Being A Patient Made Me A Better Doctor
When you choose to become a physician, you get inducted into medicine by reciting the Hippocratic Oath, which is essentially promising to uphold a highly ethical standard of practice.
It goes a little something like this: “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability…. if I am to care adequately for the sick….I will prevent disease whenever I can, for prevention is preferable to cure.”
I get asked a lot whether or not my own cancer has changed my practice. It’s a complicated question to answer.
I was a young woman working as a family doctor in Yorkville with a special interest in women’s health and beauty. I prided myself on being an advocate for my young women/men trying to navigate a sometimes flawed system barricaded by screening guidelines with rigid inclusion and exclusion criteria and “choosing wisely” articles to reduce the amount of unwarranted tests being ordered by family doctors. The empath in me always had a low threshold to put patients on work breaks for burnout and mental health challenges. But my most cringe-worthy moments were making those difficult calls to a patient uttering the words “you have cancer.” I always felt that cancer was one of the worst diseases to have. It just never seemed to go away and as a doctor treating someone with cancer, it would forever be on my differential diagnosis during that patient’s lifetime. I could not imagine being someone that would have cancer looming over them for their lifetime until it became part of my story.
On August 3rd, 2018 at the age of 37, someone said those very same words to me. It did not help that the lump in my left breast was reassured as benign for an entire year, that my mammogram was declined due to my age, and that my ultrasound findings suggested my then cancer-riddled-lymph node was simply reacting to my sinusitis. My blood sweat and tears of science undergrad, medical school, residency and several years in practice did not hold me immune to the very same cracks my own patients fell in. Did I really have to walk in the shoes of my patients to truly inhabit the meaning of empathy?
“Dr. Grossman, I am really sorry but your breast cancer has metastasized to your lymph nodes.”
My stage 3 breast cancer journey began at the moment these words were said to me and I found myself among the sea of patients, living in and out of the hospital lineups, sitting immunocompromised in the emergency room at 3 a.m., advocating for my needs that were sometimes being overlooked during rushed visits. I did not want to be that obnoxious person that pulled out “the doctor card”, but I would be lying if there weren’t moments where it came out. I needed to feel heard in a very big way.
I couldn’t stop myself from analyzing every encounter and putting them into categories of “good bedside manners, bad bedside manners.” Don’t get me wrong, there were some incredible doctors during my journey and I am thankful for their care and impact on my experience. In many ways, “medicalizing” the experience was a blessing and a curse. It was definitely a coping strategy. Throughout my journey I wanted to be respected as a health care professional in some ways, but in others, I wanted to play “lay person” so nothing was lost on me. To summarize things – I didn’t like being on the other side of the medical system.
Did I really need my daughter and family to watch my hair fall out to understand the impact of cancer on a loved one? Did I need to collect my own disability to understand the financial struggles my patients were forced to deal with when they became disabled? Did I need to have my ovaries removed in my 30s to truly be able to advise my patients about menopause symptoms?
After five months of chemo, a bilateral mastectomy with node dissection, 25 rounds of radiation, ovarian and tube surgery converting me into instant menopause, a year off work and a lot of existential self-discovery, I decided to return back to work.
I was nervous about a lot of things. How would my daughter adjust to her working mom? Would everyone’s cough and cold seem trivial to me? Would this show in my bedside manner? How would I feel about disclosing my own story? Would I burnout trying to fix a flawed system? After all, my mission became about making a difference in the system, which undoubtedly is idealistic. Would I project on every breast lump that came through my doors? Most significantly, was my high risk of reoccurrence a sign for me to spend more time travelling and being with loved ones?
What if I make the wrong choice and regret it later?
With much ambivalence and trepidation, I chose NORMAL. I chose to take a stab at normalizing my life, choosing to resume a routine and a purpose outside of taking care of my daughter and fighting cancer. I needed to shed a bit of my “cancer” identity and turn it into something meaningful. I wanted to use this experience to be a better doctor for my patients.
It was the best decision for me. Surprisingly, coughs and colds were not trivial. In fact, there was a new empathy I shared with every patient that walked in the door. A person does not need to have cancer to feel at their lowest, to want to feel heard and to want to get well. I was ready to hear their stories again, to try to get them well again, to relate to them on another level and even, at times, share my own story when the moment felt right.
Since my return, I have had to utter the bad news of “your results are suspicious for breast cancer” one too many times. I would be lying if it didn’t cause a more visceral reaction than it used to or seem more prevalent than before because of this. But now I can walk them through the journey in a way I could never before. If I burnout a little sooner trying to uphold my Hippocratic Oath and to fight this terrible disease not only as a person, but as doctor advocating for her patients, it is a risk I am willing to take. – Rachelle Grossman