The Good, the Bad, and the Hopeful
by Sallie Weissinger
Each morning the PINCC clinicians train the local doctors and nurses while non-medical volunteers interview the day's 45 patients, noting their medical histories and highlighting details that might be of interest to the clinicians (previous PAP or biopsy results that turned out positive, for example). Then we log the sheets and pass them on to the PINCC nurses and doctors and the local trainees for their breast exams, pelvic exams, and visual inspections.
On Thursday Mary Johnson came to the clinic for a PINCC exam. A stylish, poised, articulate divorced woman in her late thirties, Mary is a school teacher with three daughters. When the interviewer asked when she had her last PAP test, Mary said it had been more than five years. She said she'd been too busy teaching her students and taking care of her daughters. The interviewer - that was me - said the best way for her to take care of her students and her daughters was to have a regular PAP test. She said she knew that and would make sure to have her PAPs in the future. We talked at some length about the importance of regular check-ups.
I also asked whether she currently had a husband or partner. She said she didn't want to be with a man because she didn't trust one to not abuse her daughters. She said that her children were her major concern - they were pre-teens and teenagers, and she would not put them at risk. I wished her well, she promised me again she would take care of herself, and I assumed her exam would turn out well.
Thursday night, as is often the case, the entire group got together before dinner to socialize. Program Coordinator Carol Cruickshank, whose energy, dedication, and kindness simply never flag, asked us to share our impressions about what we had seen this week. She specifically asked us to focus on the pain we had experienced and asked us to share coping strategies. As part of the gathering, the doctors and nurses opened up about their patients. I learned that two of our doctors had seen Mary and that it didn't look good. Because her cervix wasn't entirely visible, they had to do a rectal exam and felt a bulky area that was suspicious for cancer. They ordered a biopsy, with results to come back from Managua in two months, and a PAP smear. The PAP came back as normal, but her situation is still concerning. Both doctors are hoping for a possible non-cancerous diagnosis - extremely bad endometriosis? post-menopausal atrophy (although Mary isn't post-menopausal)? - the outcome isn't promising, but they hold a glimmer of hope.
How do the PINCC doctors and nurses deal with the reality of a likely devastating outcome for Mary? Both Pamela Lotke, our medical director, and gynecologist Sharry Kreitlow say they usually are able to focus on the many patients they can help rather than on the occasional patient with certain or almost-certain cancer. The good results far outweigh the bad. But Pam's misted-over eyes and Sharry's serious tone of voice showed that they can't always focus only on the good side of their work. We all were silent after they spoke, silently hoping for the unlikely: a good outcome for Mary, her children, and her students.