Gratitude: Five Visits to the Zimmer Cancer Center

Nothing ever goes away until it teaches us what we need to know. 

~Pema Chodron

What is the worst thing you can do to a doctor?

(Well, besides sue them for malpractice, or write a blog post about them without their knowledge.)

I wrote this post a few years ago after an ovarian cancer scare. I’d never been inspired to write about a medical experience/doctor before. It felt like therapy to help me process my feelings of huge gratitude for not having cancer, for having had such an amazing doctor and the guilt for having unnecessarily taken up his time. After writing it I did the ” Is it True? Is it Kind?” test and then hit the publish button, sending it off into the blogosphere. I felt better for writing it. I thought I had put it behind me.

Then a few months ago a relative of Dr Gajewski’s found this post and contacted me. I responded but never heard back. I could see there were suddenly people reading my tiny blog that never gets any hits, especially since I’d stopped blogging. The response from Dr G’s relative had seemed positive, but after reading this post with fresh eyes, I began to question the wisdom of publishing it.  And surely it was a bad sign that I’d never heard back from this person, right? I fretted over it with friends who gave me advice ranging from take it off before you hear from his lawyer to “It’s a great post, just let it go. ”

That very same week a friend of mine’s mother saw Dr Gajewski for suspected ovarian cancer. He didn’t do the surgery, but was standing by in case it did turn out to be cancer and she had met him briefly. Both she and her mom were so impressed and comforted by him and she read the post and could not understand my worry. She pointed out to me there are a probably hundreds of reviews of Dr Gajewski on the internet and since mine was nothing if not gushingly positive there was nothing to worry about. “I think you did a wonderful job.” Well, maybe.  In the end it seemed like such a coincidence I decided to take it as a sign from the universe to leave it.

And I did try to stop thinking about it,  but something just wasn’t letting me. Like a ringing phone in another room, a message direct from my conscience was trying to reach me, but  I just didn’t want to answer it.

And then a couple of weeks ago, I was waiting for an appointment, scrolling through the latest kevinmd posts on my smartphone, and I came across this post, written by an oncologist. It is written in  a straightforward no nonsense manner, unlike the shlockiness of my own writing, but never the less packed a strong emotional * important incoming message from the universe* punch.  You can read it here. I recommend it. But if you’d rather not, the gist of it is: as a busy oncologist pulled in a million different directions, he hardly has time for anything.  But he will always, always make time for his patients who need him.

http://www.kevinmd.com/blog/2015/08/spending-time-with-patients-thats-my-job.html

And reading it, it was as if Dr Gajewski could have been writing it to me- what he could have, maybe should have said, but was too polite and professional to do. I felt a real sadness then, that I hadn’t when I first wrote this. Sadness that my guilt had been misplaced and that it had taken me this long to see it.  Because  once- in- a- lifetime doctors like Dr G will  (hopefully) always receive praise and be well compensated for their work. I didn’t hurt him at all. But every second he spent with me took him away from and delayed the care for a woman who was just as deer in the headlights scared as I had been,  and who truly needed his help and expertise.  I had understood that I didn’t need to be there and he didn’t need to do my surgery, but I didn’t really GET it, how precious and important the actual moments spent with his patients must be.  And to take a doctor away from his patients and prevent him from the doing the job he or she has spent so much time and effort trying to do? THAT,  I think, is the worst thing you can do to a good doctor. And there is nothing I can do about it now except take a breath, spin the prayer wheel and never do it again.

It also happens to be Ovarian Cancer Awareness month. Any cancer is scary to me, but there is something particularly scary and ominous sounding about even the words ovarian cancer.  The symptoms can be so vague and mistaken for so many other things. That’s partly why I was so convinced I had it. It seemed like every vague- abdominal -issues -for- months ovarian cancer story I’d read about. And it’s a fine line between being a squeaky wheel and hypochondria, but I think it’s important to stop and pay attention to our little quiet voice that tends to get drowned out. If you have bloating,   unusual unexplained abdominal pain, sudden weight gain, you should get it checked out.

And if you live in my corner of the world here in eastern N.C, and find yourself in need of a gyn oncologist, you will not find better care than the Zimmer Cancer Center at NHRMC.

Even if you’re wasting their time.

