“It’s cancer.” I have said those words to patients hundreds of times. Sometimes the news was particularly bad, news that a cancer was not only present but had spread. Other times the news was more encouraging, of a minor cancer that was easily treated. Patient responses have been as varied as the diagnoses. On hearing the news some patients were shocked and some were tearful while others were stoic or silent. All were changed by the diagnosis as all saw themselves and their futures differently for having heard those two words.
I spent most of my morning today waiting to hear those words myself. I was certain they would come. 10 days ago I had my Physician’s Assistant biopsy a new mole on my forehead. I first noticed the mole a few weeks ago. Although no one else was worried about it, its newness combined with my family history of melanoma made me concerned. My PA dutifully and skillfully performed the biopsy and sent the tissue to the lab for analysis.
Skin biopsy results almost always arrive within 5-7 days of submission. When day 7 arrived without results I started to wonder. This morning was the morning of day 10 and when results were still not in my inbox my wonder evolved into worry. I could not see any way that a benign diagnosis would take this long, especially when I had already gotten results back on patient biopsies submitted after mine. In my concern I had my nurse call the lab and ask for the results. The lab secretary told her that results were not yet available because the tissue had been “sent out for additional tests.”
That settled it for me. I was certain the diagnosis was melanoma. No one does “additional tests” on benign moles. The only question left was the seriousness of the diagnosis. Did I catch it early enough, or had it already progressed to a dangerous stage? I had the staff leave a message for the pathologist to call me back as soon as he arrived, wanting the final diagnosis as soon as possible. Waiting has never been easy for me, waiting for this call was agonizing. As melanomas can be deadly I found myself wondering what the impact on my family would be if the prognosis was poor. I began to mentally prepare and brace myself for the potential bad news.
My office staff was stressed as well. We are a close knit group and their concern was obvious. I made lame jokes that were not well appreciated and served to amplify rather than calm their fears. Sensing this I leaned over to my receptionist and quietly spoke words that were meant to encourage both of us saying, “Nothing about the diagnosis will have any impact on God’s eternal plan for me.” The truth of these words brought me comfort.
As there was nothing else I could do in that moment I went back to seeing patients, less distracted than I expected but distracted nonetheless. My eyes frequently drifted down to the clock in the corner of my computer screen. How long was the pathologist going to wait before returning my call?
When 11:30 came I decided I was done waiting. I called the lab myself. After a few minutes on hold the pathologist came on the line. “It is a lentigo maligna, a melanoma in situ,” he said. I felt a weight lift off of my shoulders. It was melanoma (the worst kind of skin cancer with the potential to lethally spread throughout the body) but it was “in situ”, meaning that it was still confined to the surface of the skin and had showed no signs of penetrating deeper. I had cancer, but it was completely curable with minor skin surgery. I would not need chemotherapy, I would not need body scans or additional testing. I had caught it in time.
I spent the rest of the day emotionally drained. I felt like someone who had been involved in a near miss plane crash or car accident, relieved but shaken by the reality of the disaster that could have been. I found myself on the verge of tears as I drove home from work tonight. I realized that something about me had permanently changed. I am now, in a way, a cancer patient.
I have cancer, cancer that could kill me if I don’t get the rest of it removed. I will get it treated and I will be cured but for the rest of my life “melanoma” will be a part of my personal medical history. It will always be in the back of my mind. Every time I look at my moles and every time I look in the mirror I will wonder if there is something there. I will need to remain ever vigilant. The fear that I may not be as fortunate the next time will likely never fade away.
The events of today have also caused me to reflect on my patients who have experienced similar near misses, as well as those who were not so lucky. I currently have patients in my practice who have been treated for lung cancers, breast cancers, and melanomas. Some are battling widespread disease and face long odds. Others have no current signs of disease but continue to vigilantly follow up with their doctors, doing everything they can to detect any possible recurrence as soon as possible. I am just beginning to understand the truth of how cancer may have changed them.
I am grateful that my cancer is treatable, grateful of the time I have been given and the future that remains. More importantly, I am grateful for the opportunity to learn and grow. I pray that this episode will help me better understand the fears, pains and concerns of the cancer patients God brings across my path.
This seems to be a part of his eternal plan for me.