Beyond the Scalpel: A Surgeon's Perspective on the Emotional and Psychological Impact of Breast Cancer

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Coming up on this episode of the
Healthy, Wealthy and Wise podcast.

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Let me say a, a quick word
about the breaker gene, a BRCA.

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The breaker gene is something that most
of you will probably never encounter.

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Thank goodness.

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It is a genetic abnormality that
only occurs in probably 1 percent of

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the population, female population.

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Uh, it is highest among women,
well obviously women, among

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Caucasian women usually.

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Of Jewish ancestry.

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Um, but what it

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does though, it it, welcome to the
Healthy, wealthy and Wise podcast with Dr.

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William t Choctaw, MDJD.

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This podcast will provide you with
tools and actionable information

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you can use to help live a more
healthy, wealthy and wise life.

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It's powered by the over 50 years of
medical experience of this Yale University

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medical school trained surgeon who is
also a western state law school trained.

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With executive experience being a former
mayor of Walnut, California, as well

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as the current chairman of the non
profit Servants Arms, and as president

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of Choctaw Medical Group, Incorporated.

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This is the Leadership Masterclass
Edition, already in progress.

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Uh, obviously, uh,

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surgeries themselves all have
various types of checks on patients.

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Um, breast cancer surgery or
breast surgery has a huge, as we

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mentioned, psychological effect.

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And I can tell you, uh, I've had patients
where once they've been diagnosed, and

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a lot of my patients are young patients,
when I say young, I mean less than 60.

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I mean in their fifties and whatever,
even in their forties, um, and

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sometimes their partner leaves.

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Sometimes their partner says,
I'm out, I'm out, I'm out.

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And as you could imagine.

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What that does to the patient,
you know, so now not only does she

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have to go through this, but she's
got to go through this without

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her partner, without her partner.

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Um, and so you have to be
patient, uh, in terms of walking

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them through this process.

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Um, and you sort of have to, you, you just
sort of have to be there with, with them.

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Um, one of the things that I noticed
one time in my practice, um, and I, and

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I learned that toward the, I would say
maybe the last five or ten years of my

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practice, I started seeing more and more
and more patients with breast masses.

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And I was trying to figure out, I said,
why am I getting so many patients with,

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with breast lumps and breast masses?

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And I, as a general surgeon, I do
gallbladder surgery, I do, um, stomach

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surgery, um, you know, hernia surgery, all
that, uh, other types of cancer surgery,

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but obviously in a very large percentage
of patients with, with breast lumps.

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And what I found out was, uh, it was
not necessarily because I was the

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world's greatest surgeon, uh, which
meant that what I wanted to think,

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but to be honest with you, true story,
I was the only surgeon in the area

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who was willing to take Medi Cal.

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I was the only surgeon who
was willing to take Medi Cal.

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The other surgeons.

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In general, um, I refused to take
Medi Cal because it didn't pay it,

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um, and you know I just said it is
what it is, you know, this is what

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I'm supposed to do, um, uh, but it
was interesting, it was interesting.

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And one final note about the surgery
part of it, uh, is that I would come

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to, another thing that would strike
me, and it's amazing how little

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things strike you, I would come and I
would look out over my waiting room.

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Um, and I would see a lot of
scarves and hats, scarves and hats,

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scarves, head scarves and hats.

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Right?

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Uh, and the reason is that those who
are going through chemo, they lose

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their hair, they lose their hair.

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So then they have scarves and hats, they
wear very nice hats and very nice scarves.

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And indeed, you know, most
hospitals, uh, certainly our

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hospital did, uh, have departments
where they can go and check out.

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Attire, because that's a big
part of feeling good about who

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you are and what you are, right?

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Um, um, uh, but, but it's just,
and, and then the hair comes back.

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The hair comes back.

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Um, and it is lighter and brighter and
curly and on and on and on and on and on.

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Um, so it's, it's, it's
an interesting process.

