Magazine article Medical Economics

Thank You, Doctor, for What You Didn't Tell Me

Magazine article Medical Economics

Thank You, Doctor, for What You Didn't Tell Me

Article excerpt

The dermatologist read through my medical history, scanned the old pathology reports, looked up at me, and said, "I honestly don't know why you're still here."

I stared at him.

"Very few people survive metastatic melanoma," he went on. "You're one of the few."

No. This can't be, I thought. What is he saying? For distraction, I looked out the window of his office on the 78th floor of one of New York City's tallest buildings. I remember thinking that the last time I was this high up, I was on a plane. Why couldn't I be on one now--or anywhere, away from this office?

His voice interrupted my thoughts. "You had a 30 percent chance of survival." My last surgery had been in 1986. This was July 1999. I'd beaten odds I'd never known I was up against.

Many years earlier, I wasn't too worried when I asked a doctor about the ugly mole on my right forearm that sometimes bled. I was young, and naive about illness. I knew about skin cancer, but wasn't it basically harmless and easily treatable? I'd never heard of melanoma.

"That's not a mole," the doctor had said. "You need to see a surgeon." I felt a tinge of alarm when he called a surgeon right then and made the appointment.

A biopsy revealed malignant melanoma. The tumor was deep and required four hours of surgery. The surgeon also explored lymph glands under my right arm. A kind, fatherly man, he reassured me I'd be all right.

Several days afterward, the surgeon strode into my hospital room, all smiles. The lymph glands were clean! I was fine, and could go home. As far as I was concerned, the whole nasty business was over.

A few weeks later, out of curiosity, I browsed through the health section of a bookstore. A statistic in one book jumped out at me: "Six thousand people a year die from melanoma."

Die? My heart beating fast, I closed the book quickly and walked away, shocked. The surgeon hadn't mentioned that. And he'd said I'd be fine. That was all I needed to know. Denial? Of course. As a reporter, I knew how to ask hard questions; I just hadn't asked any about my own condition.

Over the next few years, I had three recurrences. They were tiny tumors just under the skin, two on my right arm and one on my right side. To me, they were minor annoyances. Each time, the growth was removed in an outpatient procedure by the same surgeon who'd treated me earlier. "You must have a strong immune system," he said. "A lot of my patients get many more of these things than you've been getting." More reassurance-- but again, no questions from me. The surgeon did, however, put me on a regimen of BCG vaccine, which continued for several years.

I didn't know it then, but my chances for five-year survival had slipped from a promising 95 percent, after the first surgery, to a dismal 30 percent after the first metastases. …

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