Denial Redux

Today I saw a new breast cancer patient in clinic.  She was a lovely lady of 64, who had retired last year from her job as a special education teacher.  Her medical history had been unremarkable until last November when she began to gain weight inexplicably.  She was also short of breath, but did not want to seek medical attention during the busy holiday season.  When she finally did see her primary care doctor in January, she had gained seventy pounds.  Her primary took one look at her bulging neck veins and swollen ankles and called an ambulance to take her to the hospital–she was in florid congestive heart failure.  She refused the ambulance, saying that she was fine, and that she needed to go home and take care of a few things, but that she would get to the hospital shortly on her own.  And so she did.

When she was being examined in the emergency room, the resident noticed a very large breast lump on her left side.  He asked her, “How long has THIS been here?”  She was vague in her response–it may have been “a few months” or it may have been “a few years”. It wasn’t hurting her, and she had other things to worry about–namely her 70 pound weight gain.   Mammograms and ultrasound while she was an inpatient led to a biopsy which showed malignancy.  Cardiac echo showed both coronary disease and cardiomyopathy.  She was treated with multiple cardiac medications and began to diurese, and her heart function improved dramatically, especially after a stent was placed in her left anterior descending coronary artery.   Finally she was able to go to surgery to remove the breast mass, and today she showed up for her consultation looking very chipper indeed–a slender 134 pounds down from 206, breathing normally, with no ankle edema.  The breast cancer turned out to be stage I, and she will receive radiation therapy in the next few weeks.

When I walked into the consultation room, I introduced myself and asked her to say her name, which was somewhat difficult to pronounce.  She laughed and said, “Just call me Cleopatra, because I am the Queen of Denial!”  Fortunately, I think she is going to be just fine.