We had just finished our endocrine unit when I noticed a lump in my neck. Perhaps school had made me more vigilant, or perhaps I merely fell into the realm of hypochondriac medical student, but I couldn’t ignore this lump.
I set up an appointment with my doctor, fully expecting a diagnosis of what’s sometimes called medical student neuroticism. Instead, she agreed that it was a peculiar lump, and though she believed that it would ultimately prove to be nothing, she was ordering some tests just to be conservative and careful. I approached the tests as an educational experience, something that would make for a good story.
And then one day as I was studying in the library, I found I was having a hard time focusing on anything but the lump. I felt an overwhelming need to check the results of the ultrasound that had been done, so I shakily typed in my password to access the test results; I scanned the radiologist’s note until I landed upon the words “biopsy recommended.” I guess I hadn’t realized just how much I had compartmentalized the experience until I read those words over and over again. With my face red from crying (and embarrassment over my public display of emotion), I quickly gathered my things and ran home. Do I tell my father? Do I tell my friends? It could still be nothing.
I just wanted it to be nothing.
A patient’s worst nightmare
The first two years of medical school, the preclinical years, teach students about disease in the abstract, as testable material. We detach ourselves from reality as we memorize a constellation of symptoms and treatments presented from a podium or a textbook. I have been guilty of occasionally forgetting that what I am studying may be a patient’s worst nightmare.
“We ask patients to take on risks in order to heal,” Cherie Fathy writes, “but we should never forget how overwhelming it is to hear those risks or to play those odds.” (Courtesy of Cherie Fathy)
As students on the wards, we see mere snapshots of our patients’ illnesses. We are there as patients receive a diagnosis in the clinic or a treatment in the hospital. What we don’t see is a patient at home deciding whether that lump is even worth checking on or a mother dreading when to tell her children what she has, or how to even begin telling them.
A full two months after my initial doctor’s visit, time that was filled with scans and biopsies, I received a phone call that confirmed my worst fear. I had thyroid cancer. The news shattered my sense of invincibility that, as a 20-something, I had taken for granted.
Almost 63,000 people will be diagnosed with thyroid cancer in 2014, according to the National Cancer Institute. As a student, I had seen its gross pathology, studied its microscopic appearance and even constructed mnemonics to commit the signs of the disease to memory. I quickly learned that the 10-minute lecture we had on thyroid cancer left out quite a bit of detail, and now those details were personal.
When I sat in front of my surgical oncologist for the first time, I had just experienced one of the most radical shifts in my life. He told me that my treatment would include removing my thyroid gland and any affected lymph nodes, and this would be followed by a radioactive iodine treatment. The radiation was in the form of a pill that directed radiation to my thyroid cells, destroying any that may have spread to other parts of my body. The only stipulation was to stay away from others for at least a week while I was radioactive.
How do I do this?
In that moment, my fears transformed from prepping for my next exam to wondering, “How do I even begin to balance school with doctor’s appointments, surgery and radiation, and how do I stay strong for my family members, while internally processing this diagnosis?”
My type of thyroid cancer has around a 95 percent long-term survival rate. Knowing that did little to quell the emotional haze that set over me. Ironically, I still remember the first time I heard this number. Our professor held up a thyroid specimen and pointed to the cancer, stating, “If you ever get a cancer, this is the one you want.” At the time, I found that tremendous. Almost everyone lives! Now, I struggled to find solace in those words.
You see, patients will play odds and measure risk in very different ways than we may expect them to as physicians. In my mind, I was already the one person out of 10 who did not have a benign thyroid nodule. That I was the one person out of 10 made me look at almost every situation through a lens of “what if’s.” I constantly feared that any rare side effect would become a reality for me. Who’s to say I wouldn’t acquire a rare complication such as chronic swelling and tenderness of my salivary glads or the rumored increased risk of a secondary blood cancer from radiation exposure? What if I lose my voice because of the surgery? As a medical community, we ask patients to take on risks in order to heal, but we should never forget how overwhelming it is to hear those risks or to play those odds.
‘At least it’s thyroid cancer’
Perhaps one of the most isolating experiences came from the number of times I heard “at least it’s thyroid cancer”or “it’s so treatable” from my classmates and professors. And yes, even during my short time on the wards, I had seen patients undertake much bigger battles against cancer or other illnesses, but any illness can be a trial of a patient’s will, courage or sense of safety.
The day after Christmas a year ago, I was scheduled for a whole-body tumor scan. It was about two months after my surgery and two weeks after finishing my radioactive iodine therapy; I was ready to be done with this chapter of my life. As I braced myself against the cold metal table, the radiology tech explained that the process would take about a half-hour. If they found anything irregular or concerning, they would set up the machine for more imaging.
I gave a quick wink to my dad, who was sitting beside me, hoping to reassure him (and myself) that all would be fine. As the machine rumbled, a pixelated image of my body showed up on a screen above my head. The erratic twinkling of lights caught my attention. As parts of my body lit up, I prayed under my breath that the cancer hadn’t spread. I shut my eyes and avoided the screen until I heard the tech reenter the room.
“We think we’re going to go ahead with the second set of imaging.” I felt gutted and incredibly vulnerable at that moment. Any sense of control I thought had over this tumor, this saga, dissipated with that statement. I didn’t have the strength to look at my father before the second go-round. I just shut my eyes and dreamed about anything. Anything but cancer.
Several months have passed since I was lying under that CT scanner. I had spent the rest of that day furiously checking and rechecking my medical records to find the results of the scan. Eventually, I retreated from my efforts, realizing that there wasn’t much I could do even if I had those results. It wasn’t until I received a letter from my physician a couple of days later stating that the scan had been fine and detailing plans to reassess in a year that I started to feel as though I could begin to put this story behind me. That was a powerful feeling.
I’ve returned to my life as a medical student, spending most of my days with patients facing diagnoses that range from a simple cold to terminal cancer. I’ve also had the honor of scrubbing into and assisting with thyroid cancer surgeries to see how they are done. I wish I could say that my experience last year has revolutionized how I speak with sick patients, that I always know exactly what to say or when to say it. But I don’t.
My brush with cancer has, however, humbled me in my interactions with patients. I try never to assume that just because I know the medical facts, I understand how a patient is going to interpret them. Especially with a disease such as thyroid cancer, in which there is a high survivorship, there is a fine line between reassuring patients about their prognosis and unintentionally minimizing their concerns about a cancer diagnosis.
As medical students, we undergo this rapid and major transition from textbook learners to active participants in patient care, from learning about illness to dealing with it in real life. In a textbook, the workup of a patient’s illness looks swift and sequential. In reality, it can take weeks or months from the first time a pathology is noted to when a patient receives an actual diagnosis. And that time of uncertainty can be debilitating. Despite knowing the incredibly high percentage of people who survive thyroid cancer, I still experienced all the fear, anger and dread that can accompany any illness. Because, ultimately, learning about a disease is incredibly different from living it.
Fathy is a third-year medical student at the Vanderbilt University School of Medicine in Nashville. A version of this article was published by KevinMD.com.