Embodied teaching

by Maria L. Evans

“Take,​ ​eat: This is my Body, which is given for you. Do this for the

remembrance of me.”–from the Words of Institution, Eucharistic Prayer A, p.362, Book of Common Prayer

I wish I had a dollar for every case of a less than one centimeter diameter ductal carcinoma-in-situ of the breast that I’ve shown at our hospital tumor board for the last 14 years, looked at our clinical medical students, interns, and residents, and said, “I don’t know if this is the luckiest woman in the world or the unluckiest one. She’s 99% likely cured after her sentinel node, radiation, and Tamoxifen, but she’s hung with a cancer diagnosis for the rest of her life, for something that really, biologic-behaviorally-speaking, is a notch just below a full-blown cancer. The bigger thing is her risk for subsequent breast cancer.”

On Monday, March 17, 2014, that person became me.

Stage zero ductal carcinoma in situ, 3 millimeters in diameter, all removed on the needle biopsy, no residual tumor seen in the lumpectomy, two negative sentinel nodes, a course of radiation, and the thrill of taking Tamoxifen for the next five years.

I had to laugh that the most common question that has been asked of me is not “how are you?” but “did you look at your own slides?” (Answer: Yes, but my associate signed out the actual case. I was, after all, kinda busy at the time.) I mean, really, my DCIS (we tend to call it by its initials) pretty much looks like everyone else’s DCIS. I’m happy it’s now residing in a fixed paraffin block and on a few microscope slides in a drawer in our storage room.

But I had an added hurdle to deal with that most people in my shoes don’t even have to consider.

Remember what I said earlier about the monthly Tumor Board conference? We do a conference where we show and discuss every full-blown cancer case to every one of our trainees from 3rd year med students on up. My case history, my mammograms and ultrasounds from the last several years, my tumor in living color, projected three feet high on the smart board. We discuss what’s in store for the management of every patient. We discuss their various body parts and what’s going on with them…and I am the chair of that conference.

Several folks said to me, “You know, we don’t have to show your case if you don’t want to.” I said, “Are you kidding? This is a very classic case and they need to see the changes in the mammograms over time. It’d be a disservice not to show this case. Also, it sends a bad message when we say that they can learn from all the patients except the ones who also happen to be their teachers.” I put on a very brave face while thinking, “Oh my God. I’ve got to talk to all these young docs and docs-to-be about my boob.” Then another thought crossed my mind. I remembered the time I had a thrombosed hemorrhoid. None of the students or residents wanted to examine it, since I was one of their attending docs and teachers. It was clearly uncomfortable for them, as well as me–only in different ways. I strongly felt this had to be done, but I also knew there would be discomfort for them, and a very real chance I’d tear up or my voice would break.

I prayed about this one a lot…and in my prayer time something came to me. Jesus didn’t just teach with his words, he taught with his body itself. He taught with his healing touch, of course, but the fundamentally more important thing was that he taught with his broken body, hanging on the cross–and that three days later, the end of that body wasn’t really “the end.” It’s also clear that this method of teaching was uncomfortable for his disciples–so uncomfortable, in fact, that it was down to only a devoted few present for the very end.

“Well,” I thought to myself, “If Jesus could be vulnerable to the world with his broken body, I suppose I can stand a little vulnerability and discomfort about my broken left breast.”

The April Tumor Board date came, of course, and we discussed and showed my case just like everyone else’s, with one addition. I turned to the group and said, “I guess you all have figured out with the age and the initials M.E. on the title of this case, that this patient is me. You have an opportunity today you don’t normally get in this conference. I’d like you to take a deep breath, and ask me anything–and I mean ANYTHING. I’ll try to answer as best as I can.”

Everyone squirmed in their seat in silence at first…and one by one the questions trickled in…at first they were very clinical. But then someone asked me, “What are you most afraid of about this?”

I took a deep breath. “Well, I’m not afraid of this particular tumor. It’s gone, and I’m only a stage zero. It’s highly unlikely I’m going to die from this. But I’m pretty nervous as to how the radiation is going to make me feel…and I’m really nervous thinking about the genetic testing that I’m going to do once my deductible is squared away and the insurance will hopefully pay for it. Not so much about the breast side of things–I’ve been diligent about my screening mammograms for a long time, and I know the drill there. But I don’t like the idea of possibly having the BRCA gene, because if I have that, it also comes with a 40% risk of ovarian cancer, and I’ll have to give serious consideration to having my ovaries yanked. I’m way more afraid of ovarian cancer.”

All my career, I’ve made my living being just a tad intimidating with the youngsters. But in my heart, I knew the real teaching would happen if I could bring myself to being vulnerable, and a lot of it did, over the next few days, in the hallways, and at the other side of my two-headed microscope. It would go something like this:

“I’m really lucky,” I continued. “I have a very curable tumor, I have insurance, and I know this stuff like the back of my hand. But I lie in bed at night and think, “How do people pay for this stuff when they don’t have insurance? They don’t, that’s how. They go bankrupt trying or they don’t even do the things that you and I routinely know need to be done…and even when they are able to make at least some choices, they’re doing it with far less understanding than I have. I have found myself crying over the pain of a broken world a heck of a lot more than I’ve been crying over me. If I have cried for myself, it’s from having been shielded from the truth about my unseen privilege. It’s not popular to say the playing field needs to be leveled when it comes to health care, but I believe it more than ever.”

The reality is that all of us have opportunities all the time to teach with our bodies. Some folks have no choice or few choices as to how that teaching occurs. How will those of us who do have some choices, teach with our bodies in a way that we reveal our vulnerability in a Gospel sort of way?

Maria Evans, a surgical pathologist from Kirksville, MO, is a grateful member of Trinity Episcopal Church and a postulant to the priesthood in the Episcopal Diocese of Missouri. She occasionally finds time to write about the obscurities of life, medicine, faith, and the Episcopal Church on her blog, Kirkepiscatoid.

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