Zebra

I had three appointments at UCSF on Friday.  I viewed them as information gathering appointments that I thought would reconfirm my decision to have my mastectomy and treatment here in Santa Rosa.  But surprisingly just the opposite happened. 

Kamin drove me north in the early morning hours from the vacation home my classmates had rented between Carmel and Big Sur to meet my parents at the Mt. Zion campus of UCSF.  Over the next 5 hours worth of consults I had a glimpse back into the world of medical academia.  I met three new attending doctors but also many fellows, residents and a very quiet, smiling medical student with a smart phone harnessed to her blue scrubs. 

The whole experience brought me back not to residency, but to medical school at Stanford.  Santa Rosa is a special place to train.  Residents have significant autonomy.  After intern year, our supervision occurs more discreetly in the clinic workrooms and little comes between each resident and her patient when providing clinical care.  At major academic medical centers, there are many layers of trainees.  Although it had been three years since I had been in this setting, and certainly longer since I had a been a patient in this setting, I slid right back in. The parade of student, resident, fellow, attending did not seem odd to me.  I was not surprised when they made errors or contradicted each other.  It was only after glancing over at my semi-horrified Mother's face during the third consult that I realized this indeed was a circus.   

There is a slang term "medical zebra" for a rare diagnosis or unusual medical situation. "If you hear hoof beats behind you, don't expect to see a zebra."  It is a common medical trainee mistake to jump to the rare diagnosis rather than the more likely, common one.
 
Breast cancer is common.  But what hit me half way through my appointments at UCSF was that I am a medical zebra because of my age, because there is something funky with my breast tumor biology, because likely I have a mutation that has not yet been discovered.  And when you are a zebra, it feels safer to be in the circus because other zebras have flocked there too and you are not alone in the herd. 

Nitty Gritty:
What we do know:
1. I will be have my mastectomy at UCSF, date to be determined.
2. The results of my MRI could not have been better. No other tumors on the cancer side.  No disease on the non-cancer side which means I am still going for a unilateral mastectomy as I had hoped.
3. Her2 status is still up in the air.  My biopsy is on its way to UCSF to be re-checked.