Heme/Onc: Breast Day (Last Day!)

My last morning at the Center started out slow; I followed Sandy for about two patients before she "disappeared" (took her purse and went somewhere), so Dr. BR suggested that I follow Dr. RY, the breast cancer specialist of the group. I'd been wanting to work with her for sometime but never asked b/c she seemed so busy; Dr. RY is pretty famous in this part of town for her focus on breast cancer and women's health. As it turned out, she was also an excellent teacher and wanted me to learn everything I could about breast cancer in this one day I spent with her. For each breast cancer patient who came in, she asked me to do a breast exam right after she did (with the patient's permission, of course), and each patient was drastically different from the other. One woman had a unilateral mastectomy so I got to feel both the normal breast and the scarred tissue where the other breast used to be. Another woman had bilateral expanders s/p mastectomy on both sides, and those felt pretty firm (though I couldn't find the port where the saline is injected to make the expanders larger). Yet another woman had bilateral implants, and I was immediately stunned by how cool they felt to the touch. I recalled reading an article where a man wrote how he initially freaked out when he found out his girlfriend's breasts "weren't real," and now I understood what he meant. They just don't feel the same. We had one new patient, and Dr. RY spent an entire hour going over her medical history, diagnosis, and treatment options. Her explanations were such that an ordinary woman with no medical training could understand what was going on, so even if this was my first day of the heme-onc rotation and I knew nothing about breast cancer therapy, I could understand the way the drugs worked. The new patient had a rather small cancer that was removed by lumpectomy, but it was also grade II and lymphatic invasion, which is concerning for future recurrence. She was, however, very Type A and did not want chemo if it wasn't necessary (since the tumor had been removed with clean margins), opting for radiation only. Everyone has their own way of doing things. What impressed me the most about Dr. RY was her rapport with her patients. She sees only breast cancer patients (earlier today she and Dr. BR were trying to compare who had "crazier" patients), presumably all female (haven't seen a male breast cancer patient yet), and she builds relationships with them, woman to woman. There was one couple with whom she regularly joined in prayer at the end of the visit, and today she and Joi (her scribe) invited me to join them. The five of us then joined hands as Dr. RY thanked God for blessing our patient with good health, and I admired her for being able to pray with her patients on request. That's not something I myself would be comfortable with. Joi, after learning I played the violin, told me about a concert she attended in which the musician played a harp and described it as some of the most beautiful music she ever heard. I agreed; words can't describe what a harp sounds like when performed well. At the end of the day, I thanked Dr. BR, Dr. RY, and Helena for having me at the Center and they wished me all the best. I was sad to go; everyone at the Center had made me feel welcome, especially Drs. RP, MR, LM, and BR (with whom I probably spent the most time). As for my thoughts toward heme-onc, it really is a fascinating field and I can easily see myself going into heme/onc if not for the fact that I'm not a huge fan of research. We'll see what happens.