First Visit

I watch unhappily as a medical bracelet is put around my wrist. This is really happening.  The bracelet makes it official.  For a few panicky seconds I consider standing up, excusing myself and heading back out the door I’ve just come in, back out into the sunny summer day going on outside.  Instead I take a calming breath and try to picture something happy, like my dog at the beach.

Six months ago I was joking with co-workers about my umbilical hernia that had seemed to appear out of nowhere. You could see it through my clothes. “Have you felt Kristen’s hernia yet?  It’s like she’s pregnant!”  We had named it Henrietta.

Three months ago I had gone to my GP, frustrated by the pain I’d been having after my hernia surgery.  He had looked up from his laptop. “Wait, where are you having this pain? It says here on the CT report you needed follow up for your right ovary months ago…Something looks abnormal”

Three weeks ago the gynecologist called me and asked if I wanted to come down to his office and talk about something, that something being my referral to a gyn oncologist in Wilmington.  He thinks I might have ovarian cancer.  “I think they’ll want to do a complete hysterectomy very soon”

Three days ago I had taken my son to Margolis Men’s Store to buy a new suit.  The salesman was in a jolly mood. “I think we can make this one last until he graduates, mom.  As long as he doesn’t get too big on us”  A horrible, melodramatic thought occurred to me- that I was buying him the suit he will wear to my funeral.  Because by now I’m absolutely certain this pain I’m having is ovarian cancer and  thanks to those helpful people at Web MD, my husband and I have already staged it at a three, possibly even stage four.  Lying awake at two in the morning, I  imagine malignant cells replicating wildly throughout my body, like those spellbound  brooms in the Sorcerer’s Apprentice.

And here I am today,  checking in at the Zimmer Cancer Center.  It’s not what I was expecting.  It’s an older building with big windows through which the sunlight is streaming and the place has a peaceful, lazy afternoon feel.  If I wasn’t so completely freaked out I would appreciate this more.

Tina, who takes my vitals,  pulls out a Polaroid camera and says in an apologetic tone, as though she is used to protest ” Dr Gajewski likes to have a picture of his patients”  It is a testament to my fear that I don’t even question why a doctor would want this, but sit there glumly and feel only a sense of resignation at the frightened, frumpy 42 year old staring back at me in the photo.  It doesn’t matter, anyway.  I’m going to look even worse in a few months, hairless and puffy from the chemo and radiation .

We sit down with his nurse and she takes a health history.  She is sympathetic and kind and notices the  flowers on my toenails.  Then an intern comes in and talks to us about why I’m here.  Then we move to an exam room, I get undressed, there are the inevitable stirrups and then, like the headliner act we’ve all been waiting to see, in walks Dr. Gajewski.  He is tall and thin, wearing OR scrubs.  I can’t really explain why, but he seems instantly familiar to me, instantly likable, instantly the only doctor I want to have at this moment in time.  And you would think that meeting someone for the first time in this, the most vulnerable position known to woman, with a room full of people, this would be an uncomfortable moment. But for the first time in weeks I feel myself start to relax- like we could be discussing this over coffee.  He seems to really listen to and actually think about what I tell him before he responds.  He doesn’t interrupt me once.  I have just won the doctor powerball, I think.  And then, he looks me right in the eye and tells me he doesn’t think it’s cancer, not in an arrogant or dismissive way, but in a reassuring dad kind of way.  He orders his own ultrasound and lab work and will see me back in two weeks.  His nurse startles me with a big hug.  Getting dressed in the bathroom I am shaky with relief and suddenly I feel dizzy and have to sit down on the toilet for a minute. The automatic flush keeps activating like a Harrier jet but I just sit there smiling.

Over pizza on the way home I am talking a mile a minute, almost giddy after the grim build up of the previous weeks and my husband, ever the voice of reality, says “I dont’ know why you’re so excited. We don’t know anything yet.”

“Yes, but he doesn’t think its cancer”

“Yes, but, he doesn’t have a copy of the CT or the ultrasound”

It doesn’t matter.  Suddenly I am fearless.  Even if I do have cancer, I am convinced Dr Gajewski is going to fix it.

Second Visit

Dr Gajewski sits on one of those wheelie stools and draws a picture of  what’s  been causing my pain.  It looks like a bunch of grapes, only they’re cysts.  The good news, though, is my latest CA125 has come back completely normal. Despite the good news, he seems more serious today as he outlines my options for surgery.

