Adopting a Patient’s Perspective
When Karin Charnoff-Katz, MD, was diagnosed with breast cancer, she entered the patient experience and left a changed physician.
On my way to work as a general radiologist in Memphis, I detoured to stop for a routine screening mammogram. I was 41 and a few months late for my second annual screening. I was not overly anxious. My white attending physician coat provided me with an illusory protective shield. I believed the coat granted me a special immunity of sorts. I did not even wait for an official read after the imaging, as I was in too much of a rush to get to work. It seemed at that phase of my life, I was always multi-tasking and perennially in a hurry. Between working, losing my mother and mother-in-law to ovarian cancer deaths at young ages, and having three small children at home, every moment was teeming with activity and responsibility. I often put on makeup in the mornings while I stopped at red lights in my car. Maybe that explained my less than stellar driving record.
As I passed through suburban Memphis neighborhoods on the way to my office, my cell phone rang. It was the senior attending at the spa-like breast imaging facility, asking me to return to her office for biopsies. I stopped the car suddenly, eyes brimming with tears. I pulled into a parking lot to be alone and process the news.
After a brief respite in the parking lot, I raced back to have the procedure done. I was not yet convinced I had cancer. I still felt perfectly healthy. And I had no family history, no known risk factors for breast cancer. At the office, the radiologist showed me a snowstorm of calcifications that riddled nearly my entire right breast. I am uncertain whether she demonstrated the findings to me because I was a colleague, a radiologist, and she wanted confirmation, or if this was her modus operandi. They were little white flurries, where on my baseline mammogram one year prior, there had been none. The white flecks of calcium were so extensive that a stereotactic biopsy was unnecessary. The radiologist explained that she could randomly, almost blindly, perform biopsies in all four quadrants and she was certain her specimens would yield calcifications. Later, when I reviewed my previous year’s mammogram, I was awed by all the invisible, imperceptible changes that had occurred within my body as I went about my life.
The biopsies revealed extensive DCIS. I would have to undergo a mastectomy. I felt as though I was entering a new era in my life. As Jerzi Kozinski in The Painted Bird writes, “Disease enters a person when he (or she) least expects it. It might be sitting behind you in a cart, jump on your shoulders as you bend down to pick berries in the wall or crawl out of the water as you cross the river in a boat. Disease sneaks into the body invisibly, cunningly.” I was now part of the kingdom of the sick, a place consumed with doctors’ appointments, treatments and uncertainty.