Prior to my breast cancer diagnosis, when I thought about the doctor-patient relationship I only considered it in the context of my interactions with my own patients. Beyond that, I never really considered myself to be a “patient” or the co-existence of the two titles in my life. I saw my own doctors for annual exams, flu vaccines and employee physicals. But to me, that never really made me a “patient”. I was just having mandatory encounters with my doctors and other providers. It was not until my breast cancer diagnosis and the events leading up to it that the idea or fact that I was a patient truly began to resonate with me. I did everything I could to avoid becoming a breast cancer patient. Why? Because being a “client”, “customer” or intermittent “consumer” of health care services, as the administrators like to call us, seemed so much better than having to be an actual patient. Choosing to go get check-ups and wellness visits was much more palatable than being a full time “patient” and seeing doctors on a regular and consistent basis. I often told my patients with chronic diseases that managing their health was a full time job, a career in fact, and in my life I knew the two could not co-exist.
My breast cancer diagnosis was hard enough. When I became a patient the grueling treatment snatched away my ability to do what I love. I so badly wanted to do and be both physician and patient simultaneously but it simply was not possible. Breast cancer prevented me from serving others in the way that felt most meaningful for me at the time. It also took away my livelihood and my financial security. But being a neutropenic, chemo-brained Infectious Disease specialist was quite risky, for both me and my patients so I had to bow out gracefully from full time practice.
I know clearly that I am more than just a physician. Being a doctor is a large part of my identity and so breast cancer was yet again snatching away a piece of me. For me, this was one of the more difficult aspects of being a cancer patient. I made peace with losing my breasts. I even held a space and ritual with my family to say farewell to them. I was perfectly calm as my hair began to shed by the handful during chemotherapy. I even welcomed the idea of a prophylactic oophorectomy. It would be one less thing to worry about in the future. But the fact that I could not maintain my own doctor-patient relationships was a hard to pill to swallow. I tried, and my doctors let me. When I finally gave up practicing medicine, my doctors, surgeons, nurses and physical therapists all admitted that they were hoping that I would put my career and pride to the side and focus on my own health and well being for a change.
When I was diagnosed with Stage 3 breast cancer, my immediate focus was on getting better while maintaining my practice. At some point, I regarded keeping up with practicing medicine as equal to being treated for and healing from breast cancer. In fact, I had grown so accustomed to being an intermittent consumer of medical care that I felt or imagined that this could be the same. Sure, bilateral mastectomies and reconstruction would come with a much greater recovery time than the biopsies and lumpectomies I’d had in the past. I convinced myself that I could handle it. In fact, I was unreasonably pushing myself to go back to work in 3-4 weeks instead of the 6 weeks postoperative recovery period that my surgeon recommended. And then there was chemotherapy. I hadn’t even considered it was a possibility when I planned my return to work just 5 weeks after surgery. The side effects of chemotherapy paled in comparison to any other medication I had previously taken. Still I tried to convince myself that my treatment, healing and side effects, like everything else in my life could somehow revolve around and play second fiddle to patient care, office hours, RVUs and overhead.
How naive, right? How did I possibly think that I could do both? Physicians are trained this way. We don’t call out sick, we call out or ask for coverage only if we are confined to a hospital bed. We call out dead, but never sick. But how sick is sick enough to prioritize oneself above patient care, contracts and expectations? I thought this would be like every other time I made unreasonable requests of myself. Like the time I had a biopsy on my lunch break and returned to my office to complete an afternoon clinic. The next time, I took a day off but returned to full patient care the following day. Not much better or kinder to myself.
Now, when I reflect on this and the events leading up to my diagnosis, initiation of cancer treatment and what finally pushed me to self care, I can only admit how foolish I was. For each missed hour of work, I would add it back to the morning or evening on a previous or subsequent day. In the final days leading to my bilateral mastectomies and immediate reconstruction, I worked on my day off as well as added weekend hours. It was brutal and my body reaped the consequences of this punishing treatment. I should have taken off the stethoscope and white coat and truly focused on healing much sooner. Perhaps even weeks prior to my surgery.
By the time I climbed onto the operating table, I was recovering from a respiratory infection that I acquired at work, physically exhausted, and grossly dehydrated. This was no way to show up for a seven and a half hour surgery. I left the OR that day with an indwelling Foley catheter for strict I’s and O’s. I experienced hours of anuria requiring multiple boluses of fluids and Lasix in the OR. That still was not enough to make me sit down and focus on my getting better. Being exhausted and struggling through each subsequent work day after surgery and chemotherapy was what made me throw in the towel. I realized that when I took care of patients, I didn’t take care of me. I didn’t eat, drink, or use the bathroom for a full 8 hours on some days. This was a practice that grossly violated all of the instructions the oncologist had given me as a patient.
I finally accepted that I had been unreasonable with my body as well as unreasonable with my patients and all of our health, then and only then was I able to put being a physician on hold. I finally embraced being a patient and focused on my complete and uninhibited physical restoration.
I have been asked repeatedly if breast cancer will change how I practice as a physician. I have given it much thought and I can honestly say no. I will continue to give comprehensive and compassionate care. I will continue an encounter until the patient and I are satisfied with the plan and outcome. However, I will take care of myself as well. I am only as good to my patients as I am to myself. I will heed that good old advice of “physician heal thyself” and will allow appropriate time and space for my own healing whenever necessary.
Now, when I consider myself in the role of the doctor and the patient, I think of how I did not allow the two to co-exist. My approach to patient care did not allow or leave space for self care. I risked my health and well-being to serve others. I would encourage my fellow women in white coats to reflect on whether or not this is true for you. Do not allow your service to others to be a disservice to your own body. Where the two can safely and reasonably coexist, I encourage you to carry on. When the doctor-patient relationship poses a threat to your well being, give yourself permission to focus on your own health and healing. This focus on self will allow you to serve yourself and better serve others when your healing comes.
Dr. Alexea M. Gaffney is a triple board certified Infectious Disease specialist in Smithtown, NY. As a breast cancer patient, survivor and thriver, Dr. Alexea also utilizes speaking, teaching, coaching and social media to educate the masses about healthy lifestyle and disease prevention. She can be followed on Instagram @DrAlexea.