There’s a Reason They Are Called Patients



HOUSTON, TX – I have a mammogram every spring. The preparation is the same. No lotion. No perfume. No deodorant. It is an uncomfortable exam, but the alternative hurts way more. I don’t really breathe until I get the results, and then I exhale a quick prayer of thanks when I hear the words, “Everything is fine. Continue self-exams. Have another mammogram next year.” I’m not going to discuss the conflicting recommendations of when to begin getting mammograms or how often they should be done. I do what I do to insure my health and peace of mind.

This year was the same – except for an ancillary issue. My older daughter has been ill for several months, and my body has responded with a spike in blood pressure that is off the charts. I did not have any symptoms – that’s why hypertension is called a silent killer. O Theos me fotise, and I slipped my arm into one of those blood pressure cuffs in the supermarket and almost passed out when I read my numbers. I already stand in the shallow end of the gene pool when it comes to cardiac health, and I work hard to stave off complications. But a sick child defies all nutrition plans, exercise regimens, mindful meditation – even prayer – to wreak a special kind of havoc.

So I’ve been in my cardiologist’s office almost every week since. It’s like we’re going steady. He has changed meds, altered doses, run tests. I wear compression hose, a lovely fashion accessory I have abandoned during the day in the Houston heat, and check my blood pressure at home three times in the morning and three times before I go to bed. I can spend the evening watching TV or reading a novel, yet my numbers are still way too high. I’ve had a head CT, a chest CT, and a pelvic CT to rule out vascular issues. Everything is negative, and we continue to be frustrated. Until he prescribed an antihypertensive/diuretic that is seldom used in the United States but is common in Europe and South America. And here’s your free medical advice – the reason you’re reading this article. Indapamide has made the difference. My BP is finally coming down, and I don’t have to see my doc for three months. You’re welcome.

Except – and this is a big one – the radiologist saw something on my chest CT. My doc and I were preternaturally calm as we discussed an ultrasound to evaluate the CT and rule out breast cancer. Houston is home to the world-famous Texas Medical Center; among its many hospitals that specialize in cancer treatment are M.D. Anderson, Texas Oncology, Methodist, St. Luke’s, and Memorial Hermann. M.D. Anderson and Memorial Hermann have partnered to provide breast cancer care and, since I get my mammograms at Hermann, I quickly made an appointment for the ultrasound. First mistake – my doc didn’t order a second mammogram, which the radiologist wanted for comparison. Something was wrong with his phone system that morning, so the order came in late, and I had to return the next day. Second mistake – the radiologist did not have the CT report. It was immediately faxed, but the actual DVD took time to recreate, so I had to come in yet another day.

By then, I expected donuts and coffee when I arrived. Everyone was helpful and gracious, acknowledging the seriousness of the matter and how these delays were frightening me. I couldn’t help but think I was losing precious time because the left hand didn’t know what the right hand was doing. At that point, the only good news was that the Indapamide was controlling my BP even with this added stress.

So on day three, I sat in the waiting room of the Breast Center at Hermann, distracting myself with a novel about the Holocaust (perhaps not the best choice given the circumstances). As a writer, I have a habit of watching the people around me and constructing fictions about their lives. I wear dark sunglasses so that no one suspects. Four women of various ages were busy making out forms, exhibiting the normal apprehension under the circumstances. I found the two men waiting far more interesting. One was in his 40s, sporting a T-shirt, jeans, work boots, and a man-bun that, unfortunately, is making its way back and still only looks passable on a 20-something guy. The other was older, in his 60s, wearing khakis, tennis shoes, and a faded UT T-shirt. They both held their IPhones on their thighs.

Then they each spoke to no one in particular. “Da–,” said the bunhead. “I’ve been here three hours!” “Jeez,” said the Longhorn. “It’s been forever!” I turned and looked at them. I wondered if they were waiting for their wives, mothers, sisters or daughters. I wondered if the three hours they had spent waiting had cut into something really important they had scheduled that day, like working on a cure for cancer or negotiating peace in the Middle East. I wondered if they considered what their wives, mothers, sisters or daughters were going through while they waited.

I wondered if they knew that they could be diagnosed with breast cancer. Because men have breast tissue that develops in the same way as it does in women, it is also susceptible to cancer in the same way. Just like in women, breast cancer in men can begin in the ducts and spread into surrounding cells. More rarely, men can develop inflammatory breast cancer or Paget’s disease of the nipple, which happens when a tumor that began in a duct beneath the nipple moves to the surface. Male breasts have few if any lobules, and so lobular carcinoma rarely, if ever, occurs in men. Nonetheless, about 2,000 men are diagnosed with breast cancer annually, and about 450 deaths occur each year.

Male breast cancer treatment typically consists of mastectomy, followed by radiation therapy, chemotherapy, hormone therapy and/or targeted therapy. Since many male breast cancers are hormone receptor-positive, the drug tamoxifen is often a standard therapy for male breast cancer. For men whose cancer has not spread to the lymph nodes, adjuvant therapy (therapy given after surgery) is generally the same as for a woman with breast cancer. For men whose cancer has spread to the lymph nodes, adjuvant therapy may include chemotherapy plus tamoxifen and/or other hormone therapy. Treatment for men with cancer that has spread to other parts of the body may include hormone therapy and/or chemotherapy (http://www.cancercenter.com/breast-cancer/types/tab/male-breast-cancer/?source=MSNPPC&channel=paid+search&c=paid+search%3ABing%3ABroad%3ANon+Brand%3ECancer+Type%3A+Breast%3ABroad).

I wondered if they ignored symptoms because they associated breast cancer with women, and if they were diagnosed, their friends might think they were lesser men. In the HBO prison series OZ, inmate Ryan O’Reilly, head of the Irish gangs and a drug lord, is diagnosed with breast cancer. He actually considers forgoing treatment because he fears the enmity of the other prisoners. Of course he undergoes surgery and chemo because we need him in the storyline. But real men do not have the luxury of fictional characters, though they may share their apprehensions and prejudices. In a PSA for prostate cancer, the tag line is Don’t Die from Embarrassment. This holds true for breast cancer as well, but I’ve never seen such a PSA for men.

When I finally joined the other women in white robes waiting to be called, I wondered if any of them was related to the two men I’d been thinking about. One was older – could have been with the Longhorn. She was reading, unperturbed by the wait. Two other women were sleeping. A fourth was accompanied by her daughter, who was there to do consecutive translations in Vietnamese. Something was wrong on her mammogram, and they were waiting for another exam. A fifth woman did look ill. She pushed a walker, and was wearing bedroom slippers and a sweatshirt over her gown. Her hair hung limp against her emaciated cheeks, and she talked to no one in particular about nothing specific. I continued to read about the Holocaust. By the time I was called, the two sleeping women had gotten good results, the woman with the walker was called but never returned to the waiting area, the other reader had come and gone at least three times, and the Vietnamese woman was still there. My second mammogram was negative. I didn’t need the ultrasound. “Everything is fine. Continue self-exams. Have another mammogram next year.” Thank you to the nurse. And then a silent thank you.

The two men were gone by the time I left the Breast Center. I wondered what the diagnoses were for their loved ones. I prayed that everything was negative. But I also hoped that if anything were wrong, they would be patient caregivers. If ever they were called upon to be the strong, silent types, this was it.


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