“Since this isn’t cancer, I don’t have to do the surgery”

He stops then and looks at me.  I feel like he would sit there calmly all day, as if he doesn’t have a million other things he needs to be doing while I make a decision and I’m pretty sure the decision he would like me to make is to stand up, shake his hand and thank him for his time so he can get back to treating women who actually have cancer, but…. it’s as though I have been offered the keys to a Lexus.  I know I don’t need the Lexus, I would be fine with the Honda, but I don’t have the moral strength to say no.  I keep picturing the doctor who referred me here, the way he stared at the floor, the obvious relief in his voice as he wished me good luck.  Dr Gajewski, in contrast, seems completely unfazed.  I could tell him I’ve  been impregnated by aliens and he would shrug and say “Well, we’ll just have to deal with that when we get in there”  The truth is I only want smart, confident “I’ve only known you for fifteen minutes but I feel like I’ve known you my whole life” Dr Gajewski to do my surgery.  And so, the decision is made. His surgery scheduler will be in touch. His nurse Melinda gives me another hug.

But over dinner on the way home, the guilt hits me.” I don’t think Dr Gajewski wants to do this surgery”

My husband is winding fettucine around his fork . ” If he really hadn’t wanted to do it, I’m sure he would have come up with a reason why he couldn’t”

” Well, I think he was trying to do that, only I didn’t want to hear it…and isn’t there some rule where, once you’ve been seen, they have to treat you if you ask them to? You know, like at the ER? Once you’re in the door- Oh God, that’s it. I’m like a vampire. A vampire can’t come in unless they’re invited, but once you ask them in, you can’t get rid of them. I’m wasting Dr Gajewski’s valuable time.”

Geoff and Erik both stop eating and stare at me. Finally Geoff says “I think you made the right decision.  He seems like a really good doctor and I trust him. Once HE goes in there and says it’s not cancer, we can finally put this behind us.”

Right. OK.  I try not to picture Dr G’s serious eyes as I finish my dinner.

Visit Three

Dr Gajewski is holding my hand as his intern attempts to pry open my cervix with something that looks disturbingly like a dipstick used for an oil check up.  It’s not painful, just sort of crampy and uncomfortable.  Dr G wanted a biopsy of my uterus before the surgery but after awhile with no success the cervix remains unpryed.  The decision is made to do it in the OR instead.  I sit up, relieved.  Dr G  looks down at my chart. “So…..what would you like me to do?”

I remember one of several nearly identical conversations I’ve had with Geoff over the past few weeks.

“You need to tell him to take the uterus out too-not just the ovary. That would be stupid.”

“I can’t just tell a doctor what to do.”

“I don’t ever want to want to hear you complain again if you don’t ask him to take it out.  You just need to be assertive.”

Being assertive is something my retired Marine master sergeant of a husband has no trouble with, but for me it’s a different story.  Besides, I feel like Dr G is doing me a favor just seeing me at all now.  I’m in no position to make demands.  But I take a breath and I tell him I don’t take surgery lightly.  I would really like this to be my last surgery ever so if he’s already going in there i’d just as soon he take out what he  can and be done with it.  He doesn’t even blink an eye.

“Then let’s take care of it”

They say you always remember the doctor who delivers your baby which is true, but I know I will always remember this moment and this doctor too.  When I first got my period the summer I was 12, I  was at my great grandmother and great aunt Belle’s house.  I had no idea what was wrong with me, but was feeling so awful, I thought I was dying (a hypochondriac even then)  They gave me Alka Seltzer, their worried faces hovering over me  and when it finally became apparent what it actually was, they were relieved and excited (“Oh, its your PERIOD!”), and so was I for about a minute until it occurred to me I would have to do this again…and again.  Half a lifetime of miserable, worsening periods later and it’s about to be over .  It seems miraculous.

“Well, you convinced him to do THAT.” the intern says as soon as Dr G leaves the room.  But I’m just too happy to even feel like a vampire.

Visit Four

I no longer have a uterus, or a right ovary as I sit outside Tina’s room, waiting to get my vitals taken.  Aside from tiredness I don’t even feel like I’ve had major surgery. “Mom, you’re getting around really well!” Erik said the day I came home.  Really, it has been an almost blissful experience, so unlike my last surgery- well, unlike any surgery I’ve ever had. The day after I got home I woke up and turned to Geoff .”I feel like I should be in more pain. He really did take out the uterus, right?

