An excerpt from With Mirth and Laughter: Finding Joy in Medicine After Cancer.

I am sitting in the waiting area for the one year follow up appointment with my oncologist, Dr. Anne Blaes. Using the handy phone app, “How Long Ago,” I see it’s been eleven months, nine days, five hours, twenty-nine minutes, eighteen seconds since I went through the operation that made me cancer-free.  I read those numbers on the display, and it seems so abstract. In some ways, those days have gone by in a blink; it’s been almost a year, yet it feels like just yesterday when I was trying to hold very still in an MRI scanner to obtain high-quality images.  In other ways, I can hardly remember life before breast cancer; it seems as though it’s always been a part of me—in the past, now, and forever.

Even though I am feeling well, approaching the one-year follow-up, I had problems once again with insomnia, and strange dreams. Too much time staring at the ceiling leads to more questions in my mind followed by bizarre dreams about cancer. On websites and social media, I am learning new terms, including cancerversary, scanxiety.  It’s the fear, angst, anxiety that accompanies getting yet another scan to follow up cancer treatment, and it was definitely showing up in my REM sleep.

But right before the appointment today, in our high tech clinic building, I am given a locator badge and a tablet device for check-in.  I am directed to the breast center where I have a left-sided 3-D mammogram that is immediately read as negative, bringing a huge sigh of relief.  The nightmares leading up to this were just that: only a dream.  I’m so grateful that the radiologists interpret the scan right there on the spot; I am sure they appreciate the fact that waiting, for any length of time, would be torture for a cancer survivor.

During check-in, I note my blood pressure reading is completely normal. My weight is also back up, which is good, approaching the same number I saw on the scale all through my twenties and thirties.  I am escorted back to an exam room; after a short wait, a knock, and in walks Dr. Blaes.

“Hi there! How have you been?”

I tell her, “Great! Feeling really good!”

We share the good news of the negative mammogram, normal blood pressure, gaining back the weight I lost. I also describe my ongoing commitment to exercise, having just completed my very first indoor triathlon at the University Rec Center.

“So,” she says, “no lingering effects from surgery or the axillary web syndrome?” I tell her no, it never recurred, and I’m back to full range of motion of my right arm and shoulder, which was especially important for the swim portion of the event. Next, she asks how I am tolerating tamoxifen.

I say, “It’s my new favorite drug. I’m having zero side effects, the hot flashes are finally gone, and personally, I’m thrilled to not have a period anymore! I’ll stay on it for the rest of my life!”

She laughs then goes on to confirm a completely normal physical exam (well, my “new” normal, sans right breast) and recommends some routine tests, a cholesterol panel, a bone density scan at a future date. It’s been a great visit—boring, almost, but in a very good way.

What I really notice about the appointment, however, this time around, has nothing to do with me, my health, the tablet check-in, the locator badge, the technician, the radiologist, the rooming staff, the nurses, or the doctors. All around the Breast Center and the Masonic Cancer Center, second floor of the new building, several interactions occur that make me feel as though I have been indoctrinated into an exclusive club.

Prior to the mammogram, I take a seat next to an older lady with curly gray hair just outside the radiology suite; she glances over at me, smiles, and says, “I am a breast cancer survivor, three years out! How about you?”

To this, I reply, “It’s my one-year cancer-versary.”

“Congratulations!” she said. “Love that term!”

I tell her that’s how my nine-year-old daughter refers to it;  she proceeds to show me pictures of her grandkids on her phone. Sitting right across from us is a middle-aged man; he comments, “Good job, you two! I’m five years out, and doing great!”

I am reminded at that moment in time that yes, men can get breast cancer too.

The very same thing occurs in the waiting area outside Clinic 2B. There is a rather young-appearing woman sitting next to her husband across from me on a loveseat, a low coffee table between us. They are chatting about her upcoming appointment.

She then turns to me and says, “Are you here to see Dr. Blaes, too? We just love her!”

And then:  I see one of my patients, whom I know quite well, strolling through the lobby.  I wave, and smile; she quickly strides over to me, as I am standing up from my chair, upon hearing a nurse call my name to bring me back.  She extends her hand, saying, “Dr. Thompson!  It’s so good to see you!” I shake her hand and say hello but then the nurse is calling my name again.  As I turn to leave, I hear her say to another patient waiting in the lobby:  “That’s my primary care doctor!  She’s great!”

The other patient replies:  “What is she doing here?”

On and on it went. I notice it more than ever before, for some reason. I observe perfect strangers sharing stories about their health, their lives, and their last PET CT result, even horror stories about chemo or radiation—all supporting one another throughout the process in their own unique way.

I’m struck by this fact, thinking, Wow, this is the polar opposite of what hospital attorneys and HIPAA would make us believe—that privacy is valued at all costs, over and above what benefit there might be in sharing, spontaneously opening up to others in the most unlikely of situations.

Maybe, just maybe, I’ve gotten it all wrong about the new clinic building. Perhaps the open-lobby concept, shared workstations, collaboration zones, and touchdown spaces could all be viewed as a way to facilitate more personal contact, more face time, more verbal communication, more interactions. And not just individually or one-on-one, such as doctor and patient, but in groups of people, across professions, across disciplines, including what I just observed that day. This open floor plan brings patients and families in closer proximity to one another while waiting for a lab draw, an X-ray, or an appointment. Maybe it is not necessarily a design flaw or to save square footage but intentional, to underscore the point that we’re all in this together.

Thinking more about this, I recall my patient Laurie, a fellow physician and cancer survivor who wrote a poem and sent it to me; after checkout, I take a seat in the waiting area, pull up her email on my phone, and reread the final lines.

You have joined the millions of others, you have CANCER.

It changes your life. Whether contained or not you can never go back.

Survivors are who we are.

We are in an exclusive club that no one wants to join. But once we join, we feel an instant bond with all the other people who have been given that horrible one-word diagnosis.

I did not understand this before, but now that I have joined the club, I get it.

Survivors see the world just a little bit differently.
– Laurie Azine

Indeed: an instant bond, an exclusive club.

Right then and there, at that particular moment in time, I thought, I get it, too.

Heather Thompson Buum is an internal medicine physician and author of With Mirth and Laughter: Finding Joy in Medicine After Cancer and Mirth is God’s Medicine: Coping with Cancer as a Physician. She can be reached at her self-titled site, Heather Thompson Buum.

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