The Shadow

His fingerprints were everywhere, his presence palpable. His name was the second thing Dr. Second Opinion said to me, and that was when I knew how I had been squeezed into his schedule so soon. When he spoke to me, he already knew I was well-versed in the jargon and technical details of my cancer. There was nothing in the 100 pages of medical records I sent over that intimated this. I felt his influence again later on, when he walked me to the ultrasound room and he became giddy, “How did you find me or decide to come to me? It’s so random!” Why did Dr. Second Opinion find me any different than any other patient? Isn’t it always random when a patient chooses to see a doctor? I had a gut feeling he had spoken with Dr. Overinvolved.

I left my appointment with Dr. Second Opinion feeling the best I have felt about my thyroid cancer in years. He performed his own ultrasound and he told me the persistent TgAb is due to my previous Hashimoto’s Disease until proven otherwise. None of the medical records I sent over said I had Hashimoto’s Disease, but I did have it.

Dr. Overinvolved’s office was within shouting distance, located at the other big medical center in town. Truth be told, I had to make a pro-con list to keep myself from running to him. He had a lot of cons, one of which is his tendency to wear his emotions on his sleeve. I knew he would be frustrated, if not angry with me, for having such a high level of concern about this after so many years. Ultimately, the deciding factor was the potential for new insight about my cancer that would come from someone totally new. I had a strong sense of what Dr. Overinvolved would say. I also feared all of the emotions it would dredge up, one of which is a deep sense of ambivalence.

Dr. Overinvolved was a major player in my original diagnosis. There are the obvious reasons- he performed my biopsies, he told me I had cancer at 12:51pm on that very bright day in April, then did all the follow-up until I left. But that intense shared history started when I began keeping his secret.

I remember how he set off my warning bells and how I instinctively confronted him with a quizzical look. He looked at me sheepishly.

“I was just, uh, checking the angle.” He walked away, continuing to give me that same sheepish look that said, “I know it’s wrong but I cannot help myself.” The nurse entered the room and he reverted back to his persona as the confident, controlled authority. Then he did the biopsy- shoving a needle into my neck 8 different times. We argued. He became angry with me and by the time he snapped off his latex gloves, his shirt was saturated with sweat.

What did he do. I was laying down on the table. He came over to my left and rubbed his hips against my side and left arm. I never told anyone and I pushed it out of my mind. I had to. Too many terrible things happened to me at once and this was minor amongst all of those other events. When I wrote this sentence, a huge sense of panic arose and I had to walk away from the computer to talk myself down. I really want to type, “Maybe I just misunderstood.” No, no way did I misunderstand. That’s clear. This was not the last of his incursions on me, but it was the most blatant.

I want to scorch the earth and say he’s a terrible monster so desperately, because it seems almost incompatible with a scenario where he could be anyone good. I usually refer to him as a creeper and he clearly abused me, but I cannot ignore that there was goodness there. The goodness that I received from him is all that I have to hold onto from my cancer experience because it was lacking from nearly everyone else. I held onto that for me, not to absolve him. If he’s a terrible monster, than there was no one good involved in my experience. I cannot face that reality. But in that conscious denial, I am stuck. Trying to unpack this with another person leads to frustration. I make therapists uncomfortable and have been victim-blamed. I have read so much about the dynamics that underscores these situations but it has not released me. Dr. Susan Penfold has a great article on TELL, which is a website that talks about sexual abuse in therapy. It definitely applies. http://www.therapyabuse.org/p2-sexually-abusive-psychotherapy.htm

I extracted myself from that situation by leaving, which was a victory. Keeping myself from running to him when I found myself in this situation was another. But he lives on in my head, a puzzle I have not been able to solve or let go of. Some of that is because of me; I was raised in a very cold environment with a serious lack of empathy and any love was conditional. In contrast, he accepted me and all of the tumultuous emotions I felt at that time, never once telling me how I should feel or what to do, in sharp contrast from everyone else. This felt like a blissful revelation. He would be much less important if others had met these basic needs.

To come home and realize very quickly that Dr. Second Opinion had spoken with Dr. Overinvolved about me was a comfort and a terror. He knew exactly how to speak with me in a way that honored my intelligence and knowledge, and thus I received the explanation I needed for years. It’s a terror because it took away my anonymity. It was chilling because Dr. Second Opinion emulated him so well, minus the sexual undertones.

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How to Let Cancer Win

I have allowed cancer to win.

I have stayed in a career that I dislike in order to maximize my income, and for the health insurance.

I have no partner and no close friends.

Yesterday my physician asked if I wanted to freeze my eggs.

I’m 36.

I was 28 when I was diagnosed.

I have never been in a position to seriously ask myself if I want children, to look into the eyes of a man I love and wonder what those potential children might look like.

I have never looked into the eyes of a man I love because there has been no love.

I tried online dating, and the men are rude, crude, and often married.

I tried to go back to school for a career I know I would love, but I could not afford the sole university that admitted me.

I tried to create a new life for myself  by moving away.

With new doctors came new opinions that pulled me into an elevated and endless loop of testing.

I was young and now I am grey, with nothing meaningful to show for all that time that has gone away.

Cancer has won because I do not live, but exist.

