Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [56]
“Part of the experience is determined by the doctor,” she said. “But not only him and his team. There was my support network of friends. All caring people, all who care about me.”
What constitutes the “best experience” is highly personal. Angela Balducci, forty-four years old, liked being a stay-at-home mom in her midwestern community. Her two children were now in high school, and Angela’s days were filled with shuttling them to various activities. Petite and athletic, she made time to exercise at the yoga studio and on her elliptical trainer. Angela had been an English major in college and remained an avid reader. She kept a stack of novels in her car, devouring them whenever she had some time. While on a trip with her son, a varsity baseball player who was competing at regional play-offs, Angela developed an ache in her upper back. “I thought it was sleeping in cheap hotels and sitting in the car for hours upon hours driving to the games,” she recalled. After more than a week without relief from stretching, she went to her primary care physician. The doctor examined her but didn’t find anything abnormal. Because Angela had smoked briefly as a teenager, he ordered a chest X-ray. “I also have a little bit of asthma, so he wanted to look at my lungs.” Angela paused. The memory still weighed heavily upon her. “He called back two hours later and said that they had found a mass between my lungs. My God, it moved so fast. I found out on a Tuesday, had a CT scan on Wednesday, and a surgeon was called to perform a biopsy. They knew by Thursday that it was Hodgkin’s lymphoma,” Angela said.
In contrast with Matt Conlin and Steven Baum, who had time to choose their doctors and think about treatment over months, Angela Balducci had a cancer that had to be treated quickly. She recalled feeling “paralyzed.” All she could think of was dying, leaving her two growing children and husband without her. She turned to her husband, who became her “eyes and ears” in her interactions with her doctors.
Things moved rapidly. Angela was seen by the oncologist at the community hospital where her primary care physician worked. She outlined the treatment plan for Angela’s Hodgkin’s lymphoma, and Angela began treatment. But then she and her husband felt she should get a second opinion at a cancer center. Her local oncologist helped her arrange this. Angela and her husband went that same week to speak with a lymphoma specialist at the nearby cancer center.
Angela waited in the clinic, watching a stream of people pass by, many bald and frail, some in wheelchairs. After forty minutes, she was ushered into an examination room. A nurse’s aide took her vital signs and then had Angela step on the scale. “Oh, my God,” Angela said, “I’m down seven pounds.” The aide shrugged silently and put an ID bracelet on Angela’s wrist.
“When I was in the waiting room at the cancer center, it felt very depressing,” Angela told us. “Those people were much sicker than I was.” Soon the lymphoma specialist, a tall, thin, older man who spoke with a British accent, entered. He went over her history, examined her briefly, and then detailed the treatment that she would receive. “He was very professional,” Angela told us, “but honestly he looked totally bored. In fact, he said that I was a ‘typical case.’”
The doctor suggested the same treatment that the oncologist at her local hospital had. “Everyone offered the same chemotherapy and radiation,” she said. Angela had several friends who had been diagnosed with breast cancer, and she reflected on the difference between her case and theirs. “It took them two, three, four weeks to think out what their plan was. At each hospital, different treatments were recommended. I think that’s more agonizing.”
Angela continued, “Things were moving so fast and were so serious, the doctors had to make decisions for us. I didn’t have any real choices. They didn’t say A or B or C—which one do you want? On the decision front, for me,