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It's, it's a very interesting process.

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Uh, let me say a, a quick
word about the breaker gene.

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A BRCA.

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The BRCA is something that
most of you will probably never

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encounter, thank goodness.

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It is a genetic abnormality that only
occurs in probably one percent of

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the population, female population.

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Uh, it is highest among women,
obviously women, among Caucasian

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women, usually of Jewish ancestry.

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Um, but what it does though, it It,
it spreads breast cancer generation to

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generation, uh, at rates of five and
10 percent if not higher, to the extent

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that if a patient is found to have this
gene, uh, her physician will immediately

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tell her, you need to let everybody in
your family to know, the women in your

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family, that this is in your family and
they need to go and, uh, And, and get

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tested or they need to make decisions.

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Give an example.

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Uh, some women will say, I just found
out that my aunt had the breaker gene

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and I want a prophylaxis mastectomy.

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Uh, I don't want to worry about this,
blah, blah, blah, blah, blah, blah, I

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don't want anything to do with this.

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Uh, so different people make,
make different decisions.

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Fortunately, you probably
won't have to deal with this,

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but I do want to mention it.

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Uh, just, um, as a matter of,
of, of education about it.

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Let, let me sort of conclude, um, With
the lessons that I've learned from my

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patients, uh, in, in my practice, um, and
this again, I started private practice in

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San Gabriel Valley, Queen of the Valley
Intercommunity Hospital in 1981, uh, 1981.

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Um, and I closed that
practice probably around 20,

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20, um, 2018 and 2019, or 2016.

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Okay.

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I'm, I'm, I'm looking at my
office manager who's sort of

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giving me signs, you know, 2016.

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By the way, let me also say, and
I just reminded myself, but when

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I was talking about communication,
you know, I, I pride myself.

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And then able to speak a little Spanish.

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You know, I mean, I can, you know, I,
I can have that communication with the

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brotherhood and the sisterhood, right?

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I should say my wife right
now is covering her face.

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She's got her head down
as I'm saying this.

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All right.

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But needless to say, needless to
say, I call it medical Spanish.

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You know, you get where I'm coming from.

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But what I've learned is when the
patient has the possibility of any

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type of cancer, I don't even try.

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I immediately bring in a person who is
fluent in Spanish because what's my point?

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What did I say before?

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Communication is mostly non
verbal, you know, and so I don't

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want to say something or move a
certain way or move my head aside.

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I want to make sure that communication
is clear and above board and that

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I don't miss something that the
patient's trying to communicate to me,

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but because I'm so happy that I can
speak a few words, I'm not panicking.

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You see what I'm saying?

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Um, uh, office manager.

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True story.

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I went to her when I
lost my office manager.

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I said, just come into
the office for a few days.

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You know, I just need a little help.

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I said, I'm going to hire somebody else.

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I just a few days, just a few days.

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I I'm already, I'm already
making phone calls already.

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You know.

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We didn't have internet then,
but I'm already looking.

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Well, she came to the
office and she never left.

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And after about 30 years later,
she was still running my office.

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But I was very blessed that I could
call in my office manager, and she

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would come and sit with me, and we would
go down this road with this patient.

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And a large percentage of
my patients were Hispanic.

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Most of my patients were
either Caucasian or Hispanic.

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Um, um, smaller percentage were
African Americans or Asian.

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What are some of the lessons
that my patients taught me?

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Um, one, breast cancer is complicated.

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It's complicated.

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And what do I mean by complicated?

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I'm not talking about
complicated pathologically.

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I'm talking about complicated
in terms of people.

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Everybody is different.

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All breast cancers are not
created equal and I don't care

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what type it is or how big it is.

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If it's in you, it's different
than if it's in somebody else.

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Number two, quality of life is more
important than quantity of life.

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What I've learned is that
patients who have the ability to

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be positive tend to do better.

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Not sure why that is.

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It's just something that I noticed.

