Bad News

We specialize in good news. You don't have a dread disease, we tell people. You aren't contagious or repulsive. That spot isn't cancer after all, and even if it is, we can take care of it. They shower us with thanks and praise.

But not this time.

I had seen Heather on Wednesday, a vibrant, self-confident young woman from Colorado with the milkiest, bone-white skin one could imagine. She spoke of summer research and plans for a career in science. She had a mole in her groin that was rubbing. I'd like to have it off before I go home, she said. Shave removal was quickly done.

Her biopsy report came to my desk at the end of Thursday. Melanoma, Clark level IV, almost 3 mm thick, with polypoid architecture.

Shock gave way to uncertainty. How to tell a young woman I hardly know troubling news for which she is totally unprepared? Certainly not on the phone.

I called her cell. Where are you? I asked. I was relieved to hear her say that she was just a few blocks from my office. Come over right now please, I said, I have to talk to you.

Ten minutes later, Heather sat in one of my exam rooms. A young man stood in the waiting area.

I faced her. I don't have good news, I said. The mole I took off yesterday turned out to be cancer.

Her eyes widened. What do you mean? she asked. What kind of cancer?
Melanoma, I said. It could be serious.

Heather started to weep. She said, but that doesn't make any sense! Skin cancer is from the sun. I haven't been in the sun. Ever! This can't possibly be true, she said. How can this be happening? Why is it happening to me? It isn't fair, it doesn't make sense!

I agreed, of course, but this was not the time to say so, to say anything at all. Heather wept with agitation. I joined her, but just a little, out of decorum.

After a while, we spoke of steps to take. She had to call her parents. I offered to assist.

It would be best to go home right away, I said, not wait for classes to end. She would need the cancer removed, staged. Further treatment might possibly be needed. Possibly! she cried, her voice heavy with sarcasm, fear turning to fury.

I invited her friend in to console her. Dad did not answer. I gave Heather my cell number, so he could reach me later. She and her friend embraced, alternating tears and laughter. Both soon left the office, our acquaintance intense but brief. I had barely met Heather, and won't be seeing her again.

That evening and much of the next morning were taken up with explanations to parents and calls to doctors in Heather's hometown. She arranged to leave school and schedule a prompt consultation with a surgical oncologist. Details are easier to confront than the enormity of what occasions them.

Why me? Why now? Every ill person asks these questions, but who can say? Is it my food, my behavior, my genes? Is it my fault?

Never mind, we say, let's just try to make you better. Though we rarely know the whys of things, it usually does not matter that much. But sometimes it does matter that much. Why should a young woman with her whole life before her be in mortal danger? As Heather saw at once, it isn't fair, it makes no sense.

No, it doesn't. But there is little to do besides attend to logistics and leave to other counselors the job of helping her confront what no one can explain.

We specialize in good news. You don't have a dread disease, we tell people. You aren't contagious or repulsive. That spot isn't cancer after all, and even if it is, we can take care of it. They shower us with thanks and praise.

But not this time.

I had seen Heather on Wednesday, a vibrant, self-confident young woman from Colorado with the milkiest, bone-white skin one could imagine. She spoke of summer research and plans for a career in science. She had a mole in her groin that was rubbing. I'd like to have it off before I go home, she said. Shave removal was quickly done.

Her biopsy report came to my desk at the end of Thursday. Melanoma, Clark level IV, almost 3 mm thick, with polypoid architecture.

Shock gave way to uncertainty. How to tell a young woman I hardly know troubling news for which she is totally unprepared? Certainly not on the phone.

I called her cell. Where are you? I asked. I was relieved to hear her say that she was just a few blocks from my office. Come over right now please, I said, I have to talk to you.

Ten minutes later, Heather sat in one of my exam rooms. A young man stood in the waiting area.

I faced her. I don't have good news, I said. The mole I took off yesterday turned out to be cancer.

Her eyes widened. What do you mean? she asked. What kind of cancer?
Melanoma, I said. It could be serious.

Heather started to weep. She said, but that doesn't make any sense! Skin cancer is from the sun. I haven't been in the sun. Ever! This can't possibly be true, she said. How can this be happening? Why is it happening to me? It isn't fair, it doesn't make sense!

