Why did you go into medicine?
My decision to go into medicine was strongly influenced by my father, who grew up during the Depression. During my dad’s childhood, his family was very poor and had to live with cantankerous relatives. My father hated being dependent on other people. The take-home message he taught me and my brother during our childhood was, “Be financially independent.” My dad wanted his children to be able to earn a living, and he believed that medicine was a good way to accomplish that.
When I was six years old, I started playing the piano, and I wanted to be a concert pianist. I remember once when I was very young, someone asked my father, “What doe Laura want to do?” and my father replied, “She wants to be a concert pianist, but medicine will be her back-up profession.” I remember thinking that I had never said that—that must be what he wants!
By the time I went to college, I was drawn to science, and declared a major in physics. The summer after my freshman year in college, my dad had a heart attack, and subsequently had a couple of strokes. I was in college near my family, so I was able to spend time with him in the hospital. My decision to go into medicine was strongly influenced by my experience with his illness and recovery, my desire to do what he wanted, my interest in science, and my hope to make the world a better place. I switched my undergraduate major from physics to biochemistry and decided to go to medical school.
Why did you choose to work at a cancer hospital?
I’ve always been interested in women’s issues. When I chose to go into medicine, I became particularly interested in cancer. Breast imaging, a subspecialty of radiology, married those two interests. I liked the fact that mammograms could find early, curable cancers and save women’s lives. Breast imaging provided terrific opportunities for research and teaching. Also, women who are being evaluated for known or possible breast cancer are often anxious, and I wanted to make the experience less scary by providing information and support.
As part of my radiology training at New York Hospital/Cornell Medical Center, I did an elective in breast imaging at Memorial Sloan-Kettering Cancer Center. I enjoyed interpreting films, doing breast interventional procedures, and interacting with the dedicated faculty and staff. I especially liked helping women through the experience of breast evaluation, which may include breast imaging, diagnosis, and referral to the surgeon or oncologist who will provide treatment if cancer is found.
In breast imaging and intervention, the fundamental decision to make is whether or not breast cancer is present, and if so, to determine its type (what kind of cells it has), where it is, and how much of it there is. A cancer hospital is a terrific place to do this, and there is no better cancer hospital than Memorial Sloan-Kettering Cancer. When I finished my residency in 1990, MSKCC was recruiting a new breast imager. I got the job, and have been here ever since.
When did you discover that you liked to write?
I’ve loved to write ever since my older brother taught me the alphabet when I was three. I was always an avid reader: as a kid, my favorite activity was to go to a bookstore called Strymish’s in Boston and sit on the floor for hours, reading books. I wrote short stories and poetry in school.
My dad loved writing, and published several short stories. He wanted to write a novel, but he got stuck in the outline phase. That may be why my writing process differs from his. The job of taking a blank piece of paper and filling it with a masterpiece is daunting. It’s much easier to break this impossible task into two simple tasks, sort of a “dump and sculpt” technique. First, I get all of my thoughts down on paper, messy and unformed, in the order in which they come to me. Then, I edit. With this approach, no task is too difficult. It’s easy to dump, knowing that you will be making changes in wording, order, style, and detail later. It’s also not too hard to edit once you have an initial draft—you don’t have to face the blank page.
After I began working at Memorial Sloan-Kettering, I became passionately involved in research on breast imaging and breast cancer. I’ve written more than 100 scientific papers (as first author on more than half), including studies that developed and validated methods of doing a minimally invasive breast needle biopsy (taking a sample of a breast lump or an abnormality that can be seen on a breast imaging test to see if it’s cancer) guided by imaging, without surgery. I enjoy all aspects of scientific writing: studying the existing literature on similar topics, designing the study, collecting and analyzing the data, and writing and editing the manuscript. From the time I joined the Memorial faculty until 2007, my writing focused on medical research.
When did you decide to write I Signed as the Doctor, and why?
I decided to write I Signed as the Doctor while undergoing the experience of cancer diagnosis and treatment. I wrote extensively during my illness, documenting what was happening and what I was thinking and feeling. I wasn’t sure at the time whether my writing was primarily for self-expression or whether it might be valuable for others or both. Throughout the experience, I was keenly conscious of being “on the other side,” a cancer patient in the hospital where I had been a cancer doctor for almost twenty years. I thought this was a particularly useful perspective on cancer, both for me while I was taking the journey and potentially for others with cancer, their friends and families, and their doctors.
What was your process for writing I Signed as the Doctor?
I initially wrote the book by telling my stories in emails to friends. Most of the emails were to a dear friend of mine named Jen; she and I are close, but we’re both busy working Moms and live in different cities, so we communicate primarily by email. The use of email was a great technique because it eliminated writer’s block. I wasn’t sitting down to write a book; I was just sending an email to Jen. I also wrote emails to other friends, and sometimes I would tell the same story in different ways to different people, so I often had several drafts of the same material. I figured that when I was finished, I’d edit the emails into a more traditional narrative.
