A small, red wound—no bigger than a poppy seed—appeared mysteriously on the bridge of my nose a few months ago. At first it sat there quietly and behaved itself, and I assumed the strange bump would heal steadily and vanish as furtively as it had arrived. Only it didn’t, and pretty soon it started to grow bigger and act out. One day it would bleed; the next it would scab over in a sort of mini, leathery patch; and then, right when it seemed the ugly scab had almost disappeared—when it seemed we’d soon part ways—it would open up and bleed irritably again.
Day to day, I couldn’t predict its mood; it was like living with a touchy teenager.
Eventually, I realized that I would need to make the necessary arrangements to evict the tiny squatter. And so I went to see a dermatologist, who peered at my nose suspiciously and asked if I’d been under the sun much. I thought of all the summers I’ve spent thoughtlessly plopped in a beach chair, toes dug into the warm sand, book propped on my lap, while the sun toasted my skin a rich, bronzed color of rotisserie chicken.
“Umm… not really,” I hedged. I felt a pang of guilt, like I was 17 again and coolly asking our family doctor for birth control pills solely to regulate my periods, when I actually had something more interesting in mind. What is it that makes us want to present a scrubbed, sanitized version of ourselves to those in positions of authority?
Instantly, I recanted. “Well, I usually use sunscreen,” I allowed, rationalizing that “usually” was interpretive enough to make it a true statement.
“Well, we’ll see.” She was brusque—and efficient, clipping off a piece of the angry interloper, which in response promptly bled at her. “We’ll be in touch,” she said.
A week or so later I got a flimsy white postcard in the mail from the doctor’s office. On it were three pre-printed options with open boxes next to them, and one was checked off: “Your biopsy showed a cancerous growth,” it read next to the check mark. “Please call our office to schedule a follow-up appointment.” In ballpoint pen, underneath, someone had scrawled, “Basal cell carcinoma.”
I had to admit: It was efficient. Nonetheless, there was something a little off-putting about it—the healthcare equivalent of a service-call reminder that it was time to rotate my car tires.
My teenage son, reading over my shoulder, snorted and said, “Wait a minute… did you just get a postcard from your cancer?” Immediately I pictured a small skin growth waving to me from the deck of a catamaran in Cancun. “Weather to die for. Sights are gorgeous. Wish you were here!!!” Of course, I wish it were vacationing there, too, preferably on somebody else’s nose.
Basal cell carcinoma is pretty much the milquetoast of the skin cancer family. In medical-speak, it’s not very “aggressive.” It’s small and weak—a pipsqueak—and it generally doesn’t spread to other outposts on or in the body. Even the most ambitious basal cell carcinomas—the valedictorians of their cancerous classes—can usually only ever hope to achieve an ugly disfiguring. “It’s the one you want,” my doctor had explained. Still, I thought, that was kind of a curious way to describe any cancer, even a wimpy one.
And, even so, the news came as a downer, if only for the portended hassle of another visit to another doctor, and then a third visit to a plastic surgeon to re-putty the small but prominent spot in the center of my face.
But I cheered myself almost immediately by considering, still gripping the doctor’s postcard, the idea that this little dot on my nose was so trifling, so insignificant, that it didn’t even warrant a telephone call. Instead, a cheap piece of mail moseying its way to my mailbox sufficed. This pipsqueak was nothing my doctor hadn’t seen before, a million times. There was comfort in thinking that she already had a system, a routine in place to roust it from its perch on my nose, and I was grateful that I was in such experienced hands.
In fact, I kind of liked this process of postcard notification. It seemed an inherently easier, less messy way to deliver news that is otherwise a bummer. Imagine, for a minute, all the drama that could be avoided when the surgeon greets the family after a risky procedure. “Will she live…?” the family pleads, plaintively. And the doctor shrugs, “Go home and you’ll receive a postcard in 7 to 10 days.”
I think of all the unpleasant news I’ve ever had to deliver or—worse!—received. Slacker employees fired. Bad relationships severed. Emotionally wrought times in life when pages and pages of conversation that start with “we have to talk…” and end up, three days later, with both parties exhausted and bleary-eyed and rung out from endless faults, accusations and indiscretions examined and exposed. Wouldn’t it be so much cleaner to just send your once-beloved a white, clinical postcard, with a box checked next to: “It’s over. Don’t call.”
I was still liking this postcard process, because the day hadn’t yet come when I’d face certain realities. I hadn’t yet had the follow-up appointment with a new surgeon, when his nurse would circle the spot on my nose with a purple felt-tip pen and photograph it at pore-close range. Then, as I sat across from the surgeon and his partner and discussed the surgical procedure with a fat purple circle on my face, finally one of them, sensing my humiliation, would lean over and wash it away with an alcohol wipe, like I was a preschooler with some jam left on her face from snack time.
The truth is, when it’s our own health nothing is really routine: no pregnancy, prostate, cancer or canker is much like another—at least, when it’s happening to us, inside our own skins. But modern healthcare—with its postcards, and patient appointments stacked one after another, and whatever other efficiencies administrators can manage—seems to stumble along as if it were… workaday, just plain routine.
In fact, the system seems teed up in way to disrespect both the patient and—at the same time—the physician. The factors that lead to patients in tightly packed queues and diagnoses sent through the mail are the same ones that burn out doctors. Mostly, it’s because of the lack of financial stability and autonomy, says Salon’s medical writer, Dr. Rakul Parikh. And unlike most business transactions, in healthcare the customer is not in control.
“A generation ago,” Parikh writes, “doctors were accountable only to their patients.”
But these days, of course, they are accountable first to insurance representatives and hospital administrators, “many of whom have no direct experience in healthcare but hold power over budgets and reimbursements,” he points out. “It’s that lack of control that has frustrated many doctors and left them feeling pessimistic about the future of healthcare.” And burned-out doctors feel about and behave toward their patients very differently.
If it’s frustrating to be a patient in the system, it’s alienating to be in the doctor’s shoes, accountable to administrators rather than their actual customers. On top of it all: they have to hear folks cop to only two drinks a day when regularly they pour themselves a few more—or swear they take multivitamins, or say they wear sunscreen… when they don’t. I’m vowing to do a bit better there from now on.
This election season, talk of healthcare reform usually centers on access. But I’m wondering if we should also be talking about how to reinsert a bit more humanity—some real caring—in healthcare.