Adrienne

I met Adrienne as an intern, when I admitted her to the hospital. She was an attractive, engaging woman, a junior faculty member at a nearby liberal arts college. She spoke with an Australian accent in a low voice that was serious, earnest, and playful all at once. She had done some camping a few weeks before and strained her back. She was sure that carrying heavy packs had caused the strain, but since it hadn't gotten any better, her physician felt that she should come into the hospital.

I guess I wasn't a very good interviewer back then. Somehow I had failed to elicit the fact that she had a mastectomy.

I was still at a stage when I felt uneasy examining young women. When it was time for the breast exam, I raised her gown to below her ribs and hesitantly began to examine her breasts. I was shocked that her left breast was missing. Oh that, she responded cheerfully, I had cancer a few years ago but the mastectomy cured it. I don't give it much thought anymore. I was instantly saddened, knowing that the cause of her back pain might be a metastatic lesion. I stumbled through the rest of our conversation. I agreed with her that the heavy pack had probably caused her back strain and that with a little conservative care, she would be better in no time.

The following afternoon I looked at her spine films with my resident. I remember him saying, She's got it, all right. She'll need to be checked for other mets. She'll need castration, radiation, chemo, the works. I didn't go back …