Things Left Unsaid: Unspoken Words to My Patient

Today, you came to me with a chief complaint: Right breast lump.

You told me you’ve only been aware of it for the last 3 weeks.  Your eyes told me your terror of not realizing it was there sooner.

You told me there wasn’t a history of any breast, endometrial or ovarian cancer in your family.  But you held back that you knew there isn’t always a family history.

You told me you had a normal mammogram 3 years ago.  But you left out that part about the guilt of not having done your self-monthly breast exam or your regular mammograms.

You asked me to look at a mole, pointing to the back of your neck.  The tremble of your hands betrayed your efforts to delay my exam, afraid of what was coming next.

You told me there were no overlying skin changes or strange nipple discharge.  What you didn’t relay was the countless hours you’ve spent researching on WebMD, where all roads lead to cancer.

Cancer

That’s what I felt when I pushed on that hard, unyielding, immovable lump at 4 o’clock on your breast.

It’s what consumed my mind when I went to feel up in your armpit to check to see if there was any spread to your lymph nodes.

I tried not to write it on my face as I filled the empty space with instructions on how I do my breast exams – the lawnmower technique.  Up and down in strips, starting from the collarbone along your breast bone, down to the bra-line, continuing out to the side, all the way to the armpit.  I made sure not to stumble over the lump I so desperately want to push into oblivion.

I tried to forget the first time I met you, when I diagnosed your son with a hernia.  I tried to forget the conversation with your husband last week as I bartered with him to avoid increasing his blood pressure medication if he’d work on diet and exercise.

I tried to push out visions of your husband and son, hands circling around my neck to prevent the C word from coming out.

I tried to weed out the distress in my voice as I told you what the plan was going to be: a diagnostic mammogram with an ultrasound.

When I told you I wanted you to come back in a week so we could discuss results, you knew.

You knew I wouldn’t make you come back unless I thought it was breast cancer.

You knew your worst nightmare just came true.

You knew without me saying a single thing.

Some horrors don’t need to be uttered.

This is my cross to bear

To know I am the first healthcare provider to touch your cancer.

To know I am the keeper of a diagnosis that will devastate you and your family.

To know every crease on my face, every movement, every intonation, every word left unspoken will be etched in your memory of this moment forever.

Thank you for the privilege.