One sure-fire way to get the ‘real’ scoop on a surgeon is to talk to some homecare clinicians. Just ask a few homecare nurses — who change messy surgical dressings, negotiate wound-vacs and drains, treat surgical infections — which surgeons do a good job and which ones leave an ungodly mess behind, and believe me, they’ll tell you. At length. Or ask someone like me, a homecare physical therapist, who also changes dressings now and then, who helps people with post-op pain and impaired mobility, who has to mobilize scar tissue, and you’ll get another earful.
Or you might talk to a few healthcare clinicians who have been surgical patients. Especially other physicians who’ve been patients. Oh, my! You’ll definitely get the unvarnished 411. You’ll get a veritable treatise on a given doctor’s diagnostic skills, bedside manner, surgical technique, pre- and post-op care. You’ll also, more than likely, get some damn good snark. I’ve had the most hilarious, snarky and edifying conversations with physician friends about other physicians.
So, when several clinicians have good things to say about another doctor, based on personal experience, you can pretty much take that to the bank. Thus it was that I visited such a surgeon today to have a slightly-overdue breast cancer check-up.
I wish I could tell you his name, because it’s a lovely, mellifluous one. Sounds more like the name of an opera composer than a surgeon. But I’ll just call him Dr. C.
Long-time readers of this blog know that I have felt disenchanted for a while now with my original breast surgeon. We started out wonderfully, or so I thought, but our relationship rapidly went downhill [See my post Off My Chest for some of the ugly details.]. I’ll give her this much: she gave me her cell phone number during my first visit with her — this was before my biopsy and diagnosis — which impressed me. And although her circumaureolar incision hurt like the fires of hell for months afterward, the scar is now all but invisible and she got nice, clear margins. So, I thank her for that. And she had an absolute angel of a medical assistant, who saved my sanity on more occasions than I care to recall. In fact, I really need to send this young woman some flowers now that I won’t be dealing with her anymore.
The thing is, my breast surgeon was my only cancer doc left from the original crew. I ended up cancelling my six-month post-treatment visit with my rad onc, because he turned out to be the most useless, dishonest, unhelpful, uninformative waste of ectoplasm I’d encountered on the journey. So, sayonara to him. I finished with my med onc a year after treatment, when we both decided that the measley 7% decrease in my recurrence risk, that tamoxifen was supposed to confer upon me, was not worth the utter havoc it was wreaking on my life and my body. And, no, I’m not a good candidate for aromatase inhibitors. I like my med onc. I wouldn’t have minded seeing her again, but I’m just as glad I don’t have to. So, ongoing surveillance has been down to my breast surgeon. Whom I’ve considered dumping for a few years now.
And then, around March, when I was supposed to see her again for a six-month check-up, I got a letter from her, telling me she was leaving her practice because she’d been asked to head up a new breast health center. Since my primary beef with her is her less-than-stellar adherence to the concept of informed consent, not to mention her utter lack of compassion on a number of occasions, I took a dim view of her ability to head up such a center. The only thing that might have persuaded me to follow her there was if her wonderful medical assistant was going with her. But, alas, she was not. So, here was my opportunity to ditch her once and for all.
Enter Dr. C of the mellifluous name. And of the sterling rep among us clinicians. He is a general surgeon, truth be told. If you have a hernia that needs repairing, he’s your man. I can vouch for his skills on this, because he once repaired two hernias for a former boyfriend of mine, both of which healed beautifully and did not hinder in the slightest my ex-paramour’s romantic exertions. (We broke up for other reasons.)
A year ago, Dr. C performed an emergency gall bladder removal on one of my best friends, who is one of the aforementioned homecare nurses I used to work with. She has seen it all, and mopped up some surgical hack jobs in her time. But when she got to the emergency room last year, she made it crystal clear that the only surgeon she’d let within 50 miles of her gall bladder was Dr. C. I was with her in the ER that day, as well as after her surgery, and Dr. C was a prince throughout.
Here in our local area, we do not, thank goodness, have so many women requiring breast cancer surgery as to warrant an attending specialist at our local hospital. But one of Dr. C’s surgical specialities is breast cancer surgery. Which he has ably performed on a few friends and colleagues. He attends the conferences, reads the research studies, and works with our local breast health center, which was not, sadly, fully up and running when I was diagnosed, else I might have availed myself of their services. I have cared for a number of Dr. C’s post-op patients. His surgery is clean and competent. His scars are a thing of beauty. As a person, he is a clean-cut, fit, energetic professional. He exudes competence. His manner with his patients is no-nonsense yet compassionate. He is never patronizing. He does not presume to make your decisions for you. He provides thorough advice and answers questions and he doesn’t make you wait for results and call-backs. He’s not what you’d call warm and fuzzy, but he’s a straight-shooter, has a dry sense of humor, and he is not above being kidded. If you get him to laugh or crack a smile, it makes your day.
Plus, his staff are lovely. Always a priority with me. So, this morning, I visited him. My now-former breast surgeon’s office had not yet faxed him my file, so I got to tell him the highlights of my sorry tale in appropriate medicalese. He listened respectfully, took notes, appreciated my clinical reportage. During his exam, he found nothing suspicious in my breasts. He wrote me a prescription for my next mammogram, which is due in August. He told me that if it’s negative, I don’t need to see him again for a year.
We gabbed a bit about last year’s ASBS Conference, which he attended. He didn’t go to this year’s. “Lot of redundancy at these things if you go every year,” he said. “I read the highlights. A lot of it is esoteric. If a patient of mine needs that level of care, I refer her to a specialist.”
We talked about my decision to stop tamoxifen and my recurrence risk. “You’re right,” he said. “They told you it would reduce your risk by 50%, when for you, it’s really only 7%.” [Absolute risk vs. relative risk, one of my pet peeves.] “Never mind that you already had an 85% chance of having no recurrence. Statistics can be presented to scare people. They make it sound like your risk is worse than it is. A lot of statistics are just bullshit anyway.”
We talked about radiation and cording and chest wall spasms and scar tissue. “Your skin looks great,” he said. “But I know the interior tissue is probably a mess. Sometimes I have to do biopsies on irradiated breast tissue, and it’s like trying to cut through cement.” I told him that, as a PT, I know what to do for it, and do exercises every day, but it’s still problematic. “Yes,” he said, “radiation damage stays with you. I try to convince my patients that it’s important to stretch every day, but some of them don’t do it. And then they can’t pick up their arms at all.”
We talked about recon. “You could get a small implant that doesn’t have to be inserted under your pectoral muscle,” he told me, “if you care about the volume loss.” I told him I’d talked to a plastic surgeon last week about fat grafting. “And I don’t really care that much about symmetry,” I said. “Just as well,” he said. “I’d hate to tell you how many times I’ve had to remove implants because of scar tissue, or I have to take them out so a patient can get radiation, then try to put them back in. It’s a mess,” he said. “The less surgery, the better,” he added. “Besides, I think you look good the way you are.” This last was said without a trace of innuendo, simply as a statement of medical fact. That’s how he is. He doesn’t waste words. Whatever he says, he says as an experienced doctor. And you feel like you can take it as gospel. So, I thanked him, shook his hand again, and went home.
I can’t tell you how reassuring it was to be on the receiving end of his stolid, business-like candor. My next mamm notwithstanding, I went home feeling safer than I’ve felt in a long time. Thanks, Dr. C. I’m glad you’re on my side.