You have breast cancer." These are some of the most painful words a doctor can tell a woman. They strike fear into her heart; they mean surgery as well as potential radiation and chemotherapy for days on end, followed by the possibility that the cancer will return. The words are often just as painful for doctors. No matter how long they've been treating this disease, they never feel at ease with the hurt and fear in their patients' eyes.
Three years ago, I started working as a summer clinical research assistant for Dr. Paul Tartter '73, '77 M.D., the former chief of breast service at Mt. Sinai Hospital in New York City. At the time, breast cancer research meant little more to me than a well-paying job. But as the disease began to hurt people I knew, the research turned into an important and tangible way for me to help others affected by the disease.
Besides watching Dr. Tartter cut into patients' breasts in the operating room and lift out pink, fleshy tumors, I spent my days in his private practice and in the hospital's breast cancer clinic. (Because it is near both Harlem and the Upper East Side, Mt. Sinai attracts a diverse mix of patients.) The private-practice patients were mostly well-dressed and middle-aged to elderly. I remember one woman in her sixties whose husband accompanied her to the exam room. He fidgeted and looked away awkwardly when the doctor removed his wife's gown. Her mastectomy scar was shocking: instead of a right breast there was a flat surface with stitches, oddly juxtaposed with the intact left breast. Ravaged by chemotherapy, she was thin and pale, and wore a straw hat to cover her hair loss.
In contrast to the outwardly serene private-practice waiting room, the clinic was chaotic. At times medical students and residents were translators as much as doctors, rushing around with their high-school Spanish. Babies cried from the pediatric clinic next door. Nurses shuttled patients in and out of rooms as quickly as possible.
Yet whether they came to the clinic or the private practice, these women had their illness in common. Sometimes they would glance in my direction and give me a nervous smile, hoping I would understand, as a woman, the fear of losing a breast or even a life. Other times they would look down with tears in their eyes and I'd know they had received bad news. During my first few weeks at the hospital, I had nightmares that I would eventually go under the knife, lose a breast, and undergo the torture of chemotherapy, hoping that the poison would kill the cancer before it killed me.
After three summers and four research projects, after seeing an aunt and several friends' mothers struggle with breast cancer, I realize the disease has become an integral part of my life, wherever I go. While in Malaysia visiting relatives recently, I was able to visit the breast cancer wards of a government-run hospital, which lack not only supplies and a plastic surgeon for breast reconstruction but also the ability to overcome cultural barriers to treating the disease. I was introduced to a patient who, because she feared hospitals, had been treated by an alternative "witch doctor" for a lump in her breast. She ended up in the hospital anyway, with a chest infection that had festered after her breast had been cut off with a knife. Bone scans revealed that the cancer had already spread through her body; lumps of it were visible on her back. She was only twenty-eight.
Although doctors in the United States rarely face the challenges seen by third-world physicians, they still experience feelings of helplessness. There were days at Mt. Sinai when I could see the frustration and fatigue on Dr. Tartter's face after he'd removed his surgical mask. Memories of this disease haunt me, too, even with my limited experience. The last hour of my last work day that first summer, I decided to follow Dr. Tartter to radiology before heading home on the subway. In a small, stuffy room filled with x-rays and slides, two radiologists were putting a bone scan up on the lighted box. The patient - age twenty-six - and her husband had discovered a lump in her breast on their wedding anniversary but had waited to have it checked out, attributing the anomaly to hormones. By the time the woman came in several months later, the lump had grown and had had to be surgically removed. Now the x-ray showed that the cancer had spread to her bones. The prognosis was bad. As I stood in silence, one of the radiologists, a woman in her mid-thirties, sighed as tears came to her eyes. Dr. Tartter quietly cursed and turned away.