Today’s the day. Today I go for excisional biopsy of the lymph nodes around my neck so they can study it and determine if I have ” the good kind” of lymphoma, Hodgkins, or the aggressive kind, diffuse large B Cell Non-Hodgkins. Good kind? Bad kind? I am just not sure what to root for here. Isn’t all cancer “the bad kind?” My doctor also told me with a smile that he has never lost a patient with Hodgkins. Awesome! But wait! What about Non-Hodgkins patients? He meant to be reassuring. Instead of taking that as good news, I immediately panicked that he had somehow over bragged to the universe and karmic retribution had to be on it’s way.
Sorry, I couldn’t help a bit of sarcasm there. I know what the doctors mean. One kind has really high cure rates and one not so high and tougher to get through. Yes. Of course I understand. However, it is tough for a patient to embrace the clinical perspective right after hearing a diagnosis. Sometimes they just need a minute to try to start processing before they are able to realize whether they are actually “luckier ” than they thought or not. The moment you hear the words “we think you have cancer”, everything kind of stops. No other words have a chance to register. That dirty C word just hammers in your ears like an obnoxious bell and your mind starts racing. You need to just let it sit a minute before you start comparing stats and trying to tell them how to think about it. I know this first hand. I do it too as a doctor. I am always trying to temper my need to tell a patient that it’s not so bad and flood them with good statistics to reassure them with their need to just sit a second and take in what I said first.
Bad news is never easy to deliver, even when a patient is expecting it. I don’t really think that there is one best way to do it. I tend to vary my presentation depending on my knowledge of the patient and what I think they can handle. I was expecting this news, based on everything that I knew, but I still wasn’t instantly ready to prioritize and tier the possible types of cancer and how one was better than the other. I just needed to take in the fact that I could have cancer. That was as far as my mind could go at the moment. For me as a physician, if I know that I have to deliver bad news, I deliver the news and then I am quiet for a minute. I deliberately try to let the patient be the first one to start the next part of the conversation. I have just told them something that may soon launch them into a life-changing scenario in which they have little control. I figure that the least thing I can do is let them have control over how the conversation goes in the next few minutes. If I let them speak first before bombarding them with statistics or trying to mold how they should perceive the news, I can more clearly gauge how to tell them more and what to tell them. I think that it is really important to let them at least take control of this initial conversation. It may be the only decision that they get to concretely make for awhile. Sometimes I can’t reassure them right away. Sometimes they just aren’t ready. They are scared, angry, and confused. Sometimes you have to let them be for a minute.
I think it is tougher for my doctors to let me be for a minute. They know that I am a physician too and they figure that I can handle all the stats and details. They care almost too much because they know me. They know that I can understand the information. They know that I am interested in being my own advocate. I get all that, but sometimes it is a little too much. This time, I am the patient. I am not in charge, although I am trying to act like I am. I am putting on a brave, calm, collected face. Sometimes I think I am doing that more for others than for myself. I don’t feel very calm and collected when I am sitting in my bathtub, overreading about lymphoma and trying to give myself an anxiety attack…lol. I want to be Wonder Woman, but right now, I am just me, Laura Katz, the patient. I am waiting for news just like everybody else. I am waiting to see how my life is going to change. That will have to be good enough.
Dr. Katz
