This is a story from the time, when I was a first year resident of Pathology. I was excited to work independently in the FNAC: Fine Needle Aspiration Cytology Lab. It was about time to finish my exhausting and draining week on a Friday evening. I was ready to go home for the much awaited weekend.
A lean and skinny man came into my hospital wing with worry lines on his forehead. He gave a doctor's note to the lab attendant for the FNAC of his wife. The clinical diagnosis read: Suspicious mass in upper outer quadrant of the right breast, age 28 years, female.
The cytology lab was hurriedly finishing their work and they were anxious and ready to close the reception window. He desperately pleaded and requested the lab attendant to do his wife's FNAC before shutting the lab. That evening, the lab was preparing to close for the oncoming long weekend. Understanding the urgency and distress on his face, I agreed to take the patient in for needle aspiration.
To our good luck, we got the aspirate in the first go and we quickly made four to five slides. The slides were quickly sent for staining and subsequently, they were ready to be examined under the microscope. Excited about the last case on a Friday evening, I immediately sat behind the microscope to inspect the slides.
I considered the clinical history. It read: young age with no family history of carcinoma. I assumed that the lady probably had a benign tumor, fibroadenoma, but to my surprise there were many big angry looking cells with a fair amount of necrosis on the slides. Slide after slide, the lethal malignant cells were all over. Startled, I checked the name and age of the patient again. Even though I was sure about the diagnosis, I still wanted to review and verify it with my professor.
I looked across the window and saw the piercing eyes of the patient's nervous husband staring constantly towards the window of the reading room. I tried to not make any eye contact with him as he was tensely pacing through the corridor. While taking the slides to my professor’s reading room, I tried to maneuver through the corridor without making any direct eye contact with the patient's fearful husband. The dying to know expression on his face was indirectly interrogating me about the report. Although it was a short, fleeting glance, the eye contact I didmake with him was enough to transmit the apprehension and fear I was holding back regarding the results.
I managed to take the slides to the reading room. The Professor was about to leave; he was looking forward to his long weekend after a busy week. I really wanted him to examine the slides and requested him to confirm the diagnosis. The attending was in a generous disposition with no call for the weekend. He decided to review the case with me. He quickly confirmed that the patient has a lobular carcinoma of the breast.
Now came the most difficult part as a rookie resident. Physician competence in such conditions is critical to establish trust. How was I going to break the news? My heart was pounding as I called the patient along with her husband in the room. I had tons of questions in my head questioning my ability to confidently deliver the news to the patient and her family.
What if the feeble looking husband faints?
How is the young patient going to react?
What if one of them starts crying?
I nervously broke the news. Suddenly, the patient's anxious husband became very pale. He looked as if he was in sudden paralysis. The patient seemed to not understand or believe the diagnosis. After a short glance at each other the loads of nervous questions spilled out.
My dejected diagnosis cast a feeling of dreadfulness over me. How were they going to manage their young family? How were they going to share the news with their family?
How were they going to spend their long weekend?
After finishing my work I left the hospital feeling glum and gloomy. The excitement of a long weekend was surely damped. I tossed and turned during night for the rest of the week and suffered from insomnia. I could not dissociate myself from the patient and her husband for a long time.
Over time, I learned that as a physician you have to have some amount of immunity towards the patient's feelings. After that solemn Friday night, I finally understood that cancer not only brings pain to the loved ones but it also brings anxiety and stress to the treating physicians and nurses.
