Kimberly was shocked when she was told that she had breast cancer that had spread to her lymph nodes. It quickly became clear that she would need a mastectomy - surgery to remove her breast.
As soon as she got the diagnosis, she went on the internet to find out what other women in similar situations had to say. One piece of advice turned up over and over: If you think that you might want to have reconstructive surgery after your breast is removed, talk to a plastic surgeon before you have the mastectomy.
Kimberly thought that this suggestion made sense.
Her mastectomy surgeon -- whom I'll call Dr. James -- had other ideas.
When Kimberly explained that she wanted to talk to a plastic surgeon, "He got very angry and told me 'no.'"
Both his anger and his attempt to stop her from seeing a plastic surgeon made Kimberly leery. She did not back down. Then Dr. James switched gears, and told her that he would make the appointment for her. He picked up the phone, and Kimberly listened as he called a number he knew by heart and made the arrangements.
That made her even more uneasy.
She called her primary care doctor's office and asked who they would suggest for her reconstructive surgery. She called the doctor they recommended. The first question the doctor asked was, "Who will be performing the mastectomy?"
When she named Dr. James, the plastic surgeon said, "If Dr. James performs the mastectomy, there would not be enough tissue left for reconstruction."
Now she understood why Dr. James had reacted the way he had.
Kimberly sent out a mass email to all of her friends in the small Midwestern city where she lived, asking them if they had experience with any mastectomy surgeons. She was surprised when most of them mentioned Dr. James; many friends and relatives of her friends had been treated by him.
Kimberly very methodically contacted each woman she found out about who had had Dr. James as a surgeon. One by one, she discovered that not a single one of them had had breast reconstruction afterwards.
That picture supported the view of the plastic surgeon she'd first contacted. With a little more research, she found another mastectomy surgeon, Dr. Williams. The plastic surgeon agreed that he could do reconstructive surgery after a mastectomy by Dr. Williams.
Kimberly fired Dr. James and had Dr. Williams operate. The mastectomy was uneventful. The reconstructive surgery also went smoothly. It's been close to five years now, and Kimberly remains free of cancer.
Reflecting on the experience, Kimberly said, "I feel like I dodged a bullet."
Why did Dr. James react the way he did? Several possibilities spring to mind. First, he might genuinely believe that removing more tissue is better than removing less tissue; he is, after all, trying to save lives by cutting cancer out.
Second, he may simply be doing what he was taught. Research has shown that doctors faced with very similar patients often give them very different treatments, based simply on what medical school they went to.
Third, he might not have had the skill to manage the surgery differently.
When we needed to have some work done on our house, we spoke to several different contractors. Two of them stood out. One of them repeatedly said, "That's impossible; it can't be done," when we described various results that we wanted. Another said, "We can do that. I'll need to look into it a little more to see what it will involve, but we can get you what you're looking for." And he did.
In medicine -- and in building construction -- there are some genuine impossibilities. But sometimes there are more options than you're first given. One hint that you may be facing a doctor who can't deliver the results you care about is anger. A doctor who gets mad at you when you make a reasonable request is waving a red flag. It's a warning that you might need to look elsewhere.
It was critical to Kimberly to have the reconstruction. It was a step she needed to take to feel that she was moving forward with her life. Does every woman facing breast surgery feel the same way? No, of course not. Each woman has her own priorities and preferences.
Medicine is practiced one patient at a time. What was important to the previous patient isn't necessarily what will be important to the next patient.
Notice here that Kimberly had no argument with the diagnosis or with the treatment plan. She understood that she had stage III cancer and that she needed to have her breast removed. She accepted all of that. It was what would happen afterward -- what her body would be like for the rest of her life -- that she wanted some say in. She wanted a voice. She wanted a vote. She wanted to be the one to decide.
Is that so outrageous?