The Anatomy of Hope: How People Prevail in the Face of Illness by Jerome Groopman

Author:Jerome Groopman [Groopman, Jerome]
Language: eng
Format: epub, mobi
Tags: General, Social Science, Religion, Spirituality, Health & Fitness
ISBN: 9781588363589
Publisher: Random House
Published: 2003-12-23T00:00:00+00:00

CHAPTER 5

* * *

Undying Hope

After decades of practice and seeing many hundreds of patients with a particular disorder, a physician becomes very familiar with the various clinical aspects of the malady, yet he never stops learning about character. This is one of the great privileges of doctoring, because what you learn can inform how you want to live your own life in addition to your care of future patients.

In December 2000 I met a patient named Barbara Wilson. Barbara was sixty-seven years old, a retired history teacher, active as a volunteer in her church and the leader of its Sunday-school classes. Her husband had died suddenly in his forties from a ruptured cerebral aneurysm. They had no children but many nieces and nephews, and Barbara was close to them. Some three years earlier, she had found a lump in her left breast that was biopsied and shown to be cancer. The dogma that a radical mastectomy, the operation Esther Weinberg underwent, was optimal therapy had been shown as misconceived. Such drastic surgery offered no clinical advantage over less mutilating approaches. Barbara’s surgeon detailed two equivalent procedures: a “simple” mastectomy, in which the breast tissue and nearby lymph nodes would be removed and the underlying muscle preserved; or a “lumpectomy,” in which only the tumor and surrounding lymph node would be excised, followed by radiation to the breast. Barbara chose the latter option.

The pathologist examined the excised cancer and noted that it had aggressive features, with many actively dividing cells. In addition, the lymph node contained metastatic deposits. Barbara was prescribed six months of chemotherapy, the standard amount to try to eradicate any residual cells and improve the chances that the cancer would never return. But a month before we met, Barbara noticed a hard swelling over one of her lower ribs. She went to her local oncologist. He examined her and ordered a series of X rays and scans. The cancer had returned. It was growing in her bones and liver. Her oncologist was in the process of retiring after many years of practice, and he referred Barbara to me for continuing care.

It was a typically frigid December day in New England, the winter sun reflecting sharply off the ice that had lingered on the sidewalks since the last storm. Barbara was seated in the waiting room, wearing a heavy woolen sweater, flanked by two women friends from her church. She was tall and slim, with angular features and serious blue eyes. After introductions were made, I asked whether she wanted her friends to sit in on our discussion. Generally, I encouraged patients to have a third party, a family member or friend, along for the part of the conversation when difficult clinical issues were aired. It facilitated communication, because fear or anxiety often made it difficult for a patient to assimilate information or summon questions.

“Do I need bodyguards?” Barbara asked with a laugh. “I suspect what I am going to hear will unnerve them more than me. For now let’s leave them out here with last month’s Time and Newsweek.

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