The young woman’s voice shook as she introduced herself to me on the phone. I had received a referral to see her from one of the nurses after she disclosed that she was having problems in her relationship. Over the course of an hour, Jamie* told me the story of her cancer. She had been diagnosed with cervical cancer 9 months before and had been treated with brachytherapy. As she described the treatment she started to sob, and it was difficult to hear her words. I waited for her to finish talking and then asked permission to follow up with some questions.
Like many women who undergo radiation to the pelvis, she had found the entire experience to be traumatizing. Everything that she had gone through felt like a violation to her and the invasive nature of the treatment itself was something she could barely talk about. She said the nurses had been very kind when she had the radiation treatment; they had given her some sort of sedation, but just knowing what was going to happen was upsetting. Now, months later, she did not have a clear recollection of the procedure.
As part of her follow-up care she had to be seen every 3 months and she hated the internal examinations. The anxiety she experienced for weeks before the appointment interfered with her ability to work and she wasn’t able to sleep the night before her appointment or the week after while waiting for the results. She recognized that she was not coping with any of this but had been reluctant to ask for help in case she was seen as being weak.
I asked her about how this was causing problems in her relationship. Her voice was stronger now and she was no longer crying. She said that her boyfriend was not supportive enough and he seemed mystified why she was so anxious, because in his mind, she was cured. She had tried to explain her feelings to him and her fears about the cancer coming back, but he tried to reassure her that she was fine and should be back to normal.
“He even suggested that I was using this as an excuse not to have sex with him! The main reason that’s not happening is because of his attitude!”
We talked about this a bit more and her anger and disappointment in her partner were clear. I am always hesitant to focus on just one side of the story and I suggested that I meet with the couple in the near future so that he could tell his side of the story and I would try to help them negotiate this challenge in their relationship.
“What is the most important thing that you want to address today?” I asked.
There was silence for a while, but I could hear her crying softly.
“I have to go back next week for another follow-up appointment and I’m terrified…. And because of COVID I can’t take my mom with me and I don’t think I can handle it!”
The COVID-19 pandemic has resulted in restrictions in many cancer centers and hospitals on patients being accompanied by a family member or friend. There are exceptions, of course, but for routine care, patients are usually instructed to attend appointments alone. This has caused hardship and heartache for many but is necessary to reduce the number of people in the health care setting.
I suggested to Jamie that she call the nurse from the clinic and explain that she needed to have her mother with her for emotional support. The response was not what either of us wanted.
“She said that she didn’t have the authority to change the rules.”
I could hear the exasperation in her voice, tinged with no small amount of distress.
“What if I called the nurse navigator who works with that group? Would it help you if she met you at the clinic and stayed with you? I can’t promise that she’ll be able to but it’s worth trying…”
This prompted her to start crying and once again I was reminded how difficult this was for her. I ended our call and immediately emailed the nurse navigator. Fortunately, she was available at the time of the appointment and promised that she would be there to support Jamie. I relayed this information to Jamie, who expressed her gratitude to me.
One afternoon the next week, Jamie called me. I had been expecting her call and was hoping that her appointment had gone well.
“I got through it, Dr. Katz! I didn’t think I could, and I nearly didn’t go. But I did it!”
“I knew you could do it, Jamie!” I responded.
“And Nancy, the navigator nurse, was so helpful. She really calmed me down, she was even waiting for me when I got there. And she came with me into the examination room and she held my hand the whole time… it was as scary as it always is… but I got through it!”
“Yes, you did, Jamie, and I’m really pleased that Nancy helped you. But we need to talk about what you are going to do the next time, and the next. And if you are willing, we should engage your boyfriend in a conversation about how best to support you…”
There was a pause before she answered.
“I guess so but….”
I expected this reluctance from her. She was feeling so good about the appointment and her success at getting through it that it camouflaged her usual fears and distress. But I have patience and I know that she will contact me again, probably in the weeks before her next appointment. I can wait.
*Name and details changed for privacy.