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The Art of Medicine

You don't know what you can do until you try

Sweeney, Cameron Young MMS, PA-C

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Journal of the American Academy of Physician Assistants: February 2019 - Volume 32 - Issue 2 - p 58
doi: 10.1097/01.JAA.0000552730.80563.a6
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She stopped at the nurses' station to ask one last question of the oncologist before she left. On my way to see another patient, I paused when I heard her voice. Her appointments had been with other providers over much of the past year, so I had not seen her in several months. Her soft, fine hair now brushed the collar of her blouse and curled around her earrings. A few grains of salt mixed with the pepper. She had lost some excess weight around her hips, and her cheeks were rosier and slimmer than I remembered. “I barely recognized you!”

She whirled to face me and gave me a hug. “I am so grateful! I'm here because of all of you.” She gestured at me, the nurses, the doctor, the chemo room beyond. “I couldn't have done it without you.”

“No,” I shook my head and smiled. “You're here because of YOU.”

Before her diagnosis, she had always enjoyed good health. She grew up in California and was skeptical of Western medicine. She practiced yoga, took herbs, and drank tinctures and teas. She ate vegetables she tended in her garden and baked with eggs fresh from the hens in the coop a stone's throw from her kitchen door. She considered the risk of radiation from mammography greater than the benefit of cancer detection, so she had never had a baseline mammogram nor annual screening. When she first felt the swelling in her breast and another in her armpit, she willed them away. She was busy caring for her special needs children, her three-legged dog, and her small baking business. But the lumps continued to grow until she could ignore them no longer. Imaging confirmed masses in both breasts and axillary adenopathy. Biopsies were positive for two morphologically distinct cancers. Remarkably, there were no distant metastases.

We recommended neoadjuvant chemotherapy, surgery, and a year of targeted therapy followed by 5 to 10 years of oral antiestrogen therapy. At first, she insisted that she would rather die than take chemotherapy. “I can't do it! I don't even use Tylenol!” she wailed.

“You don't know what you can do until you try,” we countered. She went home to think it over, and we didn't expect her to return.

But she presented at the start of each cycle of chemotherapy and read a detailed record of her symptoms from a tattered notebook that she held in trembling fingers. “Food tastes metallic.” “My fingernails have ridges and lines.” “I'm so tired I don't have the energy to get out of bed, let alone bake cupcakes.” She recounted specifics of each bowel movement but refused recommendations for diarrhea or constipation because she preferred not to take more medicine. She declined antiemetics and anxiolytics that left her “fuzzy” and feeling out of control. When her hair fell out she took to wearing an Elmer Fudd hat with long earflaps lined with creamy shearling and matching furry Ugg flip flops. Her questions were many. “What can I eat to strengthen my immune system?” “When will the numbness in my feet go away?” “Are the lumps getting smaller?” At the conclusion of each visit, as fat tears wet her pale cheeks, she whispered, “I can't do this.”

Before I approved each cycle of chemotherapy I took her hands and looked directly into her eyes. “You are stronger than you think you are. You don't know what you can do until you try.”

She completed chemotherapy and underwent bilateral mastectomies. She received radiation therapy. She resumed the targeted therapy every 3 weeks that most patients tolerated with few toxic adverse reactions. She also did well physically, but returning to the infusion room so frequently wore on her fragile emotions. For an hour before each appointment, she sat in the parking lot mustering the courage to enter for treatment. Somehow, she completed the year of therapy.

She had never liked medicine and could hardly fathom taking a daily pill for years. “I've done so much, I can't do this, too!”

“You have come so far,” I reassured. “You don't know what more you can do until you try.”

She managed to take the pills as prescribed, and her visits to the cancer center became less frequent. She regained her strength and returned to her baking business. The day I saw her she brought cupcakes topped with elaborate spun sugar ribbons in shades of pink.

Every visit was a struggle with her. Her anxiety was so great that we doubted she could withstand the mental or physical insults of repeated treatments. We worked so hard to convince her how much she could endure. But in the end, she proved to all of us that you truly don't know just what you can do until you try.

Copyright © 2019 American Academy of Physician Assistants