Caring for Women: What I Have Learned
I cared for a lot of women in my 20 years of radiology practice focused on breast cancer diagnosis. While in the mass media women may be criticized as complex creatures, hormonal and “hysterical” at times, I agree with Maya Angelou when she wrote that women are Phenomenal. And Resilient. And Wonderful.
My first real connection with my female patients came as a medical intern. I cared for a 41-year-old female attorney, Kathleen, who was in-and-out of the hospital for 7 months with breast cancer complications. Laughing at her own lack of hair and eyebrows, she kept a sense of humor that awed me. Re-admissions to the hospital, usually for difficulty breathing (from fluid building up in her lungs), often went with “I’m ba-ack!”, a la Jack Nicholson. She told jokes that kept nurses smiling, flirted with my male colleagues, and found something positive in every bad lab result. I held her hand through procedures, turned up her Odansetron (Zofran) drip for nausea and Morphine drip for pain, and watched OJ Simpson being chased through L.A. freeways on her hospital television. Here I was, the caregiver, and, in many ways, she was caring for me as I watched her dying of breast cancer. Lesson 1: Women remain caregivers through all of their illnesses and trials.
Caring for elderly women was always my favorite. These spry octogenarians and nonagenarians would grab hold of my hand – and not let go! – and share secrets of longevity that usually went along the lines of: “and every night after dinner, I have a ‘Highball’!” They were never smokers. And never overweight. And they all seemed to love people. Any people. Most had no resentment, no anger, no regrets. A few – the cantankerous ones – did throw darts with their eyes and tongue, and we always joked they would live forever: too mean to die. Lesson 2: Most women really do age gracefully.
Entering a world nearly entirely made up of women (although men do also get breast cancer), I specialized in breast imaging and women’s health to continue caring for women. My fellowship training consisted of Women’s Imaging (all that reproductive stuff) and Breast Imaging (my personal and genetically-determined favorite). I cared for women seeking fertility, undergoing ultrasounds and hysterosalpingograms in a marathon to “make a baby.” These women often tortured themselves psychologically for self-imposed stigmata of being “non-childbearing.” The stress, hormones, and psychological pain seemed to snowball with each passing month. And then, after success, I would ultrasound their fetus and hold my breath as I scanned for a heartbeat and essential body parts. These young, and some not-so-young, women so desperately wanted a family. I could palpate the instinctual need to reproduce and the feeling of “failure” when unable to. Lesson 3: Women, when they want to have children, REALLY REALLY REALLY want to have children.
Having watched my entire family’s female members face and fight breast cancer, I dove into the trenches of breast cancer screening and diagnosis. Women now were all around me: patients, technologists, and support staff. The majority of the time, I was able to give women good news: no findings of breast cancer. Many of these healthy women in the waiting room were scared and anxious, but the breast cancer patients also sitting with them in the waiting room were offering words of support, strength, and concern for complete strangers. Lesson 4: Women really have a “sisterhood” that connects and supports total strangers – just observe a breast center waiting room.
When a possible abnormality is detected, and further imaging is performed, that anxiety level increases… often to the point of tears. We would have Kleenex boxes in all exam rooms, and I would watch caring mammography technologists cajole a patient through additional positioning and pictures, offering up stories for distraction, warm blankets, and words of encouragement. After completing the images and often additional ultrasound, I would discuss further options for a diagnostic biopsy with a heartfelt “I am going to help you get through this bump in the road.” I would have about 5 seconds to figure out the patient’s needs for this discussion, based on her level of:
- anxiety (teary – offer tissue; hugging herself tightly – touch gently with hand on patient’s arm or knee);
- seriousness (matter-of-fact, no beating-around-the-bush), skepticism (often reporting my own personal understanding through experiences with my strong family history, as well as occasionally needing to report my credentials – patient relieved at hearing “dedicated fellowship-trained breast radiologist,” further relieved with “Stanford and UCSF training”);
- denial (technologist even blocking the patient from running out the door); and
- support (husband or boyfriend – needing to keep him from taking over the questions and discussion; friend – help the friend “hear” so she can repeat back later when the patient can’t remember anything about the conversation; daughter – give support there too as the daughter now becomes affected as driver, logistical planner, and potential “co-survivor”).
The meaner the patient would be toward the front desk staff or technologist, and the angrier she was toward me, the physician, the more I knew that she was really scared. Those women just need a hug. Lesson 5: Women may all be very different, but they all need Tender Loving Care.
Caring for women facing a breast cancer diagnosis is rewarding in many ways.
Mostly, we are detecting a cancer at an early, curable stage, such that women are not facing “Mount Everest.” We have the opportunity to connect and communicate with women such that they FEEL comfort and caring (They “remember not what you say, not what you do, but how you make them feel,” more Maya Angelou). We have the opportunity to really, truly help a woman face or overcome one of her most difficult hurdles. And inevitably, these patients report back to me years later that they have discovered (lots of clichés) the “silver lining in the cloud” of the breast cancer diagnosis: they don’t worry about the small stuff anymore, they take time to smell the roses, and they make stronger connections with family and friends. I don’t remember seeing men have the same response to cancer. Lesson 6: Women tend to find strength and resilience in their cancer diagnoses.
Not unexpectedly, women’s personality traits become more pronounced during times of patient stress. The woman who is a bit of a “control freak” tries desperately to take control of data, research, consults, and outcomes. The needy co-dependent woman becomes more dependent on her family, our team of caregivers, the nurse navigator, and support groups.
Busy women with at-home children and work are “too busy” to get sick and need care, but they squeeze it in, just like they do with the rest of Life. Women who would usually “go with the flow” continue to do so, although with more yoga. Regardless of the personality type, women need women friends, and they need more when faced with difficulty. So, give rise to the “Army of Women” (Dr. Susan Love), “Crusaders for the Cure” (Avon), “Sisters Network,” “Sisters for the Cure” (Komen), “Bosom Buddies”, … Lesson 7: Women are GREAT at pulling together.
So, with God’s help, I have enjoyed caring for women throughout my career. And when a woman walks by wherever I go, I give her a smile. Maybe that will help her know that we are here, Together, a Sisterhood – to be strong, resilient, caring. Why have to go through a breast cancer diagnosis to know that?
I plan to continue to care for women, albeit through a more wide-reaching, technology-driven approach that will significantly improve patients’ lives. By electronically connecting breast centers across the country, providing access to essential prior mammograms and other breast exams, Mammosphere by lifeIMAGE will help women receive the most accurate diagnosis for their mammogram, without anxiously awaiting arrival of outside imaging, having to drive around and collect imaging studies, avoiding unnecessary additional imaging and biopsies, and having any potential breast cancer detected early, when it is curable. Perhaps, together, we can make it happen.
This post was originally published on mammosphere.com.