For me, the most interesting aspect of the experience was looking at life from the point of view of the cancer patient rather than the cancer doctor. Early on, I thought I’d call the book Both Sides Now, like the song written by Joni Mitchell and recorded by Judy Collins. When I looked up Both Sides Now on Amazon.com, though, I found lots of books with that name, including Both Sides Now: The Story of School Desegregation’s Graduates, Both Sides Now: Living and Dying in San Francisco, and Both Sides Now: One Man’s Journey Through Womanhood. I decided to find another title. I chose I Signed as the Doctor, because when they brought me consent forms for the procedures I had to have to diagnose the cancer, initially I signed as the doctor, because that’s where I always sign! They said no, you have to sign as the patient now.
After I finished treatment, I edited all of the emails I had written into a Word document, and it was almost 1000 pages long. I couldn’t deal with a work of that magnitude—I was exhausted, and every word seemed so important that I couldn’t imagine what to cut. I put it aside for six months, which was helpful: it gave me some distance from what I’d written, which made it easier to edit. When I picked it up again six months later, I was able to edit out large portions of the book, until it was trimmed to a manageable length of less than 250 pages.
During the process of editing, which took about six months, I took a writing class at Gotham Writers’ Workshop, a cool group in New York that offers writing classes all over the city. It was terrific—a dozen students of all different ages and backgrounds who had little in common except a love of writing. The comments of the other students and the teacher helped me make my story accessible to non-physicians and people who had no experience with cancer. I gave the manuscript to interested patients who were living with cancer, and they commented on what did and did not speak to them. I also got comments from my treating doctors, other physicians, friends, and family, which I used revise the book.
Did you feel you were treated differently because you are a doctor? If so, how?
My experience with cancer was affected by my being a doctor. When I was barraged with information, especially when I was initially diagnosed, I was able to understand most of what they told me, and able to look up, figure out, or get explanations for the rest. I was amazed to see how much information is thrown at you, particularly at the beginning of treatment. Having the medical knowledge also allowed me to question the things that my doctors told me, and to understand when a side effect I was experiencing was a necessary evil or whether it was something that could be prevented or relieved.
In some respects, my being a doctor didn’t affect how I was treated, but helped me respond to it. For example, when I was told that my head “could not be numbed” before they stuck a needle in it to give chemo, I knew that wasn’t true and brought my own bottle of anesthetic spray (I include the information on what to get and how to get it on the list called “For Those with Cancer and Their Loved Ones”). When I threw up after chemotherapy was injected, I learned that injecting too quickly increased the likelihood of vomiting, and I was able to ask that the injection be slowed down. I share the information that I learned from my experience in the book and on this site.
My being a doctor helped by occasionally letting me detach from the experience and observe myself. Sometimes I felt like I was working undercover, like in the book Black Like Me in which John Griffin (the author) disguises himself as African American so he can experience life as a black man in the 1950s deep South. As a doctor, I appreciated the opportunity to use what I was learning from my own encounter with cancer to help other people. All individuals coping with cancer can use their powers of observation to help them deal with the process, and can draw on their experience to benefit others.
What did you learn about medicine from the perspective of the patient?
I learned a lot about pain. It was astonishing to see how otherwise wonderful doctors don’t always consider pain control as important as it is. I experienced first-hand that some procedures hurt a lot. Sometimes, doctors are so focused on curing the disease (eg killing the cancer), that they feel that if patients are in pain, they should just “suck it up.” My feeling is, if the pain is necessary to cure the cancer, I’ll suck it up, but if you can cure cancer in a way that’s painful or in a way that isn’t, wouldn’t the painless approach be the obvious choice? I also learned that it’s both difficult and essential, as a patient, to be your own advocate. Listen to your doctor’s advice, and don’t be afraid to ask questions if you don’t understand.
I learned that some things that doctors tell patients are much easier said than done. For years, when I’ve told a woman that she has breast cancer, I’ve encouraged her to try not to anticipate too many steps in advance, because in medicine each step determines what decisions you’ll have to make at the next step; you can waste a lot of energy worrying about choices that you’ll never have to make, and you need to conserve your energy for the things that matter. As a patient, I learned how true that is, and also how hard it is to follow that advice.
Some of the most important things that I learned were not from the doctors, but from nurses and patients. It was a nurse who told me that it’s OK to cry, but that you should try to keep it to less than 20 minutes a day. A patient told me that I should pretend each doctor’s visit is a trip to the airport: that way, I’ll expect a long wait. Another former cancer patient (who also happens to be a doctor) told me that cancer is the best excuse you’ll ever have, so use it! “Play the cancer card,” she called it. She taught me that cancer can get you Christmas gifts out of season, get into restaurants that are usually booked for months, go to the front of the taxi line, and board airplanes early. If you allow yourself to be open to other people during this experience, they can be there for you in ways you never imagined.
Did the experience of being a cancer patient make you a better doctor?
I hope so. Nothing helps you understand an experience more than going through it yourself. Now I can use my experience from inside and outside the white coat to help others. I was always a big fan of local anesthesia, and now I numb things up even more than I used to when I’m doing procedures—NOBODY is going to feel unnecessary pain! And I realize the importance of treating people as individuals, of taking the time to speak to them and answer questions, or preserving their dignity, and of relieving anxiety and fear. As doctors, our job is not only to cure cancer, but also to relieve suffering. We should strive to do both.