A Care Conference

By: Zoe Cross, MD

stop me if you’ve heard this one:
an oncologist, a radiologist, a surgeon, and a patient walk into a room
won’t you please sit down Ms. M
thank you doctor
thank you for coming in this morning Ms. M
thank you doctor
we thought it would be prudent to meet in person to discuss your results, Ms. M
thank you doctor
I am very sorry to tell you this but the cancer is back, and it’s the left breast this time
oh. I see.

The oncologist says:
I’m afraid this is a very dangerous type Ms. M, worse than the last time
these things happen and it’s very good that we caught it
that means we have a few options left
I don’t mean to frighten you, but to clarify, we will use the word “aggressive”

The radiologist says:
let me show you your scans Ms. M
imagine we have sliced through your chest as if you were a tree trunk
and this is the new cancer here, see how the borders are quite indistinct
it’s a finding we refer to as “spiculation”

The surgeon says:
Ms. M this time I am not sure we can get it all
as you see on your scan it’s spread, via the lymphatic vessels,
behind the wall of muscles that protect your heart and your lungs
and there may be a time when we will label it “inoperable”

do you have any questions for us Ms. M

Ms. M is thinking about
a wriggling cancer being reeled in on the end of a fishing line
that if she were a tree cut into slices, she’d soon be counting the rings and shedding coppery leaves
how the mass in her left breast looks, to her, like a galaxy;
she can almost identify constellations amid scattered stars of lymph nodes and calcifications,
and if she didn’t know better, she might describe it as “beautiful”

The patient says
thank you doctors for telling me
you have told me everything I needed to know.

Zoe Cross, MD, is a third-year resident in Family Medicine in the Department of Family and Preventive Medicine at the University of Utah in Salt Lake City, UT. Her medical areas of interest include topics such as global health, tropical infectious disease, childhood obesity prevention, and palliative care.

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