'When the Doctor Becomes the Patient'

June 1, 2012

Mary Maxwell, MD, on learning to let go.

It was a warm September afternoon, and I had just arrived home with my 5-year-old daughter after picking her up at school. My husband happened to be in the house and when the phone rang he answered it, before handing it to me. On the other end I could hear the voice of the surgeon who had done an open breast biopsy on me a few days before. I wasn't overly concerned during the multi-month workup because, after all, doctors take care of other people - they don't get sick themselves. When I heard the surgeon say "your biopsy showed invasive ductal carcinoma," I felt as if a huge wave in the ocean was crashing down upon me. I could even hear that rushing sound that happens when the wave pushes you way down beneath the surface of the water.

My husband and I immediately drove to the surgeon's office to discuss my initial treatment, and the surgeon dutifully outlined lumpectomy and radiation versus mastectomy. I had already decided that I would choose to have a mastectomy despite the evidence proffered by commonly accepted treatment protocols which supported the "breast saving" approach. While I felt the fear that all patients feel when they hear they have cancer, my "fight or flight" instinct was crying out to get rid of the cancer - all of it.

When I told my surgeon, a man a good decade my junior, that I had decided on a mastectomy he raised his eyebrows and looked me full in my face. Yes, I wanted him to remove my entire breast. It was similar to when I stopped running distances at age 40 because I decided that I wanted to walk at age 80. I was willing to give up my entire breast at age 50 if it would give me a better chance of seeing my child graduate from fifth grade, or high school, or college. It turned out to be the right decision as my disease was multifocal, but I didn't have this confirmation until weeks later when the final pathology report arrived.

The next 10 days felt like a mixture of waiting for execution and a call to action. There were still more tests and procedures to endure, as well as the pre-op visit before surgery. As I tried to condition my mind to the fact that I had cancer, I believe I experienced the five stages of death and dying that I had learned about in medical school. Some of the stages exacted a stronger hold on me than others. The day before my surgery I was gripped with the urge to make a break for freedom. I had a full tank of fuel in my vehicle and cash in my wallet. I knew that there were places in Wyoming - which is the state that borders my own - where I could just disappear and not have to face the surgeon's knife the next day. Fortunately this thought was fleeting, although it did give me some real comfort during the few seconds I allowed it to play out in my mind.

That night my dear husband afforded me a rather quirky sendoff to my surgery the next day. He, our daughter, and I all bared our chests and took some family photos - photos which I have not wanted to see again to this day. At the time it seemed important to me to have some visual reminder of how I had once been.

My surgery went as well as I could have hoped, and many times I have felt immensely grateful that I live in such a great country where the healthcare is the best in the world. It was indeed difficult to become the patient so suddenly, and to require surgery, but I didn't really have a choice. I knew I wanted to live and I decided I would do whatever was needed to keep on living - I didn't want my fear to control my decisions.

As part of my treatment I was advised to have my ovaries removed, and so six months after the first surgery I was back for yet another one. This one of course would end my ability to reproduce, and it seemed like yet another big part of my core identity as a woman was being wrenched from me. I just kept reminding myself that I wanted to live, and if this treatment was necessary, then I would do it.

Much of my recovery period was filled with grace shown to me by other people. There were beautiful flower bouquets, cards, calls, visits, meals, and expressions of love and concern by the people in my life. These things really did make a difference to me; changing the way I viewed the world and my relationship to it.

I have recently watched other physicians succumb to breast cancer, and of course, I speak with women who have had experiences with breast cancer; in themselves, a relative, or even an acquaintance. I find myself silently fishing for the positive stories - the ones where the patients survive. But on a professional level, I know that some women die an awful death.

While I feel I have given up a lot of myself these last four and a half years, I have also gained a lot too. Just appreciating my own mortality has shifted my thinking in many positive ways. Now I can really mean what I say when I meet a patient with breast cancer and tell her "I know how you feel."

Mary Maxwell practices anesthesiology part-time in Ft. Collins, Colo., and her family raises Angus cattle on her husband's multigenerational family farm. Necessity has required that Maxwell expand her medical practice into the realm of minor veterinary procedures on the farm.