At 62, I unwittingly turned into a cliché: the doctor who becomes a difficult patient. The hard mass in my right breast, sitting directly beneath the nipple at the 6 o’clock mark, startled and unsettled me during a lengthy August night when it first jabbed me as I restlessly navigated a spell of insomnia.

I had had a screening mammogram scheduled for September 12 on my calendar for weeks, following my PCP’s sorrowful look during a follow-up appointment, her head shaking as she said, “You are messing up my mammography numbers.” Feeling reprimanded and embarrassed, I made the appointment.

**The scheduling trap**

Uneasy weeks dragged on. On the day I was finally set to go through with it, I gathered my courage and drove north to the modest community hospital that had provided me the earliest slot. What scheduling had failed to inform me was that screening mammograms are only for asymptomatic women. This distinction lies far beyond my professional and highly focused medical knowledge. As a physician, should I have been aware of this? Maybe. But if I, as a doctor, missed it, what hope does the average patient have? Radiology scheduling protocols should reflect this.

My diagnostic mammogram was arranged for October 3. Weeks away.

Rosh Hashanah arrived, and I spent it lounging in my pool, somewhat eased in my torment of waiting by a book from my rabbi, who has been living with metastatic breast cancer since mid-2020. On Yom Kippur, as the long, solemn day approached its conclusion, I found myself before the open Ark housing the exquisite Torah scrolls draped in white. I prayed and wept as I had never prayed before. No atheists in foxholes, right?

**A breach of privacy**

The diagnostic mammogram occurred the following day. While I waited in the sitting area, uncomfortable in the johnny, one of the technicians came out and focused her remarks on the similarly dressed woman opposite me. “Great news!” the technician declared. “The mammogram looked fine, nothing to worry about.” This was clearly a violation of patient privacy. But for me, already quaking from the dreadful possibilities, it felt even worse. The technician inflicted moral harm.

During the ultrasound-guided biopsy, the mammography images were displayed on a computer screen in the ultrasound suite, and there it was—a blot of unwanted whiteness in my breast. As the radiologist stood to my right, referencing the computer screen on my left, about 18 inches from my face, he guided his needle. I could see the ugly, spiculated mass for myself, and it appeared immense, mockingly undulating in response to the needle. I felt stupidly proud of my composure after the radiologist exited the room: I didn’t burst into tears; I unleashed a barrage of very bad curse words. Composed? Ha.

**The role reversal**

The pathology report came four days post-biopsy. The next morning, on Monday, a week filled with patient appointments loomed, and nausea immobilized me. Aside from the tears, gasping sobs alternating with mewling whimpers persisted unabated for an entire week. During my consultation on Thursday, my surgeon broke the fourth wall: She scooted her rolling stool until she was directly in front of me, looked straight into my eyes, took my hands, and said, “You are struggling like this because you are used to being the one providing comfort, not needing it,” or something to that effect. My breast surgeon is a true humanist.

I hope this experience will make me a better physician. As a neurologist caring for older adults with cognitive decline and dementia, I must deliver harsh diagnoses, and believe me when I say, there are circumstances worse than Alzheimer’s disease. May I gain wisdom from my own ordeal to provide comfort alongside the medical plan, soon, in our time.

The system also has work to do. Patients encounter a system that frequently assumes they comprehend invisible bureaucratic distinctions. I mean, screening versus diagnostic mammography is logistical trivia, not clinical insight. Physicians are not immune to this pitfall.

Staff need improved training to ensure that privacy breaches in the waiting area are eliminated. Empathy must be promoted from above and ingrained into the very essence of everyone working in cancer centers and mammography suites. Failing to instill these values will perpetuate the sort of moral injury I experienced.

Ultimately, my surgeon was correct. I struggled not merely because I had cancer, but because illness had thrust me into a role for which my training had left me completely unprepared. Physicians are taught, both implicitly and relentlessly, to be the steady ones, the interpreters of fear.