Tag Archives: Diagnosis of lung cancer

Twelve. And counting.

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Twelve years ago today I was forty five years old, my youngest child was seven and I was sitting in a hospital bed. I’d been admitted four days earlier after several weeks of antibiotics for a walking pneumonia that just wouldn’t clear up. A CT scan the previous Monday had revealed a large mass in the lower lobe of my left lung and the differential diagnosis was recalcitrant pneumonia, fungal infection or a neoplasm.

I didn’t know what a neoplasm was but my husband’s face had fallen when my general practitioner spoke that word. After she left the room he explained that it was another word for cancer. We’d then driven directly to the local hospital where I was placed on IV antibiotics.

Those first days were awful. I was in a room with three other woman, one of whom was dying and another who’d had a severe asthma attack. As I lay in bed I worked incessantly on my laptop researching everything I could about lung cancer. One thing stood out–the dismal five year survival statistics–15%.

The day of my biopsy the patient before me was a prisoner, handcuffed to his wheelchair and accompanied by two officers. When my turn came the surgeon performing the procedure told me that it was highly unlikely that I, a young never smoker, would have lung cancer and that what he was seeing on the CT scanner looked like a fungal infection.

After the biopsy I had to lay very still for several hours without speaking so as to minimize the chances of a pneumothorax. This was difficult as one of the attendants was someone I casually knew, and she kept asking me questions. My lung did partially collapse, as it now has every single time I’ve had a biopsy.

On Thursday morning my doctor came to my room first thing. My husband hadn’t arrived yet and she stalled, telling me a protracted story about her daughter and some dramatic production that featured a field of sunflowers. She said “You know, a sunflower represents hope.”

When my husband entered the room my doctor got right to the point. “I’m sorry but you have lung cancer.”

I really don’t remember anything she said after that as both my vision and my hearing seemed to have suddenly constricted. I had this sensation that I was in an airplane and it was going down. My husband would end up having to call my family members–I was simply too devastated to speak to anyone.

However something incredibly fortunate happened later that day, something that changed everything.

I was assigned an oncologist, who spoke to me only briefly. That evening my husband called him with a question and this oncologist was incredibly rude. We decided that he was not someone to whom I would like to trust my care. And so my husband immediately called one of my dearest friends, whose husband was a surgeon, asking for their opinion as to a good doctor.

Her husband had done his residency at Massachusetts General Hospital, and he gave us the name of the thoracic surgeon he had worked under. And that is how I ended up at a major research center rather than a local hospital. Because of one rude oncologist. To whom I actually now owe a thank you.

#twelve&counting

Just not a just world

There are two kinds of people. Those that believe life is fair (everything happens for a reason) and those who don’t (shit happens).

These differing viewpoints may seem like no big deal until you start thinking about the moral implications of belief in a just world. I suppose if everything is working out for you it’s a pretty convenient philosophy. However, if life has thrown you some major curves (such as a diagnosis of terminal cancer) than you probably don’t believe we all get what we deserve.

My own diagnosis of lung cancer left me completely gobsmacked. How on earth did a young, seemingly healthy woman who had never ever touched a cigarette (me) get lung cancer. And yes, I was struck by the unjustness of it all. I mean, why me?

Well, first of all, lung cancer in non and never smokers is nowhere near as uncommon as most people believe. Approximately 60-65% of newly diagnosed cases occur in former or never smokers.

Secondly, life is not fair.

However, most of us grew up believing in a just world, a well ordered place where sensible and good behavior was rewarded and risky or bad behavior duly punished. This viewpoint not only shaped our moral code, it lent us an invisible cloak of safety.

This philosopy is the very reason that those of us with lung cancer are consistently asked as to whether or not we smoked. The asker wants to be reassured that our lung cancer is the direct result of cause and effect. Of course they haven’t stopped to think about how this question will impact us. If the answer is yes, the implication is that we are the agent of our own misfortune. And if it is no, we are reminded once again of our extraordinarily bad luck.

Belief in a just world is the thinking behind the stigma associated with a diagnosis of lung cancer. Stigma is defined as ‘a mark of disgrace associated with a particular circumstance, quality, or person’. In the case of lung cancer, our diagnosis is inextricably linked to shame and a blame the victim mentality.

Which makes us all incredibly sensitive to any suggestion that cancer, and our disease in particular, is almost entirely preventable. ‘Helpless to Prevent Cancer? Actually, Quite a Bit is in Your Control‘ reads the catchy title of a recent article from the New York Times. The author, a professor of pediatrics (and therefore, I think, not an expert on adult cancers) makes statements such as this: ‘… you’d have to be living under a rock not to know that smoking causes lung cancer…’ Or this ‘About 82 percent of women and 78 percent of men who got lung cancer might have prevented it through healthy behaviors.’ The author makes a stab at empathy with this observation: ‘You don’t want to get into situations where you feel as if people don’t deserve help because they didn’t try hard enough to stay healthy’. However, the word deserve and that bit about not trying hard enough harkens right back to shame, shame, shame.

The way in which disease is characterized matters. Talking about lifestyle changes that can optimize health is always a good thing, but it is important to remain sensitive to the language that is used.

Calamity of all sorts and cancer in particular is often beyond our control. Nobody deserves lung cancer, whether they smoked or not. But sometimes, shit just happens.