That Interval Between the Biopsy and the Report
This essay, first published in 2008, still rings true. Now that I have had my own run-in with cancer (I am now an almost one-year survivor and doing great), the sentiment rings more true than ever.
Words are, of course, the most powerful drug used by mankind. -Rudyard Kipling
“But, Doctor, tell me! What do you think it is?” We have finished the operation, catalogued and sent all of the specimens, closed up the wounds, and bundled the patient off to the Recovery Room. It will be a couple of hours before the patient is fully alert. And it will be a couple of days before the reports are back from the laboratory. “Doc, you’ve seen other cases like this! You must have an opinion about what the pathologist will say.” Of course I do. But, I think to myself, I have guessed wrong. What good would it do to raise hopes inappropriately or, on the other hand, dash hopes needlessly? I have, on more than one occasion told a family that I was pretty certain that the specimen would show no cancer, only to find out days later that I had been wrong. I want to avoid the sinking sensation that has accompanied that mistake.
“I wish I could tell you, but I’m just not certain. We will wait for the reports together.” There is a time of limbo in Medicine that begins when the procedure is completed and ends when the patient learns the results. It occurs millions of times each year after everything from major surgeries to blood tests. Although it was not the point of her essay in The New York Times, Dr. Paula Chen touched on these moments as a friend's father waited for the results of a pancreatic biopsy. From a relative’s perspective and now from my own, waiting for the doctor to call or stop by after a procedure is akin to listening for the footsteps of the principal coming down the hall after you have been sent to the office. The wait is long and tense. From the physician’s perspective, the time between the procedure and the report is a breather that allows a release of concentration from this patient because nothing more can be decided until the report is available. The physician can refocus on someone else during the interval. The wait can seem very short. Finally, the report hits your inbox. Or you call the lab. Or you are paged by the pathologist. Or, these days, the patient gets the report on MyChart before you do, and you find a computer to call up the details as quickly as you can. At that moment, the physician finally has the critical piece of information that the patient needs to hear. Sometimes the report will bring relief and joy; sometimes, just the opposite; sometimes, just a shrug. But, no matter how long or short that interval between the biopsy and the report, we must share—clearly and promptly—even when it is hard and even when we don't know exactly how. People are waiting.