Wally the Whale & A Second Opinion

Southern California has a problem. The rotting corpse of Wally the whale keeps washing ashore up and down the coast.  Wally first landed in Playa del Rey on July 1 and after coming ashore five times in Orange County, made her (yes, Wally is a female whale) debut in San Diego County on Grandview Beach in Encinitas on July 16.

So what does this have to do with thyroid cancer? Oh so much.

Over the last six years, I have tried to tow my cancer and all related experiences far enough out to sea that it would drift away and become part of the past. But that has never happened. Every six months or every three months it comes back around when I have those labs done and I see those tumor markers numbers I should not have…and nothing happens. It never goes away and I need it to go away. That’s why I put all that work into obtaining a second opinion.

The medical portion of the second opinion is not all that different than what’s been happening. This endocrinologist says he would not have done anything differently, however, he believes the three months follow up is not all that necessary for someone with such a favorable pathology report. He also performed his own ultrasound, an aspect of my follow-up that has been missing from my care since I moved away from Dr. Overinvolved. I did not realize how comforting it was to have the physician looking at and interpreting those images in front of me until it no longer happened.

There has simply been too much for me to question over the years.

The non-medical portion of the second opinion illustrated exactly why I needed one in the first place. None of the three endocrinologists I have consulted with since I moved have talked to me like an intelligent person. They have not explained anything. I read all the literature on my cancer; I can get in the weeds and that’s by design because I like to partner with my physicians. The only dictator over this body is me. My current endocrinologist, with her world-class education at the world-class medical center is a phony. She barely makes eye contact and has done nothing to establish trust with me. She does not explain anything or initiate any discussions with me. I am two-dimensional, just words on a piece of paper to her and that was never so obvious as it was when I met with the second opinion endocrinologist, who talked to me like he knew me and exactly how I operate. We waded into the weeds. It was like talking with Dr. Overinvolved, minus the sexual tension.  I felt completely reassured and I think I know what I need to do. I also really liked this endocrinologist and if I lived closer, I would absolutely hire him. He was genuine and invested, as was his staff, and no one is that way where I live now. He offered to do my care from afar but I don’t know how that will work with my HMO.

It seems a bit ridiculous that I ran away from my hometown and the only people who know how to take care of me the way I need to be taken care of are in…my hometown.  I keep washing ashore like Wally but not because of ocean currents; but because home seems to be where my heart is. How else can I explain going back there for a second opinion and being transported right back into the good part of what was an essential and healing relationship, but with someone completely new?  Perhaps it is not my world-class doctors at the world-class medical centers that are the problem, but me.

 

Anatomy of a Second Opinion

My HMO authorized a second opinion for my thyroid cancer two and a half months ago.  I went through my copies of my medical records and discovered many gaps, so I went about the business of contacting three different medical centers in an effort to fill them. I was about 90% successful. One of them I had to request twice before they sent me anything and part of what I needed they said they did not have, which I know is wrong. The other said they would respond to my request in five days. It took twenty-eight. My authorization runs out in two weeks. I can’t wait around any longer. Last week I faxed over 110 pages of medical records, per their request, and wait for them to call me, hoping I can still get in.

In the interim, I spent inordinate amounts of time scrutinizing the imaging tests that came to me on white-labeled CDs. I looked at pictures of malignant lymph nodes and compared them to my images. I calculated L/S ratios. I watched my last node biopsy, thinking, incredulously, “That lymph node looks totally benign!”

In June, I saw my primary care physician because my heart palpitations became terrible; I woke up more than a few times gasping for air and I suddenly can’t breath while I am working out. Dr. Overinvolved instructed me to never be afraid to make an appointment if I feel I have become hyperthyroid. That’s what I thought was occurring, so I went, and it was an awful, terrible, no-good appointment for reasons that will get their own blog post. My EKG is normal. My echo is normal. I started having panic attacks at the gym when I climb stairs and I don’t know what to do to make them stop.

Over Memorial Day weekend, my endo’s office called me to reschedule my three-month follow up. She only works one day a week and has decided to switch her one day from Tuesday to Wednesday. So now I am having a four month follow-up. My respect for her and any sense of trust I have in her expertise has dwindled further.

I had my blood drawn at the three-month mark anyway and my numbers are exactly the same. She has no comment in the interim, so I have to wait until late July to hear what she wants to do. I know what I want to do, and hope that the second opinion will agree with me.  There are two choices I find acceptable. Scan me. Or put me on yearly follow-up. I’m taking my life back.

If I fail to make the HMO’s deadline, I will go see Dr. Overinvolved and pay cash. He will tell me to take my life back; I know exactly how he thinks about thyroid cancer and there’s no question he will agree with me…and that’s why I would prefer to see someone else for that unbiased perspective!

I miss him. He is that safe person in my head, despite what he did. I have not yet found a way to reconcile what happened. I’ve read more books on the topic of transference and sexual abuse by health/helping professionals and it’s clear that when these things happen, the patient being wonderful or special has nothing to do with it. We are merely a vehicle and it’s all about them and their unmet needs. I keep trying to tell myself this, but I need the romanticism of the story to keep myself going. There was no one else, nothing else good to come from this and I need it to have a purpose. Without that storyline, I’m not sure how I would cope. Perhaps I would cope better.