She was 34 years old when we discovered her breast cancer. Ten years earlier, I delivered her baby. I watched her grow up. She came for a routine pap smear.

She left with life-changing news.

Exam, mammogram, and biopsy

Her breast cancer was confirmed, and she disappeared. We made phone calls, left messages, and sent certified letters to no avail. In medical terminology, we call this “lost to follow up.” She ghosted us.

We continued our pursuit. Months later she returned. She did not follow up with the breast surgeon or Oncologist. She didn’t like them. Her family had other opinions.

She was angry.

I could feel it.

This was life or death

I would like to say I encouraged her to seek treatment, but I didn’t. I pushed her to get help. Not a gentle nudge but a shove. It was intervention time. I spoke the cold, hard truth. The goal was to break the dangerous cycle of denial. After relentless encouragement, she promised to go.

The resentful look in her eyes told a different story.

She was not ready.

She just wanted to leave.

Surgery, chemotherapy, and radiation

I saw her a few months later. My intervention worked. She had bilateral mastectomies and removal of the lymph nodes. She was undergoing chemotherapy and radiation. She was still angry.

She resented me.

I knew it.

I reminded myself her care was all about her. This moment was not about me. My job was not to be liked but rather to help her get well. In desperate times, patients focus their frustration on what they can control. Patients need a place to channel their feelings and rage. My job that day was to be the target.

Fear manifests as anger. She was furious and frustrated.

But she was alive.

Three years later we meet again

She came to see me yesterday. With a huge smile on her face, she embraced me in a giant bear hug. She held the hug a little too long. She grabbed both my hands and squeezed them tight. We locked eyes. She said, “thank you.” She appreciated my fight to get her treatment.

Then, with a beaming smile, she told me her cancer was back.

My heart sinks

After three years of remission, her breast cancer came back. The metastatic disease has spread to the chest, lungs, and brain. It is inoperable. She is restarting chemotherapy. She qualified for an experimental protocol with a 2–3% survival rate over three years.

I am rarely speechless. I can not talk. Tears fill my eyes. I try to fight it.

I am the doctor she trusts to take care of her. I am losing it.

What? No? Not possible. That can’t be true. She has a teenage son.

Quickly, I process her reveal. Inoperable metastatic cancer. Experimental protocol. 2% survival rate.

I stop fighting my emotions. I cry. I manage to say, “I am so sorry.”

She looked me in the eye and said “But I am ok”

She explains she came today just to see me. She wants me to know she “is good.” Her spirits are great. This was the best she felt in years. It took a long time for her to get to this place of acceptance.

She has found joy in living.

She shares her story. In the past, she blamed me for finding her cancer. She was frustrated every office ended in bad news. She resented me for forcing her into treatment. She was furious she had cancer.

Now, she is at peace. She is thankful. She appreciates all that I did. She needs me to know she is no longer angry. She has accepted her fate. She has found a happy place. She is loved.

My eyes glisten with tears. Her eyes glimmer with joy.

I am in awe of her strength, her will, and her compassion. We finish our visit with another hug.

It was my turn to hold the hug too long.

Afterthoughts

I think about her often. I try to shake the memory. I can’t. She was closing the open loops. Seeking resolution.

When I think about her, I smile.

My heart fills with admiration and gratitude. I am thankful she blessed my life. I am thankful she came to see me. For 15 years, I had the honor of being her doctor.

She found her happy place.

I will find mine knowing the true reason for her visit was to say “Goodbye.”