At 62, I unwittingly became a cliché: the physician who makes a poor patient.

The hard lump in my right breast, directly inferior to the nipple at the 6 o’clock position, shocked and shook me in the middle of a long August night when it first poked me as I tossed and turned my way through a bout of insomnia.

A screening mammogram for September 12 had been on my calendar for weeks already, ever since my PCP looked at me sadly during a follow-up visit, shook her head, and said, “You are messing up my mammography numbers.” Chastened and chagrined, I got on the schedule.

The scheduling trap

Tense weeks passed, glacially. On the day I was finally to do the deed, I screwed my courage to the sticking place and pointed my car north to the smallish community hospital that had offered me the earliest appointment. What scheduling failed to tell me was that screening mammograms apply only to asymptomatic women. This distinction lies well outside my professional and highly specialized area of medical expertise. As a physician, should I have known this? Perhaps. But if, as a physician, I did not, what chance does the average patient have? Radiology scheduling scripts should reflect this.

My diagnostic mammogram got scheduled for October 3. Weeks away.

Rosh Hashanah came, and I spent it floating in my pool, only somewhat comforted in my agony of waiting by a book from my rabbi, who has lived with metastatic breast cancer since mid-2020. On Yom Kippur, as the long, intense day wound toward its end, I stood in front of the open Ark containing the beautiful Torah scrolls bedecked in white. I prayed and cried as I have never prayed in my life. No atheists in foxholes, right?

A breach of privacy

The diagnostic mammogram took place the next day. As I sat in the waiting area, chafing in the johnny, one of the techs came out and directed her attention to the similarly attired woman sitting across from me. “Great news!” the tech said. “The mammogram looked fine, nothing to worry about.” First, this was a clear breach of patient privacy. But for me, already trembling from the dreadful possibilities, it felt even worse. The tech inflicted moral injury.

During the ultrasound-guided biopsy, the mammography images were on a computer screen in the ultrasound suite, and there it was, a blob of unwanted whiteness in my breast. During the biopsy, the radiologist stood to my right, referring to the computer screen to the left, about 18 inches from my face, as he guided his needle. I could see the ugly spiculated mass myself, and it looked enormous, undulating mockingly in response to the needle. I was stupidly proud of my stoicism after the radiologist left the room: I did not burst into tears; I did let loose a fusillade of very bad curse words. Stoic? Ha.

The role reversal

The pathology report arrived four days after the biopsy. The following morning, the Monday of a week filled with patient visits across my schedule, nausea paralyzed me. Except for the crying, gasping sobs alternating with mewling whimpers, without surcease for an entire week. During my consultation on Thursday, my surgeon broke the fourth wall: She scooted her rolling stool until she was directly in front of me, stared directly into my eyes, grasped my hands, and said, “You are struggling like this because you are accustomed to being the one offering comfort, not needing it,” or words to that effect. My breast surgeon is a humanist.

I hope it all makes me a better physician. As a neurologist who takes care of older adults with cognitive decline and dementia, I must make hard diagnoses, and believe me when I tell you there are things worse than Alzheimer’s disease. May I glean insight from my own experience to offer comfort in addition to the medical plan, soon and in our time.

The system has work to do, too. Patients face a system that all too often assumes they understand invisible bureaucratic distinctions. I mean, screening versus diagnostic mammography is operational trivia, not clinical wisdom. Physicians are not immune to that trap.

Staff need better training so that privacy violations in the waiting area disappear. Empathy must be championed from above and absorbed into the DNA of all who work in cancer centers and mammography suites. Failure to inculcate these values will perpetuate the kind of moral injury I experienced.

In the end, my surgeon was right. I struggled not simply because I had cancer, but because illness had forced me into a role for which my training had left me utterly unprepared. Physicians are taught, implicitly and relentlessly, to be the steady ones, the translators of fear, the dispensers of calm. We are not taught how to inhabit vulnerability without shame, or how to accept comfort without feeling we have failed. When my surgeon met my eyes and took my hands, she was not offering reassurance about margins or staging. She was naming the disorientation of a professional identity abruptly bereft of its usual defenses. In that moment, medicine felt less like an algorithm and more like a human art, one that I had practiced for decades, but only in that moment truly needed.

Amy E. Sanders is a neurologist.