What My Cancer Taught Me: Overcoming and Learning from Ovarian Cancer
Dr. Puxiao Cen shared her impressive story of ovarian cancer diagnosis, treatment and recovery with Baylor University Medical Center's quarterly magazine, Proceedings. Dr. Cen explains how her cancer diagnosis helped her to better understand her patients and grow as a physician. Read her story, originally featured in volume 28, number 4 of the Baylor Health Care System’s prestigious peer-reviewed journal, below.
What My Cancer Taught Me
In the summer of 2007, I was diagnosed with stage II ovarian cancer with metastatic lesions on the bladder. After two surgeries and seven rounds of chemotherapy, I am in remission and have undergone transformational changes from the experience. Fortunately, we live in a time of advanced medical development that allowed for early detection and effective treatment of the cancer—for which I will be eternally grateful. While this has given me a very good prognosis, it did not make the process any easier, despite the unflagging support of family and friends. I learned that no matter how much you are loved, being ill is a lonely journey.
The vast majority of illnesses most people experience are acute in onset, self-limiting, and relatively short-lived, like the common cold. However, with a chronic illness like cancer, where there is a long, drawn out, constant fight against the disease, individuals experience fluctuations of confidence and the will to fight. Not only that, but due to the protracted nature of the disease, they inevitably harbor feelings of guilt for being a burden to loved ones. Consequently, they try to be a “good patient” and not tell anyone, caregivers and doctors alike, about the physical and mental suffering they experience.
When I first learned of the diagnosis, I approached it from the role of a physician, which made it extremely difficult to experience the fear or sadness often observed in patients with similarly serious verdicts. When I read the pathology report, I was solely focused on the hard data about the clear cell carcinoma that I was found to have. My clinical mindset led me to spend a vast amount of time online learning about the latest research, just like I do for my medical practice. For all intents and purposes, I felt that my daily routine was not going to be disturbed by the cancer.
Looking back, I realize this thorough studying of my computed tomography (CT) and positron emission tomography (PET) images, pathology reports, and literature research was a way for me to insulate myself from the shock of the bad news. Because the mind spends much of its time trying to defy change, seeking an unstressed state, I fell back to the comfort of doing what I know well. By reflexively studying the science behind the diagnosis, I was helping to shield myself from the emotional impact.
This experience helped me better understand why some patients spend a tremendous amount of time and energy studying even the most minute details of each differential diagnosis. They even print out the information from their online search and bring it to the office visit to discuss with me. In the past, sometimes I was confused by such behavior, which I considered a refusal to accept the medical “truth.” I would say something like, “Relax; it is not as complicated as you think,” or “Don't worry; let me take care of you.” My patients' reactions would even make me feel untrusted. Of course, only after behaving the same way, obsessed about information on my own illness, did I understand my patients' insistence on knowing “everything” as a way to gain a sense of control.
The need to maintain control over one's life and pretend that nothing has changed can be pervasive. Even when my colleagues were kind enough to take over my workload so I could take time off, I continued to use electronic medical records to follow many of my patients. I simply was not able to let go of my routine. By ignoring the reality and the upcoming extended period of hiatus for the treatment of a serious illness, I was using work as a way to feed my denial.
Prior to my cancer surgery, I would stand next to my oncologists during my appointments, and we would look at my images and discuss my case as if we were talking about a mutual patient of ours. By pretending to be the doctor of someone else, I would appear to be the most compliant and calm patient. It was only in the postoperative period after the undeniable trauma of the surgery that I was able to transition from being a physician to being a patient. It finally occurred to me that I was not the attending physician anymore; I was the one who had cancer and was receiving treatment.
As a patient, I experienced the inconvenience of “medical routines” firsthand. While I understand the necessity of chest x-rays, blood tests, and urine cultures when I had a fever, especially in the context of postchemotherapy neutropenia, the process struck me as irritatingly intrusive, especially when it happened in the middle of the night. After all, that was when I felt weak with fever, chills, abdominal pain, diarrhea, dry mouth, and headache.
All the testing that goes along with cancer can be tiresome. Getting a CT scan with intravenous and oral contrast is not an easy feat. Each time I received intravenous contrast, I would have intense nausea and vomiting. Even the oral contrast required drinking about half a gallon of thick liquid that is completely unpalatable even though it tastes like strawberry, banana, apple, or grapes. Knowing that the taste is chemical made each gulp a small challenge.