I agreed, of course, but this was not the time to say so, to say anything at all. Heather wept with agitation. I joined her, but just a little, out of decorum.

After a while, we spoke of steps to take. She had to call her parents. I offered to assist.

It would be best to go home right away, I said, not wait for classes to end. She would need the cancer removed, staged. Further treatment might possibly be needed. Possibly! she cried, her voice heavy with sarcasm, fear turning to fury.

I invited her friend in to console her. Dad did not answer. I gave Heather my cell number, so he could reach me later. She and her friend embraced, alternating tears and laughter. Both soon left the office, our acquaintance intense but brief. I had barely met Heather, and won't be seeing her again.

That evening and much of the next morning were taken up with explanations to parents and calls to doctors in Heather's hometown. She arranged to leave school and schedule a prompt consultation with a surgical oncologist. Details are easier to confront than the enormity of what occasions them.

Why me? Why now? Every ill person asks these questions, but who can say? Is it my food, my behavior, my genes? Is it my fault?

Never mind, we say, let's just try to make you better. Though we rarely know the whys of things, it usually does not matter that much. But sometimes it does matter that much. Why should a young woman with her whole life before her be in mortal danger? As Heather saw at once, it isn't fair, it makes no sense.

No, it doesn't. But there is little to do besides attend to logistics and leave to other counselors the job of helping her confront what no one can explain.

We specialize in good news. You don't have a dread disease, we tell people. You aren't contagious or repulsive. That spot isn't cancer after all, and even if it is, we can take care of it. They shower us with thanks and praise.

But not this time.

I had seen Heather on Wednesday, a vibrant, self-confident young woman from Colorado with the milkiest, bone-white skin one could imagine. She spoke of summer research and plans for a career in science. She had a mole in her groin that was rubbing. I'd like to have it off before I go home, she said. Shave removal was quickly done.

Her biopsy report came to my desk at the end of Thursday. Melanoma, Clark level IV, almost 3 mm thick, with polypoid architecture.

Shock gave way to uncertainty. How to tell a young woman I hardly know troubling news for which she is totally unprepared? Certainly not on the phone.

I called her cell. Where are you? I asked. I was relieved to hear her say that she was just a few blocks from my office. Come over right now please, I said, I have to talk to you.

Ten minutes later, Heather sat in one of my exam rooms. A young man stood in the waiting area.

I faced her. I don't have good news, I said. The mole I took off yesterday turned out to be cancer.

Her eyes widened. What do you mean? she asked. What kind of cancer?
Melanoma, I said. It could be serious.

Heather started to weep. She said, but that doesn't make any sense! Skin cancer is from the sun. I haven't been in the sun. Ever! This can't possibly be true, she said. How can this be happening? Why is it happening to me? It isn't fair, it doesn't make sense!

I agreed, of course, but this was not the time to say so, to say anything at all. Heather wept with agitation. I joined her, but just a little, out of decorum.

After a while, we spoke of steps to take. She had to call her parents. I offered to assist.

It would be best to go home right away, I said, not wait for classes to end. She would need the cancer removed, staged. Further treatment might possibly be needed. Possibly! she cried, her voice heavy with sarcasm, fear turning to fury.

I invited her friend in to console her. Dad did not answer. I gave Heather my cell number, so he could reach me later. She and her friend embraced, alternating tears and laughter. Both soon left the office, our acquaintance intense but brief. I had barely met Heather, and won't be seeing her again.

That evening and much of the next morning were taken up with explanations to parents and calls to doctors in Heather's hometown. She arranged to leave school and schedule a prompt consultation with a surgical oncologist. Details are easier to confront than the enormity of what occasions them.

Why me? Why now? Every ill person asks these questions, but who can say? Is it my food, my behavior, my genes? Is it my fault?

Never mind, we say, let's just try to make you better. Though we rarely know the whys of things, it usually does not matter that much. But sometimes it does matter that much. Why should a young woman with her whole life before her be in mortal danger? As Heather saw at once, it isn't fair, it makes no sense.

No, it doesn't. But there is little to do besides attend to logistics and leave to other counselors the job of helping her confront what no one can explain.