this possible? It was supposed to be a swollen lymph node—nothing complicated. Not cancer….

She droned on.

I hung up.

I was a month shy of seventy-one when I heard her words—words I’d hoped never to hear.

Forty years had passed since my mother’s breast-cancer diagnosis and mastectomy. In her day, few people spoke of the disease without some degree of stigma—and the thought of a radical mastectomy made everyone shudder. The one time I saw my mother’s scar, I gagged and ran to the kitchen sink. This was not the body of the mother I knew and loved.

The question was inescapable: That’s never going to happen to me…will it?

I started going for semiannual exams with a breast surgeon, monitoring every shadow on the imaging tests. Despite three false alarms, including biopsies, I never heard those dreaded words.

Instead, my mother heard them again, fifteen years after her mastectomy. The chemotherapy drugs they’d dripped into her veins had depleted her bone marrow. Transfusion followed transfusion, but nothing worked, and metastatic disease consumed her body. She endured a painful, miserable death at seventy-two.

I thought back to the moment, eight weeks before Dr. James’s call, that had set everything in motion.

“Are there lymph nodes in your breast?” I’d asked my surgeon husband. In the shower, I’d felt a pea-size lump, hard and movable.

“Could be,” he said. His gentle touch was comforting. There it was: clearly visible, easily palpable, slighter tender. From my work, I thought I knew that early cancers didn’t hurt, and tumors didn’t move freely. We were puzzled. I went to bed blissfully unaware that, as I slept, cells were dividing in the wrong place at the wrong time in the wrong way.

I saw my gynecologist two days later. “I doubt that it’s anything serious,” she said. “Wait and watch it for six to eight weeks. If there’s no change, call me.”

I waited five weeks, then asked her to recommend a breast surgeon. I knew that I needed a biopsy. At the consultation, a week later, the surgeon seemed unconcerned, but recommended an ultrasound.

Then the alarm sounded: The radiologist took one look at the scans and ordered a biopsy, stat.

For seven weeks, my breast cancer had hidden in plain sight while I waited for the medical professionals to find a needle and a microscope. Now it was all about a scalpel.

Before her death, my mother had participated in the first breast-cancer gene study for women of Ashkenazi origin. My sister and I had sat with her during the intake interview as she named female relatives who’d died of breast cancer. Suddenly there were pink leaves all over our family tree.

Is one of us next? I’d wondered.

Now, staring at the phone in my hand, I knew the answer.

How should I tell my husband? Call or text? I couldn’t imagine reading a message like this one, but I couldn’t say the words aloud. I forced my finger to tap the letters: I  h-a-v-e  b-r-e-a-s-t  c-a-n-c-e-r.

Wait. No. Yes. Send.

My husband’s reply blinked instantly—a single word, cursing the Fates, echoing my fury.

I sat still, dazed. A dog barked—not the brown, cuddly one curled up under my feet but the phone ringtone that I’d assigned my husband years ago.

“Come home,” was all I could say. He was already on his way.

I found a different breast surgeon, who met with us the next day. My tumor was very small and caught early, so, to my relief, I needed only a lumpectomy. We set a date in mid-January.

The surgery went smoothly; recovery was quick. I was lucky to find an oncologist who was smart, empathic and emotionally available.

My treatment included four cycles of chemotherapy three weeks apart, one month’s rest, then twenty sessions of radiation.

Cancer treatment during the COVID pandemic was the worst of both worlds. Patients couldn’t be accompanied to office visits or treatment rooms. Masks muffled voices and concealed facial expressions. Everyone looked like no one. I felt lonely, frightened and anxious the whole time.

By most standards, I tolerated chemo well. The nurses were sensitive and helpful. I never felt ill or suffered great fatigue, though little things cropped up: rashes, collapsed veins, blood counts slightly off. And the big thing: hair loss, which I found psychologically devastating.

Radiation oncology presented different challenges. The center, a cold, cavernous space, was eerily empty of staff and patients. The doctor, rarely present, showed no interest in my concerns. My radiation burns were uncomfortable. But, thankfully, those penetrating beams did their job successfully.

Two years later, I look in the mirror and see a healthy body with a head of soft brown hair brushing my shoulders. It’s only in my mind’s eye that I still see the patient I was.

My physical scars healed long ago, but I’ve had to work at easing the psychological ones. I was hard on myself—and others. I kept looking for someone or something to blame, and my anger took me to ugly, uncomfortable places. But I also persevered in searching for ways to meet my needs.

Desperate for support from other women who were going through cancer treatment, I wanted to hear their coping strategies and their stories and contribute my own. Through an organization that offered free counseling to women with breast cancer, I connected with a warmhearted counselor, herself a breast-cancer survivor. During our sessions, I confronted my ghosts, talked through my fears and frustrations and got much-needed validation. When I wandered to worst-case scenarios, she guided me back to solid ground. It was just what I needed—the one element missing from my chemo cocktail.