Some of the testing can be isolating in both a literal and figurative sense. Lying in the bed of the PET or CT scanner, I felt as if the automatic instructions from the machine, and even the voice from the technician outside of the room, were alien and distant. The feeling of isolation can easily cause a person to regress to a more vulnerable state.
One island in the storm was patient-controlled analgesia. I was grateful for the chance to control the dose and timing of the medicine for my pain. I understand now that the potential of pain is a big part of a patient's suffering. When you give patients the chance to plan and implement their own pain control, the sense of relief is priceless.
Medicine And Statistics
Prior to my cancer, whenever I used statistics as a part of shared decision-making with patients, I expected them to understand that medicine is a science, albeit an imprecise one at times. However, many patients wanted absolute, yes-or-no–type answers. It is not uncommon for patients to regard statistics as irrelevant. In the past I considered such patient behavior a result of a lack of scientific background. Now, I feel the cold objectivity and the businesslike nature of statistics.
Surely, a physician should endeavor to be as objective as possible, while remaining tactful in the delivery of unfavorable information. This objective yet tactful stance can be viewed by patients as distant and detached. As a physician, when I heard patients or their family use terms such as “you doctors,” I would feel disparaged and unappreciated. Now I know that patients who feel helpless and afraid may see a world divided. When I was suffering, I felt alone, caught in the middle of the evil disease and people who were trying to get rid of it. I was a passive, powerless entity in the process. Such a mindset can cause one to become defensive and critical of others. When one feels voiceless in the decision process, it is hard to view the care team as on one's side.
Before the cancer, my body was a quiet supporter of my ambition. Ironically, it was in sickness that I felt the strength inside me. When I looked in the mirror and saw a thin, pale, bald-headed person looking back at me, I could feel the strong vitality inside my head. I alternated between feeling trapped inside my broken body and the resolve of seeing that caring for this frail physical being was an exercise to get my mind in shape. What a contrast in health and spirit: a worn-out shell versus a sharp consciousness!
There is a duality of thought when one considers the time one spends in the sick bed: the age-old quantity versus quality conundrum. On one hand, it is time one would not otherwise have if it were not for modern medicine. On the other hand, it is time lost because the quality of the time is diminished by treatment that renders one sick and weak, preventing the enjoyment of life. One sacrifices the quality of today in the hopes of having a better future.
Cancer taught me several lessons as I transitioned from the role of a doctor to patient. One lesson was an appreciation for the “teaching burden” that patients have to shoulder. Residents came to my room and took my medical history, going over a lengthy review of systems, performing a thorough physical exam. We should all be thankful to patients for lending themselves to the training of our new physicians.
Another lesson came from the opening of oneself to total strangers. During my cancer treatment, as I met the flow of new physicians, such as an anesthesiologist before the surgery, I felt a distinct recoil in my gut. This thought remains with me when I meet a patient in the emergency room or hospital ward for the first time. I cannot help but wonder how they feel when I, a heretofore unknown entity, propose an invasive procedure such as cardiac catheterization. Do they feel the same uncertainty I felt as a patient? It certainly gives one pause.
Even basic, everyday medical equipment took on new meaning for me after cancer. During one of my chemotherapy infusions, I had sudden hypotension and bradycardia, to the point that I passed out. When I came to, I saw a crash cart next to me and was struck with fear. Now, whenever I see one, I am emotionally transported back to that moment and feel a vague but real threat emanating from it. Perhaps to patients—not just children, but also adults—who have experienced emergencies and life-threatening conditions, many pieces of equipment regularly used by doctors and nurses could evoke a similar emotional response of fear, dread, or anxiety.
My journey through cancer has given me a new appreciation for the nuanced perspective a patient requires. In the past I would sometimes hold my patients' hands and say, “I understand how you feel.” Now I say, “Although it is impossible for me to know exactly how you feel, I will try my best to understand you and see things from your side.”
These are the insights I have gained from being a patient. Doctors and patients are alike. Life experiences help us to see other people's points of view. The success of any treatment relies as much on the kindness and forgiveness we show to each other as it does on medical expertise and advancements. The latter is often limited by resources, whereas the former requires only a good heart.
Download alternative formats of this article, inlcuding PDF and e-reader versions at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569245/ and download current or past issues of "Proceedings" here: http://www.baylorhealth.edu/Research/Proceedings/CurrentIssue/Pages/default.aspx.