Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.
Saturday, September 09, 2006
Breast Cancer Women
Something you may not know, and won't get by looking at most renditions of them, is that the legendary Amazon warrior women are said to have cut off their breasts. One, more accurately. In order to shoot their arrows with their bows, the left breast (assuming right-handedness) was removed. (The linked article above has it wrong, I think.) Pantomime it on yourself: the left breast would be in the way, particularly if bare-breasted, as they were, so it is said. And here's the kicker: it's in the name. Amazon. A (for absent); Mazon (same root as mastectomy: referring to the breast.) Of course, none of this is confirmable, but it is an accurate account of the legend. And so I told it to Gloria and her husband, competitive archers.
Women are tougher than men, no doubt in my mind, having operated on both more than a few times. The fact emerged first in medical school, when a fellow (male) student fainted dead away as we heard a lecture on blood types. A lecture, not even a lab! And about types; not even the gooey stuff itself! The prof was unsurprised: "Happens all the time," he said. "Always the men. Ladies live with blood. It's no big deal to them." Bunch 'a wimps, we.
Don't get me wrong: I'm well aware how devastating the idea of cancer can be, and how mutilating many operations are -- mentally as well as physically. And yet it's been a source of inspiration over the years to witness how well most women are able to adjust to mastectomy: with bravery, with calm, with humor. I learned many years ago, when inspecting a surgical wound, not to say "beautiful," no matter the operative type. And yet I've heard lots of patients, when they looked at their mastectomy scar, say "gee, that's not as bad as I expected." And many, for various reasons, chose not to have reconstruction later, when they'd initially figured they would.
This is not a treatise on the benignancy of mastectomy, nor a suggestion that women who have a hard time with it are somehow deficient. I'm just saying -- because it's been a source of amazement to me -- that for some women, it turns out to be ok. More ok than they'd expected it to be. On the day of her surgery, I pulled back the covers on one lady to discover that she'd crocheted a quite impressive nipple/areola in brown and pink yarn and placed it on her chest; delighting in my surprise.
So, back to Gloria. A very athletic woman, tall and muscular, she and her husband sat in my office hearing the results of her biopsy. In addition to all the usual fears, they were concerned about their archery careers. They competed at a very high level, and had tournaments coming up. How soon, they wanted to know, would she be able to pull a bow? That was as high on their list as any other issue, and I was glad to hear it: desire to get back into life is important, whatever the operation. I hadn't known about this avocation of theirs, and it gave me my one and only chance to tell the Amazon story. And yes, it was her left breast, and she was right-handed. She loved it.
There was no question in her mind which option to choose: it was mastectomy for her, and she recovered like the athlete she was, proudly arching (or whatever they call it) and telling the legend to her competitors in short order. As I recall, her husband got her some sort of Xena paraphernalia to wear, as well. Sometimes, things have a way of working out.
[Addendum, 5/2014: I was sent this link to some very inspirational quote by celebrities who've dealt with breast cancer.]
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very enlightening post.
i knew about the legend of the amazon women, but i dont know if i really buy it. as a legend its cool, however.
im not surprized women deal with the changes from a mastectomy better than men. we dont get our sense of self from our bodies as much as men do. in spite of the additional pressure on women to have the perfect body. even if we manage it, its never really who we are.
Thanks as always for your inspiring postings. Amidst all the misery that's afflicted the practice of general surgery in the past few years, your blog is a much-needed breath of fresh air.
My practice (with its general surgery component) is on the brink of closing down. We were in one of the AMA "crisis states" and the medical malpractice rates were accelerating so rapidly that they basically killed our ability to keep the practice running. One of my colleagues had been in the business for decades, had helped thousands of patients including many women with breast cancer, and took such pride in my work that he encouraged me to pass that along in the occasional lectures I did while a visiting professor.
But he had the misfortune of being named in one of those ridiculous "bullet-spray" lawsuits by a malpractice lawyer against the practice-- for a moderately adverse outcome that could not have been prevented even given the heroic care we provided-- on top of almost a half-dozen more in recent years, and he's decided to call it quits.
He's never had a lawsuit prevail against him, but the cost of settling those idiotic BS suits brought by some lawyer gaming the system was too much to bear, not just financially but in terms of his most basic sense of respect for his job. Despite working 90-hour weeks for many years and enduring tremendous self-sacrifice for thousands of his patients, the legal briefs by the malpractice lawyers portrayed him as an arrogant and negligent fool (a misrepresentation that verges on being criminal), which hurt him far more than any of the (ultimately unsuccessful) suits could have. He did not deserve such vituperation and has decided to leave as a result.