“Of course he took it out- Why wouldn’t he have?”

” I know the ovary gave him trouble. Maybe he ran out of time and said screw it, its staying in.” But no, it really is gone.    Today my toenails are painted pink, Erik is taking me out for sushi after my appointment in honor of my birthday tomorrow.  Life is good.

And then out  of the corner of my eye I see Dr Gajewski come walking out with two women.  He stops to talk to his surgery scheduler and they sit down in the lobby, directly in my line of vision.  I’m not sure how I know which one of them is the patient, but I think it’s the expression on her face.  I recognize it from my own  mugshot from my first visit and  it’s  like a kick to the gut.  Fear I think, is not something  commonly seen on someone’s face- at least not in this country.  Boredom, anger, happiness, but not outright fear.  This, however, must be a look Dr Gajewski  sees all the time.  It strikes me then what a tremendously hard job he has.  I’ve known a lot of Marines and pilots. I try to picture any of those brave people doing his job and  think “Nope”.  A day of  this kind of stress and they would run for the hills.  My own stomach is in a knot just thinking about this woman and what she might be facing and I won’t ever speak to her, or see her again.  And there stands Dr G, who I’m sure could have gone anywhere, done anything with his life, and yet for whatever reason has chosen to  take this on, day after day.  All I can see of him right now is his arm resting in the door frame…a wristwatch, a wedding band. I picture him standing in his kitchen, glancing through the day’s mail, bombarded with life’s everyday concerns…progress reports, bills, Dad, can Is? and Don’t forget that we have tos.  How does he put her face- all the faces- behind him at the end of the day?  It seems like such an enormous weight to carry.

When Dr G and Melinda come in to see me they seem happy for me. “You were a challenge” Dr G says.  And despite all the guilt I’m feeling, I’m so glad he was my surgeon.  As Geoff says,” If he had trouble,  just imagine what would have happened if that other guy had done it.” Best of all, there was no sign of cancer, just like Dr G expected.  I tell him he is a natural born surgeon and he just laughs which is the first time I’ve seen him do this.

We discuss my going back to work and I find myself complaining about the long hours at my job as a lab tech. Dr G listens patiently and then says ” Well, I think you’re lucky to have a good job.”  He tells me he worked as a lab tech before he went to medical school and I think  ” Of course he did.” As a gyn oncologist, Dr G does everything: the surgery, all the oncology stuff, plus he could deliver a baby if the need arose.  He’s like Superman. And I have never felt more like a whiny, self absorbed  slack-ass in my life.

“Ok kiddo, we’ll see you back in six weeks”

Melinda gives me one of her giant hugs.  I’m not a huggie person. Nobody tends to hug anyone in my family unless the situation is dire- like a death or someone moves to a different continent and Melinda’s hugs always catch me off guard, but today I really hug her back.

Later, I ask Erik over sushi “Someone wouldn’t hug you or call you kiddo if they hated you, right? ”

Erik looks up from his dragon roll. “Mom. Why would someone hate you?”

” I don’t know. I’ve never felt more grateful for a doctor’s care, and at the same time more selfish and undeserving. Ugh. I just can’t get past it ”

“Maybe it was just nice for him to fix something simple and not have to deal with the whole cancer scenario. Besides, I’m sure he’s way too busy to hate you.”

Sometimes Erik seems much older than fifteen to me.  Sometimes I think I can see the 40 year old he will become.  I hope I will still be around then and that he will live close enough so we can still go out for sushi now and then.  I think how different this would all be if I did have ovarian cancer and how lucky I am. Erik is right. I am probably not even the tiniest blip on Dr G’s radar.  I’m making a big deal about this because I mistakenly think I am a big deal.  I need to get over myself.  As if on cue my phone starts to vibrate. It’s Dad calling from NH to say he’s at the ER with Mom who has had a possible stroke.

Last time

I feel really good.  It’s as though a master switch has been flipped somewhere in my body and all my cells have heaved a collective sigh of relief.  I don’t think I really understood just how crappy I felt until suddenly the pain was gone.  A week or two after going back to work my lab director was talking to me and in mid sentence stopped and asked ” Kristen, are you tanning?” “Tanning??  No, I think I’m just healthy now!”  For the first time in a long time, I feel well.