It hasn’t been easy finding my way forward. But I have done so, as I never thought I could.

And while I don’t entirely agree with the cliché that time heals all wounds, I can honestly say that time does soften the edges.

Deborah Levin, a licensed clinical social worker, has lived in a family of doctors since childhood. After graduating from Barnard College, she worked at a literary agency, then moved on to raise a family. In midlife, she obtained her master’s degree in social work, working in medical settings and private practice to help patients and families cope with serious illness, death and bereavement. “I write not only to reach my own truth and validate it but also to reach out and connect to others. I hope readers will relate to my experiences and understand that they are not alone.” Her work has appeared in The Journal of Analytic Social Work, Voices/Journal of the American Academy of Psychotherapists, The New York Times, GRAND Magazine, Grown and Flown and Pulse. She lives in Westchester County, NY, with her husband and lovable labradoodle.

Comments

10 thoughts on “Under the Microscope”

  1. Your story profoundly touched me. I have had four biopsies—all benign—but I now go to my annual mammograms with intense anxiety. I cannot imagine receiving such a curt message that you did. I cannot imagine dealing with this at any time, yet alone during the pandemic. Remain strong—and may your breast cancer be a part of your past, never of your present or future.

  2. Thanks for your touching story, and glad to hear you are doing well. Hope you continue to remain well.
    As an intensive care doctor myself (albeit neonatal intensive care) I have had situations where I needed to convey a sad/bad news to the parents of my patients. It is a painful task, yet, following William Osler’s advice, I try to convey the a bad without embellishing it, yet with extreme care and concern. Almost never have I conveyed a bad news over the phone. I include baby’s primary nurse when possible, often in a side room all of sitting across from each other. Most of all, I am very attentive to my own demeanor—deeply concerned, yet professionally precise, concise but completely open. Often in high risk neonatal medicine outcomes are difficult to predict. And I have been first one to admit, if I don’t know to tell the parents. I avoid throwing a bunch of statistical data. Most importantly, I try to be in the shoes of parents of my baby patient. The first session is always a beginning for a series of counseling sessions. I will remember to narrate your experience to my students—thank you for sharing it v

  3. Thank you for writing about your experiences. I too had an unexpected diagnosis of malignancy during the pandemic. Undergoing surgery followed by radiation was a singular episode of isolation and terror. As you describe, for safety reasons, medical staff were always covered with masks, waiting rooms scheduled to be empty, surgical and radiation rooms left empty for thirty minutes to allow for air to clear of any aerosols, no family able to be with you.
    I think of the ache family loved ones continue to carry by memories of the loneliness their mothers, fathers, aunts and uncles must have experienced during their final moments of life.

  4. I found your account of insensitive doctors and casual responses to your concerns beyond infuriating. How dare they treat you like an example in a medical textbook! When a mammogram plus ultrasound plus needle biopsy (all done in one session, because the clinic wouldn’t let me leave until they’d gone the whole nine yards) turned up a small, probably benign lump, my internist had me in the surgeon’s office within 24 hours. The surgeon–kind and reassuring–had reviewed all the tests and told me he was 99.9% sure it was benign, but he would take it out. Why? I asked. “We don’t like lumps in people.” A sense of humor, too. Within another 48 hours, he’d taken out the lump, told me it was nothing, but pathology would confirm. And so it did. I was anxious, of course, but while all the medical people I saw took my anxiety seriously, they were very reassuring. I so glad that you did, finally, have a positive experience and good outcome. Would that all women with scary prognoses were treated well.

  5. Oh my goodness, Deborah Levin, such a roller coaster experience. Well written,. Agree totally that competence can be paired with empathy. Thank you so much for sharing your story.

  6. Thank you for sharing your story. How harrowing at the start, thankfully leading to restored health now. May every moment of your future bring happiness and good health, and may your story resonate with those providing care in our healthcare system. For some reason I loved the statement “Everyone looked like no one.”

  7. I am glad you stood up to that unfeeling, insensitive doctor! It is so impersonalizing to experience what you did in that moment. I am also glad you weathered the storm and did well despite the rocky start. Your story is such a reminder about how important sensitivity and human-ness is when providing health care, and how profoundly hurtful health care is when sensitivity is absent. I’m glad you weathered the storm, and hope you never have to go through that again. Thank you so much for sharing. Wishing you the best of health from here on in.

  8. Boy, that was hard. So sorry about all that happened to you. Very glad to hear you found comfort and company.
    One thing occurred to me. Those insensitive doctors are unfortunately likely not emotionally available to themselves either.

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