I love medicine. The chance to interact with people at their
most vulnerable, to learn about them and their loved ones, to help them through
a diagnosis of cancer, to provide hope in the present and a way to envision the
future—it truly is a remarkable thing. Most days I still consider how lucky I
am to be doing such important work. I’ve learned I am human, and that it’s not
antithetical to the practice of medicine. I try to be conscious of my own
emotions and of my own biases, so that at the end of the day, I can feel good
about the care I’ve rendered—to know that I’ve treated patients as equally as
possible, and that I’ve not determined a course of treatment based on my own
impression of “what’s best for them”. Still, in medicine, as in life, patients
are also people, and people aren’t perfect. They have their own thoughts and
wishes, they have read the literature to reach their own conclusions, and they
have their own prejudices, too. In those times, I will admit that even after
more than two decades as a doctor, I still struggle to respond.
Such was the case with June. I had met her several years
ago, while she was in the hospital. She was in her sixties, of Japanese
descent. She spoke some English and told me she had moved here later in life.
Though she never married, she had found a community of friends and had settled
comfortably. She did well until a few weeks prior when she had the onset of
abdominal swelling. Initially she thought she had eaten something terrible, but
then the pain and vomiting started, and after one restless evening, her friends
had taken her to the Emergency Room. She was found to have ascites by imaging
and her bloodwork suggested cancer.
We were called to see her after the diagnosis was
established—high-grade carcinoma, favoring a Mullerian origin. Given what we
knew, I agreed that the likely diagnosis was ovarian cancer. I called a consult
and she was seen by a colleague, a wonderful gynecologic oncologist from
Mexico. Following an exam and review of the imaging, he called me.
“Yes, I agree—ovarian cancer. But the imaging suggests the
disease is widespread. I think she would benefit from neoadjuvant
chemotherapy,” he said. We talked more about it and together we rendered our
joint opinion—first chemotherapy, then surgery. I had hoped we could still cure
her of what appeared to be stage III disease.
She wanted to go home and take care of a few things so opted
not to start chemotherapy in the hospital. I felt it was reasonable; she had
her ascites drained and was much more comfortable. While I thought chemotherapy
should start “sooner rather than later,” I saw no reason we needed to start
immediately.
A few days later she came to my office to make plans about
treatment. She was doing okay, and she told me she and her friends had read up
about ovarian cancer. She was glad we weren’t doing surgery right away—in fact,
she was not so sure she wanted to have surgery. “I need my income,” she said.
“Taking 6 to 8 weeks to recover from surgery isn’t possible.”
“Well, I am glad you’d like to start with chemotherapy. I
and your gynecologic oncologist feel it would be best. The goal of surgery is
to take out all of the disease, and given your scans, reducing the cancer you
have now would result in better chances of us doing just that.”
I noticed her scowl when I mentioned my colleague—an
expression that remained on her face as I talked.
“Can I be honest with you?” she asked.
“Of course,” I replied.
“I need another surgeon. That one was nice enough but you
can’t trust them,” she said.
“I’m not sure what you mean,” I said. It was all that came
to mind.
“His accent made it hard for me to understand him,” she
stated. “But then, I find all of them hard to understand. And he seemed a bit
young. I’d like a surgeon with far more experience. And one that speaks
English.”
I understood then. She wanted a different gynecologic
surgeon—someone experienced and someone without an accent. I sensed the irony
because she herself was Asian. I wondered if she had ever experienced
discrimination, to know that she was being judged by her appearance and by how she
spoke, not by her abilities or her achievements. I bristled at first, recalling
the times it had happened to me—I was too young, I didn’t dress like a doctor,
and once, because I was Asian.
I struggled to respond. Part of me wanted to confront her—
to defend my colleague as the gentleman and talented surgeon I knew him to be;
to point to his accolades and to introduce her to his patients, who universally
loved him. I wanted to tell her how wrong she was to judge a man by his accent,
or by his age.
I didn’t though. One of the first lessons I learned in
medicine was that there is a time and a place for everything, and this was not
the time to call someone out for her biases (or more frankly, her prejudice).
This was a time to show compassion and to ensure she, and all patients that
came after her, was treated with dignity and respect, and received the care
that all of us would want—and deserve.
So in the end, I put my hand on hers and explained, “Well,
if you want a new surgeon, then I can arrange for a second opinion. For now, I
want to get you started on treatment, so that you can feel better. That’s our
number one priority.”
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