The Patient Will See You Now: Part 2

You can read part 1 of this post here.

What? Did she really just say that to me?

I looked down at the paper, which was indeed an order for a mammogram. As I tried to hand it back to her, I said, “Excuse me, but I won’t be needing this, as you can see from my chart.” She looked puzzled, but instead of opening my chart, she said, “Of course you do. You’re in your 40s, so as you know, you need a mammogram every year.” (Okay, if you’ve read my blog before, you know that I take serious issue with that statement, since there is no evidence of benefit for women in their 40s of average risk, yet there is evidence of potential harms associated with mammograms at that age. But I digress…) Considering the mood that I was in, I’m proud of myself that I didn’t immediately fly off the handle. But I was furious. I looked at her and waited until she finally looked me in the eyes. “No, I do not. If you had read my chart, you would have seen that I do not have breasts. They took all of my breast tissue, so there is nothing to conduct a mammogram on—except perhaps my silicone implants, but that wouldn’t make much sense, would it?”

Unbelievably, it wasn’t clear whether she heard me, so I tried again. “The most recent records in my chart should include a note from my oncologist about my recent breast cancer diagnosis. And it should also include surgical records about my bilateral mastectomy and immediate reconstruction. Without having any breast tissue, I really don’t think that this mammogram is necessary, so I ask that you take this back, please.” She accepted the piece of paper, mumbling “sorry” under her breath, and then simply walked over to the wall to grab the blood pressure cuff. She asked me absolutely nothing about my breast cancer diagnosis, not the type or stage; whether it was estrogen receptor (ER), progesterone receptor, and/or HER2+; what type of surgeries I’d undergone; which specific chemotherapy drugs I’d received; nor whether I had received radiation. Even when she reviewed my current medications, she did not ask whether I was taking Tamoxifen or an aromatase inhibitor should my cancer have been ER+.

When she finally did speak, it was to ask when my last period was—more solid evidence that she had not even taken a glance at my chart. After all, it was my gynecologist who had broken the news to me that my original chemotherapy had taken my fertility. As I struggled to remember the last time I’d menstruated, she became impatient and said that I could “just estimate.” My response: “I’m not trying to remember a specific day from last month, since it’s actually been a few years. But I honestly cannot remember which year it was.” No response from Nurse Ratched.

And the icing on the cake…remember when she picked up the blood pressure cuff? She immediately went to my left side and went to grab my left arm. I stopped her and said, “Look, I’m not trying to be difficult. But please take my blood pressure from the right side, not the left.” She simply raised her eyebrows, waiting for an explanation. “My breast cancer was in the left breast and in the sentinel node, so the surgeons had to remove several lymph nodes.” Eyebrows remained raised, waiting for more information to try to make some sense out of what her patient was rambling on about now. “I don’t know how strong the evidence is. But my surgeons asked that I never have my blood pressure taken on the left side. They explained that because some of my lymph nodes were removed, I was at risk for developing lymphedema. Because blood pressure cuffs constrict tissue, some suggest that it may cause or worsen lymphedema. So please take my blood pressure on the right side.” She finally lowered her eyebrows, moved to my right side, and took my blood pressure. With no small relief, I’m sure, she then felt she was done with her “difficult” patient and headed to the door. But before she fully escaped, I called after her and pleasantly asked, “Could you please make a notation on my chart that my blood pressure needs to be taken on the right side?” She briskly nodded her head and left the room.

I immediately put my head in my hands and tried to keep the tears from coming. This nurse was clearly in the wrong profession, and I knew that the encounter I’d just experienced really said nothing about me, but spoke volumes about her. But I was absolutely livid, embarrassed, upset, and even emptier inside than I had felt just a few minutes before.

When my gynecologist entered the exam room about 15 minutes later, I’d had enough time to compose myself, and he came in with his customary warm smile, friendly handshake, and good wishes to my family. He also spent several minutes asking about how I was holding up after my diagnosis, discussing the treatments I’d received thus far, and talking about my options concerning Tamoxifen versus an aromatase inhibitor. He obviously knew a great deal about my diagnosis before he stepped into the room, was genuinely concerned, and provided me with the same exceptional care that he always does. So despite the terrible experience I’d just had with one of his staff members, I did continue with my gynecologist. However, on the spot, I decided that I would never see him in this specific office location again. Rather, I’d vastly prefer to make the substantially longer drive to another of his office locations, because I absolutely refused to have any dealings with that nurse again. I truly hope that after she’d walked out of my exam room, she thought about our encounter and realized that she owes her patients so much more: just for starters, actually LOOKING at the chart, LOOKING at her patients in the eye, LISTENING to her patients, and treating us with the RESPECT and the concern that we deserve. But I did gain something crucial from this painful experience: from that day on, my new motto was “The patient will see you now”—in other words, only when my healthcare provider is fully prepared, respects my time as much I respect his or hers, knows my recent and past medical history, is ready to truly listen to my concerns, and genuinely engages with me as a crucial member of my own healthcare team.

Sadly, however, I very much doubt that this nurse gained anything from our difficult encounter. Rather, I’d say it’s far more likely that she started shaking her head immediately after closing my exam room door, mumbled under her breath about what a “bad, noncompliant patient” I was, and then briskly went on to ruin her next patient’s day. In retrospect, though I’d been struggling with feelings of emptiness on that terrible day, it was actually the nurse who was truly, profoundly empty—empty of compassion, empty of empathy. My only regret is that I did not tell my doctor about his nurse’s atrocious, insulting, unprofessional behavior. However, I sincerely hope that if she didn’t learn anything from our encounter, her behavior eventually caught up with her and that she’s now in a different profession for which she is better suited—perhaps as a clerk at the DMV.

Postscript

Importantly, I need to stress the following: I’ve been blessed that this is one of the few times I’ve had such a bad experience as a patient—particularly concerning the number of healthcare providers I’ve needed to see. Over the years, I’ve received care from truly superb, talented, warm, and compassionate cancer care coordinators, oncology nurses, oncologists, surgeons, and cardiologists, and I’ve promised myself that I’ll write much more about these experiences rather than about the few “bad apples.” Unfortunately, human nature being what it is, we often tend to focus on the few negative events and not give nearly enough attention to the remarkably positive ones. Speaking to The New York Times, Clifford Nass, a professor of communication at Stanford University, explained that “The brain handles positive and negative information in different hemispheres. Negative emotions generally involve more thinking, and the information is processed more thoroughly than positive ones. Thus, we tend to ruminate more about unpleasant events—and use stronger words to describe them—than happy ones. In the same article, Roy Baumeister, a professor of social psychology at Florida State University, said “Many good events can overcome the psychological effects of a bad one.” That is certainly true in my case. Alina Tugend, the article’s author, concluded by saying, “That’s a good reminder that we all need to engage in more acts of kindness—toward others and ourselves—to balance out the world.” Words of wisdom, indeed.

“The individual is capable of both great compassion and great indifference. He has it within his means to nourish the former and outgrow the latter.”

~ Norman Cousins