Two of my other colleagues have also left the field-- one of them, unfortunately, having been sued in a breast cancer case, ironically enough, despite her tremendous efforts on behalf of her patient and having done more than even the most strenuous calls of duty. I have escaped this level of traumatic lawsuits only because I am less than a decade into my field, but because of the attrition in our practice, we are having to close down.
I love surgery and my colleagues and patients more than I can express, but I am sorry to say, I am deeply pessimistic about the future of general surgery in the United States. The malpractice attorneys have basically destroyed our profession here; I'm shocked at the number of my colleagues leaving the profession, some even leaving the US entirely for other countries. Until this fundamental problem is solved, all the joy we have in doing surgery and providing patient care won't matter much. It'll be swamped out by the litigation madness falling like an avalanche on our field. Your blog is one of the few remaining breaths of fresh air I still have, to remind me of the value of doing what I do.
anonymous: what a heartfelt and raw and right-on post. You have expressed what I see happening all around me. In a way, this blog is bitter-sweet: it's a way for me to connect to the core of what's good about being a surgeon. And it also reminds, as you so well describe, what's not so good, particularly now.
In my case, I ended up burning out much younger than I'd have thought or wanted: mostly because I had become incredibly busy, and because I never took much time off. Making rounds every day and every weekend, on call or not. Taking calls on my patients at all times. Working always on my day off. Added to that, the issues you raise and the ever-increasing bureaucracies, decreasing reimbursement, loss of a sense that quality meant anything to those paying for it. And yet, at its core, being a surgeon is an honorable, humbling, and deeply rewarding thing.
If I may be so bold, you might like my book, which is mostly about training, but which ends with reflections on then and now. If you're interested, there are links on the blog....
Thank you very much for taking the time to write such a deeply felt and moving post.
Thank you for this post, Dr. Schwab. I hold "Gloria" in high admiration!
I'm saddened, however, by Anonymous' comment ... I don't know what the people who are using litigation in medicine as a cash cow think they're going to do when they're done destroying healthcare ... it will be gone for them, too ...
It's going to be a round lesson, I think ...
Xena paraphernalia.... that is TOO MUCH INFORMATION. Some things should remain between husband and wife, and this is one of them.
Thank you for information. Glad to have stumble upon your blog
That's a great story! Love it!
It turns out that the "without breast" story is a folk etymology! A fun one.. but not really true.
There were Amazonian women.. and they were fighters.. and it's more likely that they Greeks borrowed the Iranian word "ha-mazan" which means to fight together.. and over time they made up the legend to explain where the word came from.
I often prefer the folk etymologies over the real stories.. as they are more fun!
Your trusty philologist
I am almost positive a right handed archer would be hitting her right breast with the bow string.
You could be right, depending on position. But I was thinking along these lines.
A therapist friend of mine told me to look up this legend because i had breast cancer at 29. It is very inspiring that us warrior women have been so strong and brave throughout the years. Breast cancer as shocking as it can be makes us stronger! The scars across my chest resemble a battle i won and that makes me very proud. Thanks for the great post!!! Amy
As a patient who has over the years seen great docs and surgeons and not so great ones, this is my thought. We are all imperfect. Anyone who thinks it is realistic to expect doctors to be perfect should get their head checked. (MD does not stand for minor deity). How can we as patients ask our docs to try as hard as they can for us, and not allow them to make the occasional mistake? If we want them to go to bat for us we need to go to bat for them. As a former figure skater I can tell you that if you don't fall once in a while, you are not trying your hardest. As a former paralegal, I can tell you if people want affordable healthcare (or any healthcare for that matter) they better get their act together and start petitioning congress for changes in our tort laws. Unfortunately, I do not believe people will do this. Taking responsibility for one's health and also allowing for a little reality to enter their expectations seems to be more work than the average over weight, tv watching, american wants to do these days. Oh did I sound negative about my countrymen? You better believe I am - and I'm thinking of moving to Costa Rico or Panama after then next election too - no matter who wins. I'm sick of the attitudes in this country.
As it happens, I wrote something on that very concept (the "bad day"): http://surgeonsblog.blogspot.com/2007/03/fielders-choice.html
I do have some on the legal system, too...
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