Beneficence

On days when I am burnt out on the gym and it is too hot for me to hike in the mountains, I walk along the beach near my apartment. Sunday was one such day. As I strode down Main Street to the walking path, down the Strand and back, my mine wandered from work, to foregoing graduate school, to whether I should move again or not, to cancer, to Dr. Overinvolved, what it would be like to not be alone, and other mundane topics.

On my way back home, the waves crashing nearby, I found myself replaying the day I had radiation treatment. It’s been on my mind lately as it became a discussion topic in a health advocacy class I recently took about crisis, communication, and informed consent. I meant to tell a different story that day, but as I started writing, something occurred to me. Dr. Overinvolved never provided an opinion about whether I should have radiation or not. He said he could go either way and it was up to me. I was anxiety-ridden and traumatized, so I was most interested in reducing my long-term risk. Of course I pursued it! My tumor marker was a little jumpy, just as it is now, so I said yes, let’s do it. I knew the risks and I had read all the research. But he never said, “You should have this.” or “You should not have this.”

So what was he being paid for, exactly?

In one of the many books I have read about professional boundaries, one of the precursors of boundary violations is a professional who is uncomfortable with his/her power and authority. The professional is either too distant by denying the importance of the professional relationship or tries to be less in charge by denying his own power and authority (equalizing the relationship). Both are for the comfort level of the professional, not for the good of the client and both destroys boundaries that protects clients like me.

On this day, he and I walked out of the exam room together and out into the crowded lobby to take the elevator down to the basement where he would give me the radiation pill. We were out of context and he felt hugely present to me. I could feel him next to me as we stood in the elevator, even though we weren’t touching at all and I felt safe, protected, bolstered, and strong. We arrived at basement level and he pointed at the chair I was to sit in. As I scurried over, he knocked on a door and a man came out of a little room. He was the radiation tech. He confirmed my identity and what dose I was to receive, then told us to wait. Dr. Overinvolved sat in the chair next to me and pretended to read my file, glasses on his nose. I remember glancing over and thinking, “I hope that’s stimulating reading material.” The tech reappeared with a clipboard and a form that asked questions about pregnancy and breast feeding. Dr. Overinvolved sprang into action.

“Why does she have to fill that out?” asked Dr. Overinvolved

“All women of childbearing age have to fill it out,” replied the tech.

“It’s unnecessary,” said Dr. Overinvolved, becoming clearly agitated.

“She has to,” replied the tech.

“Her pregnancy test was negative, you know!” yelled Dr. Overinvolved.

“She has to fill it out!” And with that, the tech went back into his little room, slamming the door behind him. I sat there, bewildered, clipboard in hand and said quietly, “Ooookay, guess I better…fill…this…out.” It took five seconds for me to check off every single “no” box on the form. He didn’t say anything.

That’s not weird at all. Nope. Not one bit.

We finally went into the little room with the tech where he handed me a cup with a dust-filled capsule in it. I swallowed it. We all stood there for a few minutes to make sure I didn’t throw it up, then we got in the elevator. When we arrived at the first floor and the door opened, he said something about when I would have a scan and that someone would call me. I was walking away from him with my back turned as he spoke, since I was going to be emitting gamma rays very shortly. I looked back over my shoulder at him and smiled to let him know I heard him. He was walking backwards very slowly, watching me walk away, and his face just lit up with the brightest, most sincere smile I had ever seen from him. I thought to myself, “Wow.”

I didn’t know it at the time, but that was the last time I would see him.

I felt that everything was finally finished. That was one of my reasons for choosing radiation. It was common for all thyroid cancer patients to have radiation and since I did not, I felt that my treatment was incomplete somehow, that the possibility of something lurking was strong. A lot of my fears that were at play when I chose radiation came true anyway. My tumor marker never went away and it is not stable, making my follow up difficult, which means I have worried about something lurking, though not so much since the second opinion.

As for him, I find it very hard to believe he has acted like this before and it has gone unnoticed. This wasn’t the first time I witnessed him yell at the staff, either. Once he yelled at a nurse for giving him the wrong file and he used patient names in front of me too, like he was giving me a glimpse behind the curtain. At some level I must have given him some relief from the stress and responsibility of his job, or he saw me as someone who could do that for him. I always made a point to tell him that he helped me because I don’t think many of his patients ever got better. But me, I am the former fat girl cancer survivor success story! I was on track to become one of his diabetes patients and instead, I became once of his cancer patients and lost nearly 100 pounds, all at once, and while doing that, I taught myself all of the terminology and standard treatment protocol for my disease. He once said to me, “You know more about this than any of my other thyroid cancer patients!” He sounded impressed and I beamed at him.

As for me, I know that I am “guilty” of trying to equalize the relationship by doing this as well as care taking him to some extent. I had spent a lifetime playing up to authority figures and ministering to their needs in order to garner their approval. I was nobody’s daughter, just a lens that others used to see their own reflection. I was abused, not valued, and I internalized all of it.  If I were just “good” enough, maybe I could get that approval and treatment I deserved.  I attached to him like a barnacle because he validated me, he saw me and I am ashamed of that, of the thrill it gave me.

When I presented a portion of this scenario to my class (me taking the full responsibility for choosing radiation or not), they responded by saying I did not give informed consent and that he was trying to further his own agenda at the expense of my medical care. The word “neglect” was used more than once, a word I would never have imagined using, yet it fits. I can chalk it up to another instance when “the only good one involved in my care” did not demonstrate beneficence. My ambivalence persists.

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