Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [49]
Despite the stress of running a gallery and dealing with highstrung artists and intense buyers, Julie told us that she was not a “worrier.” “I’m almost pathologically positive. ‘It’s going to be okay’ is the mantra in my mind. There was no one with breast cancer in my family. And anyway, I had a normal mammogram two months earlier.
“I had a meeting waiting outside my office, a young up-andcoming artist with his lawyer. I had to tell them the meeting was not happening, and off I went to the radiologist. Right then and there, they found I had not one but two lumps. One of the lumps was in the breast, and the other one was a lymph node. The radiologist told me right in the middle of the hallway that it looked like cancer even before the biopsy. I’m not one who’s going to gush tears.” Julie paused. “I was like, ‘Oh, that’s too bad.’ But I would feel terrible for the person who would be knocked on the floor by that.”
Within a week, a surgeon removed the two lumps, as well as several other lymph nodes under her arm. As expected, the breast lump and one of the lymph nodes proved to be cancerous. It turned out that Julie hadn’t felt the cancer in her breast when she had removed her T-shirt; instead, she’d felt the lump in the adjacent lymph node. “The amazing thing, the radiologist said, was that I felt it at all, because it was so small. It was one of those ‘believe in fate’ kinds of things.” The radiologist retrieved her earlier mammograms but found no abnormalities. “So within two months, a lump had grown in my breast, and then shot off to the lymph node.”
In contrast with Matt Conlin and Steven Baum, who received repeated reassurance from their doctors, Julie was given clear and urgent messages. “I felt I had to move quickly, to find the ‘best of the best.’” She paused. “That’s what we call it in my work—everyone is always trying to find the ‘best of the best.’” It’s “the best new young artist, the best photographer for the catalog, the best lawyer to write up the contracts. And I believe these people really do have qualities that make them better than anyone else. Now, I needed to know who was the best of the best in breast cancer. I discovered a new way to use my Rolodex.” She learned that several of her clients sat on the boards of hospitals, and others had raised money for cancer organizations, so she contacted them. “I got their lists of the best cancer specialists in the state. I put together all the lists and saw who was repeated.” Quickly, it became clear to Julie that one oncologist was at the top.
Mary Frances Luce, a researcher on decision making at Duke University, points out that trying to find “the best doctor” or “the best hospital” is, in part, a form of coping. Patients with a serious diagnosis cannot avoid the reality that they will have to make many difficult decisions. Looming behind each choice is the possibility of a negative outcome—an effective therapy might have debilitating and lasting side effects, or the disease, even if treated in the most effective way, might not be cured. Choices must be made, one option selected rather than another; none is guaranteed to succeed, and each has risks. Luce and other researchers term this “decisional conflict,” and it is a major source of emotional stress for patients already dealing with the physical difficulties of a disease and its treatment.
People try to cope with decisional conflict in different ways. For those with deep religious faith, prayer and a belief in God’s benevolence may provide comfort and a sense that “He will guide.” Care from “the best,” in Luce’s formulation, is another coping mechanism, a way to avoid “hot” decision making by dialing down the emotional temperature to a more tolerable level. The patient reassures herself that she can reduce the uncertainty of choosing among difficult options and increase the odds of success at the “best” hospital with the “best” specialist.