Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [44]
Steven met with the urologist the next day. He brought his wife to the appointment. The doctor spoke with confidence: “You have a very little bit of aggressive tumor, but we will get it all out with surgery. I wouldn’t recommend radiation for you because your gland is too big.”
“Before he brought it up, I was already worried about side effects,” Steven told us, “but the urologist told me, ‘You are not going to have any side effects. It’s all going to be fine.’ The urologist went on to say that ‘after thirty years of doing this operation, I have perfected my technique. I have the best results in Los Angeles. My assistant will contact you to set a date for your surgery.’”
The urologist stood up to escort Steven and his wife to the door. But after a few steps, Steven stopped abruptly and asked, “What do I do about my anxiety?”
The doctor nodded sympathetically. “I can schedule you in two weeks. We’ll be finished with it.”
Baum told us how he left the appointment feeling strangely elated. “I said to myself, Oh, my God, this is going to be fine. It’s a great relief to go from thinking I’m dying tomorrow to hearing that the operation has no serious side effects because the doctor has done it so well so many times, and that I’ll come out as good as new.” Steven’s wife, also a psychologist, was similarly swept away. “She said, ‘Well, if I had a prostate, I would want this operation, too.’”
Steven, an energetic man with a full head of curly hair, a ruddy complexion, and a ready laugh, was keen to talk about his interactions with doctors and the insights he had gleaned from trying to choose a treatment. “As a psychologist, I’m trained to have experiences and then to look at my experiences and be able to see clearly what’s happening to me. Certainly if I’m so confused, so overwhelmed, doing and thinking things that I never expected, it might be useful to others to hear my story.”
After his diagnosis, Steven told us that he initially had “bizarre” and unrealistic thoughts. “I thought, Maybe I don’t really have cancer. Maybe the laboratory mixed up my biopsy with someone else’s. I just couldn’t believe I was going through this.” Steven’s “bizarre thoughts” are not uncommon. People often feel a sense of unreality and denial when receiving an unexpected and serious diagnosis. Steven Baum’s “bizarre” thinking also has some connection with fact. When he had searched the Internet, he found a recommendation that patients should always get a second opinion from a certified pathologist on the biopsy. Indeed, pathologists can differ on the Gleason score, some interpreting the findings differently despite the same uniform criteria.
Steven explained: “When you feel so insecure, you want someone who is stronger than you are—a powerful person who is going to make it all go away. As psychologists, we look at the doctor as a parent figure. What he is essentially saying is, ‘I’m going to take care of you.’”
Steven understood from his training the tension between the desire to believe and the need to doubt. “More than anything else, you want a savior, someone to hold you. It goes way back to when you were a child, wanting a parent to say it’s all going to be okay. And my urologist was saying that. So a part of me was saying, ‘I want him to take care of me. Everything will be fine.’” Then he checked himself. “But the other part of me was saying, ‘Are you a fool?’ I’ve had three strikes with him. He told me three times that everything was okay, that the prostate gland was big but had no growth, that the high PSA level was not meaningful given the size of the gland, and the biopsy was not really necessary and would be negative.” Steven Baum, like Matt Conlin, was unnerved by having received repeated reassurances that turned out to be wrong.
But unlike Matt Conlin, who considers himself “a numbers person,” Steven Baum, by his own account, is