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Number three, patient experiences are
different even with the same illness,

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sort of like what I mentioned before.

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Number four, none of us have absolute
control over healthcare events.

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It does not matter how many
schools you've gone to.

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It does not matter how
many degrees you have.

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Everybody is different.

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And if you do not learn humility as a
physician, uh, become a cancer surgeon.

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You will learn humility very quickly.

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Um, and certainly, so what you figure
out is you are not in control of this.

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You may do stuff that helps people,
but you are not in control of this.

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And I try to have this conversation
with the patients and I usually start

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off with something like saying, uh,
and my approach is I would do my

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surgeries on Thursdays and Fridays.

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The results would be
ready by Monday morning.

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Um, and so every Monday I knew going
in, it was going to be a good day.

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Uh, for some people or not a good
day for some people and my approach

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is I didn't beat around the bush.

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I said, this is Jones.

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Um, the catheter board shows that
that lot we took out is cancers.

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And then I said something, now let
me tell you what we're going to do.

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You know, let's, let's
talk about your journey.

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Um, and so, um, I've learned to
expect the unexpected, um, next,

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uh, we will never understand why.

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Many patients will say,
doctor, why do I have this?

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I eat right, I exercise, I blah
blah blah blah blah blah blah blah

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blah, and I would say, um, Mrs.

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Sanchez, I do not know.

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I honestly do not know.

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Um, um, next thing my person's taught
me, uh, that doctors help, God heals.

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Uh, we, we may be able to help
the patient and that's our job,

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to help, but I can't heal you.

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I really can't.

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That, that's really your body and
the stuff that's in your body that

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I didn't put there, that I have no
control over, uh, but that works in

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spite of me and in spite of you, by
the way, especially when you sleep.

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Um, and that's a much higher power than,
than we humans, a much higher power.

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Um, uh, the next thing, it's okay to hug.

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Now, when I graduated from medical
school, we were told you were a surgeon.

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You know, you, you, you put distance
between you and that patient.

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You do not show emotion, blah,
blah, blah, blah, blah, blah.

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And I would argue certain
personalities go in the surgery.

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Um, so when you hear about the surgeon
being very this and that, I understand

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that actually I used to be that way.

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Um, but my patients have
taught me it's okay to hug.

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It's okay to, it's okay to cry, you
know, you definitely wouldn't do that.

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You know, uh, the instructors
would say, no, no, no, no, no.

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Then you lose perspective and
how can you treat people if

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you're not, blah, blah, blah.

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But what I've learned is that
it doesn't change who you are.

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It doesn't make you less than action.

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Makes you more than, you know, 'cause
patients, oh my God, he's human.

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My doctor's human, or she's human.

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Uh, and so.

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My experience, my experience, what my
patients have taught me, that those

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are assets, they're not liabilities.

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Um, and that caring is therapy, and
that indeed, expressions, appropriately,

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say, appropriate expressions of, um,
compassion and caring under appropriate

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circumstances are therapeutic.

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Um, and I will always
remember these lessons.

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And finally, I can always say, um,
uh, someone once asked me about

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where this quote came from, and I
don't know whether I mentioned it.

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This is from Gandhi, um, uh, and,
um, But I, I always loved it when

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I heard it, and so I always use it.

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Be the change you want
to see in the world.

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Thank you for listening to the Healthy,
wealthy and Wise Podcast with Dr.

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William t Choctaw, MDJD.

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You can listen again to this and
any of the previous episodes.

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Leave a comment or pose questions to
the doctor by going to www.twp.com.

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That's www.thwwp.com and you've got it.

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It's also available wherever
you get your podcasts.

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Be sure to follow, like, share, and
subscribe if you haven't already.

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Then tune in for the next
episode of the Healthy, Wealthy,

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and Wise podcast with Dr.

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William T.

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Choctaw, M.

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D., J.

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D., a production of Changemakers
Communications, LLC.