I’m in the lobby waiting for my last appointment.  I’m comparing notes on the recent hurricane damage with a man sitting near me.  Without any warning, his eyes lock onto mine. “You know, God never gives you more than you can bear”  I feel my throat constrict and I nod, even though I hate it when people say this.  As if  God  hands out tragedies to people like cards in a poker game. Here’s some breast cancer for your wife, leukemia for your child, an IED for your brother.  Let’s see how well you bear it.  I just don’t believe that’s how it works.  And I know this man is about to tell me what God has given him to bear. But really, who am I to judge how he’s chosen to cope with what he goes on to say is his wife’s pancreatic cancer?  He is determined that she won’t have to  worry about anything at all while she deals with her illness.  He’s taking care of everything, he says.  I do a quick mental checklist and think  I have never known anyone, celebrity or otherwise, who is a pancreatic cancer “survivor” and my heart aches for him.

The lobby is filling up with patients who have finished their treatment, as if chemo school has just let out.  The man’s wife walks over and sits in the chair between us. She is shaking uncontrollably.  Someone comes and puts a blanket around her. ‘Oh God” she whispers “Oh God. Oh God.”  A woman using a walker stops on her way out and calls out to her “Good bye, Miss ~, I love you.”  She looks up in response and  tries to raise her voice. “I love you, too”  My eyes well up and I stare down into my lap. I can see her sandals with little flowers on them in my peripheral vision.  They disappear into a blur as a tear plunks down onto my Nook.  Everyone in this lobby has more reason to cry than me.  I’m about to get up and go to the bathroom to get a grip when Dr G’s nurse thankfully arrives to get me.  I want to say goodbye and wish them well, but I can’t even speak..It’s not Melinda today, but a different nurse.  She does a double take when she sees my face but seems to know to just let it go.  No one is a stranger to tears here.

A Dr Patel  does my pelvic exam.  He seems very relaxed and confident for an intern . For a minute I  think maybe he’s not an intern.  Maybe  Dr G is out today and I won’t get to say good-bye.  But no, he is, and  everything looks great.  I’ve healed up nicely.  All thats left is for Dr G to give us his blessing he says, and I can be on my way.  He leaves to get him while I get dressed.  I had set out this morning in such a positive happy mood and now I feel emotionally raw and sad. Do not act like an idiot, I tell myself. Just smile and say thank-you like a normal person would.

When Dr G comes in he tells me I look great and I tell him I feel so much better and that I’m giving him the credit for it. He says he’s glad he was able to do this for me but then I ignore my own advice and say something about how I know he didn’t need to do this surgery and I don’t want him to think I take it for granted.  He says “OK” in a way that seems a little weirded out, and I let it go at that.  But when he goes to shake my hand I feel an overwhelming urge to hug him.  He’s done so much for me, and there will be no Melinda hug today.  So I do. Kristen, ” please respect my personal space”, always the hug-ee, rarely the hug-er, gives Dr G a hug and I immediately sense that I shouldn’t have. Maybe Dr G is a non hugger too.  Or maybe, wisely, not one to hug a vampire. For the first time Dr Patel looks worried, like I might want to hug him too.

What I really want to say to Dr Gajewski, is that even more than telling me that I don’t have cancer,  doing my hysterectomy and relieving me of a lot of pain, the best thing he’s really done for me is that sometimes now when I’m about to complain about something or feel my thoughts turn to self pity, I picture him standing outside an exam room door, looking down at a patient’s chart.  A woman on the edge of panic stares up from a polaroid. He’s about to walk in and take on all the fear and worry, the surgery and the chemo and do whatever he can to fix it, to save her.  When I think of this, it stops me in my tracks. But of course I don’t.  Instead he and Dr Patel walk me out to the front of the office.

“You know where we are if you need us”

“OK. Thanks, Dr Gajewski.”

And then I walk back out through the now quiet lobby. Back out into the sunshine.

~

I felt a need to write about this as I came up on the year anniversary of my hysterectomy.  The whole episode had such a huge impact on me, not just in the obvious physical way, but mentally as well.   I am convinced everyone could benefit from spending a few afternoons at the ZCC.  I was so impressed by the genuine kindness of everyone I met there. They are good people.

And wherever you are today, Dr Gajewski,  I hope it’s a really good day.

Love~K