The other day I went into a checkup feeling fine and went out feeling anxious, and all because of one innocuous word that the doctor said.
She probably didn’t mean anything by it. But the way I heard it, it was loaded with meaning.
“You’re lucky because your squamous cell cancers are still on the skin,” the dermatologist said.
“Still?” I said.
I tapped her on the arm.
“Did you have to say still? Couldn’t you say it any better way?”
“Well,” she said, “We’re all just still here. We never know what’s going to happen tomorrow.”
But, she added quickly, “You’re lucky your Dana-Farber team follows you so closely.”
I’m writing about skin cancer on a blood cancer site because stem cell transplant recipients seem to be susceptible to second cancers, including squamous cell cancers.1
I have had so many of these that I lost count. Luckily, they have all been “in situ,” on the skin. Though some have been deep enough to require Mohs surgery, in which a surgeon removes a layer at a time until the margins are clear.
A friend with Type 1 diabetes also bristled at the word still. So I know it is not just me.
Her doctor had asked, “Do you still feel your lows?” This implied that the time could come when she would not have the signals telling her when to treat dangerously low blood sugar (hypoglycemic unawareness).
My friend was upset.
She thought a better way would have been, “Do you feel your lows?”
She was hoping that she would always feel them, and the doctor’s use of the word “still” implied that she might not.
This is both a case of us giving the medical profession too much power and of them not being sensitive to the way patients hear things.
Because, obviously, their language – in this case the use of the word still – has no power to make us better or worse or stay the same.
It reminded me of an experience about 10 years ago when a physician’s assistant upset me with her choice of word. It wasn’t the word itself, but how she used it in a sentence.
What patients hear
The word: assuming.
It was when I had graft failure after my second stem cell transplant. The donor’s cells had disappeared. I hadn’t relapsed, but I was sick. Since I didn’t have much of an immune system, it was a challenge to get me well.
My sister, Diane, was in a chair in my hospital room. I was in the bed eating breakfast. The PA who was taking care of me walked into my room to tell me the day’s plan.
“Assuming you get better….,” she said. I didn’t hear the end of the sentence. I was stuck on the word assuming, the conditional nature of it. As in, I might not get better. I dropped my spoon.
Diane said, “My sister doesn’t like that you said assuming.”
The PA replied, “Well, of course we assume you’ll get better. That’s why we have a plan.”
After the “still” experience with the dermatologist, I called the friend who has diabetes.
“Well, she said, we’re still here.”
Stem Cell Transplant Side Effects. American Cancer Society. Available at https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/stem-cell-transplant/transplant-side-effects.html