Photo courtesy of Rachel

I found a lump. A poorly defined, approximately 3 cm x 4 cm area of dense tissue, lumpy type thing. In my chest. Specifically, on the side of my breast. I’ve also been having weird stabbing pains in my armpit. Oh and I have a family history significant for leukemia and some other cancers that I'm not sure of. All I know is that both sets of grandparents died of cancer.

This is where the intersection of minor amounts of medical training and neuroticism becomes dangerous. With finding a lump, reflexively, a differential diagnosis starts developing in my head…Fibrocystic change, fibroadenoma, mastitis, breast cancer…

Then of course I’ve got to work through the differential… I’m young, so it’s most likely fibrocystic change. Painful can mean infection…but there’s no redness, tenderness to suggest mastitis…Cancer can cause breast pain…

Instead of trying to be my own doctor, I should just go see a real one with years and years of relevant clinical experience. Then I could stop freaking out (usually while trying to fall asleep) about the fact that breast cancer is on the list of possible diseases I’ve diagnosed myself with. I could stop obsessively palpating my chest, trying to compare left to right, going a little crazy because self-palpating is hard to do, going even more crazy because I think I’ve palpated the spot to the point of bruising, and now it just hurts all over.

I know for a fact that if a friend or family member approached me with a story like this, I would’ve insisted upon (berated them into) seeing their doctor. “Why are you telling me this?” I’d probably yell. “No, I don't know what it is. Make an appointment with your doctor! ESPECIALLY if you think you felt a breast lump!”

But since it’s me, I just keep putting off a proper doctor’s visit. Part of it is that it’s almost impossible for me to see my primary care physician without taking a day off—she’s about two hours away from where I’m living. Thought the biggest factor is I don’t consider myself my top priority—getting through medical school is.

Yes, the thinking warped. Obviously I want to be reassured I don’t have breast cancer. At the same time, it is actually more important to me that I do well during this rotation, to the point where I refuse to let anything, anything, even my own health, get in the way.

My mentality isn’t exactly unique. Medical students and residents are probably some of the least healthy, most non-compliant, terrible patients you could ever meet. We eat like crap (fried cafeteria food, at all odd hours), exercise sporadically, are constantly sleep deprived and stressed, and too often use alcohol for stress relief. Pretty much we engage in each and every behavior we typically discourage patients from doing. Oh irony.

I can’t say I know what exactly we’re trying to prove to ourselves. I guess, in a way, the insane drive, the single-minded focus, is what helps us survive the doctor-training process.

Sometimes you need to hit rock bottom before you're ready to change. While discussing my breast pain with a friend, I actually said to her, “Eh it’s probably not breast cancer, but if it is, I don’t really want to find out right now. There’s only a few more weeks left on the service, and knowing it was cancer would really get in the way.”

Saying it out loud really put the stupidity of my logic into perspective. Think it's time to see a doctor.

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