Two Lumps, Two Medical Experiences
by Caroline Delbert
One summer at Beloit College I lived in a sunny upstairs room and worked part-time as a museum attendant. Each day was a “rage against the dying of the light” of my upcoming senior year of college, until one evening when I’d gotten into bed and felt something: A lump in my breast the size of a shooter marble.
I fussed with it until it ached, then began sobbing and called my mom. We both understood the significance of this lump, because my mom’s eldest sister died of breast cancer when she was 26, and another sister had survived breast cancer in her 40s. This was scary shit — an emergency.
My college town had 35,000 people and a dedicated hospital complex. I went to their urgent care clinic where a nurse practitioner felt the lump and kept an admirably alive-colored face as I rattled off half a dozen female relatives who’d had breast cancer. The NP and a surgeon who looked like actor Tim Reid agreed that this item on my person was probably nothing, but should definitely be excised. They weren’t grim, but they were steely and very businesslike. I felt taken care of and carried along.
Dr. Tim Reid removed the lump a day or two later. I awoke from general anesthesia with bandages that were alarming until I saw what was under them. The surgeon did a phenomenal job, and you can’t see my scar unless I told you where it was and you focused your gaze on it. The lump ended up being benign, as everyone had guessed, and I was happy and relieved. I was on my mom’s public-school-teacher insurance, and, at the time, it was the middle class version of a health care Cadillac plan. The hospital billed thousands of dollars for my outpatient procedure, and I didn’t have to reach into my pocket to pay for any of it.
Four years later, my life was unrecognizable compared to that younger version of me. Having failed to get into grad school (a mitzvah-by-committee, in hindsight), I worked at a rapidly growing startup that was healthy and stable enough to offer a group insurance plan. My doctor was a very rich, very tan old gynecologist who looked like twilight-years George Hamilton. He believed in swift action and frequent visits, which he subsidized for me when my insurance only covered one annual visit.
When I was 24, I found another lump. Dr. George Hamilton advocated swift action, and the only surgeon he recommended was outside my network. The possibility of removing a second lump from the same breast filled me with dread, and I pictured my abstract future-body covered with the telltale zipperteeth of stitches. My mom’s doctor referred me to a renowned specialty surgeon in my network and I no-showed for two hard-to-get appointments to avoid the possibility of more surgery on what I felt sure was another simple benign lump. A year passed and the guilt of ignoring the lump accumulated in my spirit like medieval black bile.
A few months before my 26th birthday, I lost my job and went on unemployment. Insurance-wise, the timing was a blessing: I snuck back onto my mom’s insurance, and began my new job right before aging out. For whatever reason, I felt emotionally prepared to tell a doctor about the lump and accept the practical consequences. First was a visit to a gynecologist at the illustrious hospital where I’d previously no-showed. With a fresh referral in hand, I then saw the surgeon. She always has at least one resident or intern with her, and during that first visit, having an extra person gave her a reason to discuss everything with me in deep detail. She explained the technical terms she used and spoke to me as though I were a fellow adult who’d spent 25 years in my own body: “Has the lump been the same size this whole time?” “Has it changed shape?” “Does it hurt?” Dr. George Hamilton had told me to swear off caffeine because it caused lumps; my new surgeon reassured me that caffeine only exacerbated what my body was already doing rather than causing it.
You have options, she told me. (I acted nonchalant so she wouldn’t know how badly I wanted to go steady with her, medically speaking.) We could sweep in and remove the lump; we could do a needle biopsy; or we could wait and see. She said that all signs indicated the lump was benign — just a fibrous knot in a body prone to those. I chose to wait and see.
Three months later, she brought me back in and together we learned that nothing had changed. We repeated this process six months later, then after six more months. Each time, I pay for a consultation out of pocket for $25, and the total cost is something like $200 if I don’t have an ultrasound or any blood work done. Even without the mental and emotional cost of additional surgery, I’d have to see this world-class breast-cancer specialist dozens of times to equal the cost of one outpatient surgery, years prior, at a small hospital in the Rust Belt.
Looking back, I believe I was over-treated both in my college town and by Dr. George Hamilton, and my insurance (which, believe me, I understand is a huge privilege) played a part in both suggested courses of treatment: Hey, if it’s covered, why not?
But these experiences and my ongoing relationship with my surgeon have taught me a lot about what to ask, what to accept, and how to look at my body. The most capable doctor I’ve ever seen is also, not coincidentally, the only one who’s really listened to me and asked serious open-ended questions.
My mom’s sister had the same initial experience that I did: She noticed something alien and alarming. But in the mid 1960s in the rural Midwest, she found unnavigable obstacles around each corner. Her husband forbade her to see a doctor, though he had a good job and insurance. Treatment at the time was not flexible, with a small window of efficacy that had passed by the time she was finally allowed to see a doctor.
Right after my 27th birthday, I got a letter from my hospital asking me to volunteer for a prevention study. (Medicine does its best language work when addressing people who already know how likely we are to get some terrible disease.) I signed up and have already gone through a circus of indignities. The first thing people ask when they hear about the study, though, didn’t even occur to me: “Are they paying you?” Nah, and though I’m plenty broke, that’s not the point of it. I’ve already had a birthday my aunt never got to see and, like time or blood, this is a contribution I can easily afford.
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