View From the Other Side of the Stethoscope
As an internist and cancer survivor, Wendy S. Harpham, MD, FACP, offers a unique perspective on oncology practices.

Friday, February 10, 2017

Lessons of Risk-Reducing Oophorectomy

My recent risk-reducing oophorectomy amazed me, and not just because of the impossibly small scars. Compelled to understand why, I reflected on the differences from my earlier cancer surgeries. New insights led to new affirmations, some of which might be useful to clinicians caring for patients with a deleterious gene who choose surgery.

The first thing that surprised me, the observation that first got me thinking, was everyone's focus on my post-op physical comfort. As if experiencing surgery for the first time, I marveled at all the tender kindness for my predictable post-op pains. The nurses stayed on top of every twinge throughout my brief hospitalization, responding with a blend of medications, reassurance, and deftly placed pillows.

After I got home, my husband gingerly assisted me to the bathroom every couple of hours, letting me direct our every move.

While I'm sure I received the same attentive care after my decompression adenectomy decades ago, none of it registered because the activities in my head, if not around my bed, were dominated by the cancer diagnosis. Pedestrian concerns such as getting to the bathroom were snuffed out by concerns about dying. Morphine, shock, and fear created a sensory fog pierced only by existential pain.

An imperfect metaphor of a car wreck comes to mind. If an ambulance whisked me away, nobody would be talking or caring about my car on the tow truck. If I walked away unharmed, we'd be focused on fenders and axles. With my risk-reducing surgery, it has been all about the car.

The differences of risk-reducing surgery began months earlier. I called to schedule a consult with the surgeon, as opposed to my doctors calling a surgeon to the ER to see me. My choosing a convenient day and time for me stirred my sense of being in the driver's seat, a feeling reinforced a few weeks after the consult when, with my physicians' blessing, I pushed the surgery date back a few more months simply because I wanted to attend a family event.

That said, I had an unfamiliar worry, one I hadn't had when medical urgency pushed me to the OR. Perusing my calendar for a convenient date to remove healthy organs felt a bit surreal, with an occasional flash of anxiety about being responsible for choosing surgery, with its risks. I say "flash" because it resolved with the simple reminder that I was choosing to decrease my risk of cancer for the rest of my life.

"For the rest of my life" became my operative phrase. While arranging care for my elderly mother and preparing dinners for my freezer, it was never lost on me that my doctors had recommended this surgery with the expectation of my living long enough for the risk to matter. The idea of a long life made the expected post-op downtime sound short—and worth it. As for the pain and inconveniences of the surgery, they seemed far more manageable and more predictable than the pain and inconveniences of cancer treatments.

That sense of predictability made signing the consent form a new experience, too. With my IV in place, I felt confident and ready to get the show on the road. How different from when worrisome adenopathy left me no reasonable choice other than to sign the consent form, my shaky signature reflecting the likelihood that the findings would make my whole life uncertain.

My first cancer surgery was merely a prelude to a journey laden with losses and defined by heightened uncertainty. Those losses made me terribly sad. My risk-reducing surgery has been a brief interlude defined by predictable post-op pain and a loss that is a gift for all my tomorrows.

Other patients undergoing the same procedure would never call their risk-reducing surgery "a brief interlude," especially if sudden menopause caused symptoms and/or an increased risk of future problems, or if they suffered a post-op complication. Certainly, patients whose risk-reducing intervention involves extensive, disfiguring, and/or multiple surgeries would not relate to "a brief interlude." That doesn't change the fact they pursued the best path for them.

Whatever the circumstances, patients who choose to undergo risk-reducing surgery are freely choosing to accept the risks, with hope of making their life the best it can be. Given that truth, you might see a time before or after their surgery to offer encouragement with one or more of the affirmations that helped me:

This surgery was an option because your life expectancy is long.

This surgery is preventing cancer—and not treating cancer.

This surgery is elective. You thoughtfully chose the best option for you.

Choosing surgery is choosing to decrease your risk of cancer for the rest of your life.​

Less than a month after my surgery, I feel fine. Since the beginning of the second week the toughest part has been refraining from lifting my grandson, the baby I cradled last spring in the birthing room. That heavenly moment was made possible by superb cancer care. Risk-reducing surgery strengthens my hope of my seeing him learn to walk and talk and, before I know it, grow into a man.