by Vivian W. Bucay, MD
It was a Wednesday, and I was in an especially good mood for many reasons. First, it was Wednesday, the one day of the week when the afternoon
is mine to do what I please, free
of obligations.
Furthermore, both my mother and mother-in-law had arrived the night before from New York and Mexico City, respectively, in order to celebrate Grand-parents’ Day with our three daughters.
It also was May 10, which is Mother’s Day in Mexico, and a rare opportunity for the family to celebrate this special day twice in one week.
After I finished seeing the morning’s patients, it was around 2 p.m. and I was taking care of some administrative office duties when I learned that I had a call from South Texas Dermatopathology Lab. Nothing unusual – probably a notification of a serious diagnosis in one of our patients.
I have always felt that everyone can define the day in which life changes forever. What I had not realized when I awoke that morning was that May 10, 2006, would be that day for me.
“Vivian, I’m afraid I have bad news. Nodular ulcerated malignant melanoma, possibly metastatic,” echoed the solemn voice over the phone. I was shocked but not surprised and remained unexpectedly calm. I have always considered myself calm, cool and collected in times of crisis, mine as well as others.
My first response was to ask for a copy of the histopathology report to put in my chart, which was hastily assembled by Courtney Aldridge, PA-C, the physician assistant who has worked with me for the last four years. Courtney had actually performed the difficult skin biopsy of the irritated skin deep in the umbilicus. That had been Friday, May 5, and I had finally grown tired of the serous drainage that had stained my clothing intermittently for several weeks. The differential diagnosis was “pyogenic granuloma vs. neoplastic.”
Who knew that the dermatologist who forever preaches sun protection to anyone who will listen could develop a polypoid nodular amelanotic melanoma in an area that hasn’t ever seen the sun? Great teaching case, I thought, as I reviewed the photographs Courtney and I had thought to take pre- and post-biopsy.
After calling my husband Moises Bucay who, as an interventional cardiologist, handles bad news very well,
I called Alexander Miller, director
of surgical oncology at the Cancer Therapy and Research Center and someone to whom I have referred patients with “serious” malignancies over the past few years.
This is where you enjoy the advantages for a physician-patient, when compared to those of the “mere mortal.” We know who to call and how to have our calls put right through – what an advantage!
I have always prided myself in taking and returning calls quickly, but now know I was not fast enough. Physicians are so overwhelmed by increasing demands on our time that we forget a basic aspect of the physician-patient relationship, which is trust built through good communication.
My new role as physician-patient has rekindled the sensitivity that had been extinguishing itself, gradually, over the years.
Listening to our patients is far more important than “documenting” every trivial, irrelevant item that may or not be of medicolegal consequence. Quality of care must remain our foremost concern as physicians. Through an unfortunate personal experience, I am happy to report that quality of care is alive and well in the San Antonio medical community.
By 4:30 p.m. the same day, I was seeing Dr. Miller, who explained the course of treatment that would include a full metastatic workup prior to surgical
excision. I had a PET-CT (negative) on May 11, followed on May 12 by an endoscopy, colonoscopy and a small bowel capsule endoscopy, assuring that no part of the GI tract escaped visual inspection. Again, being a medical “insider” offers the incredible advantage of instant results, avoiding the excruciating agony of waiting for the news.
By coincidence, Dr. Miller was hosting a conference May 13 and 14 on controversies and advances in mela-noma. Many of the world’s renowned experts in the field of melanoma would be present, and we were invited to attend and present my case.
I am as academically inclined as the next physician, but the “patient” in me took over and opted for the escape mechanism of shopping with my daughters, mother and mother-in-law, while my husband attended the conference.
Dr. Miller mentioned that he wanted me to take three weeks for recovery after the surgery, which was scheduled for
May 16. Really? Three weeks for recovery?
Could I at least have a tummy tuck?
Apparently not, I realized after the surgery, which also included a sentinel lymph node biopsy. Encouraged by the results of the work-up, I was beginning to feel more confident that all would be well. On Friday, May 19, I called Dr. Miller’s office inquiring about the sentinel node biopsy results. His nurse told me that he had spoken with Dr. Bucay, to which I replied, “Well, not this Dr. Bucay.” My husband overheard the conversation and confessed that, yes, there were micrometastases to the lymph node. I had also earned a second surgery. At that point, I officially considered myself a cancer patient.
I went back to work a week after the first surgery, whether because of denial or the high overhead as a solo practitioner, and was not surprised to find that the staff had pulled together to make sure that the office ran smoothly in my absence. I am privileged to work with these amazing and supportive women.
I shared my melanoma diagnosis with the patients. The physician in me wanted to use this experience as an educational opportunity to improve patient care. Interestingly, I learned a very important lesson: the therapeutic power of acknowledging someone else’s pain and suffering. My patients had become my angels, listening to me; sending me and my family meals, endless flower arrangements, and thoughtful get-well cards; and taking turns driving me to the month-long daily appointments for intravenous interferon infusions at the CTRC.
A radical right groin lymph node dissection on May 30 yielded two more positive nodes (micrometastases) and a lifetime of lymphedema and its risks. Pathologists at M.D. Anderson reviewed the initial biopsy and confirmed a primary malignant melanoma with a thickness of 3.3 mm. Together with the positive lymph nodes, that placed me at stage 3b – statistically speaking, that gives me a 50 percent chance of five-year survival.
My medical oncologist, Ron Drengler, MD, encouraged me to explore all treatment options, including clinical trials, before settling on a course of action. I went to see the medical director of the melanoma clinic at M.D. Anderson in Houston and also was able to seek an opinion from interferon pioneer John Kirkwood, MD, at the Hillman Cancer Center in Pittsburgh. The current standard of care for the adjuvant treatment of melanoma is one month of intravenous interferon followed by 11 months of subcutaneous dosing. I am in my third month of interferon therapy and back at work.
They say that knowledge is power and, to that end, I can quote studies, statistics and all things related to melanoma. Nonetheless, my strength comes not from my newly acquired knowledge, but rather from the faith and hope of family and friends.
With that, I wake up every day and choose life.
Dr. Bucay, a board-certified dermatologist in practice since 1991, is the proud mother of three daughters, the proud wife of one husband and the luckiest physician around, being blessed with countless caring patients and friends.
