I shifted my weight from clog to clog, restless and uneasy as my surgical team spoke to our patient. She was a middle-aged woman living a middle-class life, small and hunched over in her hospital bed, voice quiet and demeanor restrained. Her hair was neatly combed over, her skin looked fresh and dewy from a recent shower. Her boyfriend stood nearby, calm, a protective hand rested on her shoulder.
She consented to the surgery. The team explained to her the risks of the operation, both common and rare, and watched her pen her neat signature to the form. We thanked her, and promised to see her within hour to wheel her to the operating room. Next up in line for her attention was anesthesia.
The surgical team moved on to prep for the OR but I, in my capacity as a time-rich medical student, stayed.
"Y'all should definitely tell me to leave if you want a moment alone, but thought we could talk?" I said.
She smiled and asked me to stay.
We talked about her life, established in a small town in New England, and how far she had to drive in to get her surgery in Boston. We talked about how long the recovery could take, and whether she would be able to get back to teaching when school started up in September. She asked me questions about where I grew up (India), what I studied in college (English), and why I wanted to be a doctor (this was a longer answer). We dawdled around the central subject, the one that both she and I knew we were consciously avoiding.
It was only when I saw anesthesia approach out of the corner of my eye, and knew that her undivided attention to me would soon be less so, did I blurt it out: "Why didn't you see a doctor about this sooner?"
My patient was in a hospital smock, one of those shapeless, flimsy cotton gowns that only just cover a person's front, and freely expose the posterior to the elements. Right below the drawstring by her neck was a 10-inch, black, fungating sarcoma -- a tumor of the soft tissues -- that had grown slowly but surely over the course of years, like a cluster of thick vegetable roots, or black mushrooms that gave one the impulse of wanting to secure it tightly in one's palm and yank them out from the soil.
When my surgical team had discussed this morning's cases the evening prior, we had all discussed this particular one with vigor. What kind of person would harbor a tumor like that for so long? What had to happen for someone to deny the tumor's existence until it was unavoidable? She had told the surgical oncologist in clinic that she was coming in to get it excised because it was starting to cause her pain. Since I don't know what he said in response, I can only imagine that it was incoherent.
But here she was in front of me, this perfectly ordinary lady with a job, a boyfriend, and her faculties intact.
"Honestly, I was just afraid of the surgery," she said. "I always knew it would be bad. I was afraid that the surgery would incapacitate me and alter my life forever."
I barely had a chance to pass this limen, so honestly proffered, of her psychological fears and impulses before anesthesia came through. I excused myself and closed the curtains behind me.
It would have been easier if she'd presented with a psychiatric illness, early-stage dementia, a pathological denial that stemmed from a deeply buried fear of cancer from watching a parent pass from it. This would have made sense to my surgical team. But our patient refused this role, insisting rather on an identity independent from her damage, clearly outside its gravity.
The surgery was brutal, involving three senior plastic surgeons, a surgical oncologist, and an orthopedic surgeon, not to mention a whole army of junior and senior residents, who over the course of seven hours made a wide excision, sparing as much of her healthy muscle underneath, and created enormous flaps from her spare skin to cover the wound. The tumor had advanced so far, had planted multitudinous roots that were extremely challenging to extricate. In some ways, she had created a self-fulfilling prophecy: By waiting for so long to address the subject, she had essentially assured herself of all the things she feared -- a difficult surgery and a difficult recovery.
I circled back to her bedside after the surgery, when she was finally wheeled to the post-op waiting room for close observation. She was still groggy from the recent anesthesia, so I talked to her boyfriend instead.
"It was a point of contention between us," he said, acknowledging my unspoken question. "I wanted her to see a doctor from the very start, but she wouldn't listen."
He continued, without any prompting: "I know everyone must be wondering how I stayed with her. I mean, it was ghastly, right? I don't know. I was in love with her, you know? But also, I was impressed with how she refused to let her ugliness subsume her. She didn't let it become her identity. To me, she was still the person I loved to watch old films, garden, talk politics, eat sweets from our favorite bakery with. She wasn't her tumor. She was my best friend."
We stood in silence, holding onto the rails of her stretcher. She moaned gently in her sleep.