"Beatrice" came in for her annual gyn exam. I hadn’t seen her in a few years but I knew she was a very busy workingwoman whose job often required travels abroad. I knew she didn’t like to miss her visits but sometimes her life just got too overscheduled for her annual exams. Beatrice is smart, quirky, bold and big. Everything about her is oversized. She is full bodied and full breasted with a personality to match. During previous visits, she often had me laughing hard enough I couldn’t continue my line of inquiry or her exam. She liked cracking me up! So, with this, I entered the exam room looking forward to her breaking up my day with humor and humility. Little did I know, this year, she would raise the bar on admiration, as well.

She and I were talking about her past few years and she told me she had a "breast reduction". I asked her about the surgery and had it gone well and was she pleased with the results. She responded by saying “it certainly was the best way of getting rid of cancer and getting new boobs at the same time”.

She proceeded to tell me about cancer that had been found in one of her breasts about two years prior and had chosen to have both breasts removed to reduce the risk of recurrence. She also had a strong family history of breast cancer and had opted for the more aggressive treatment for fear of a genetic risk as well. She had always wanted smaller breasts since her “mamas” as she called them, were a cause for much shoulder pain, difficulty finding clothing that fit across her chest and bra fitting was a nightmare! She then went on to recount how she got to “pick new breasts” when she discussed surgical repair with her plastic surgeon after the mastectomies. She relayed the picture viewing, the prosthetic cups, and the advice of her male doctor who had his own opinions about “what might look nice on her”. She told me how she and her friends had many a conversations about b versus c cups- nipples or none? She then told me the pros and cons of all these decisions with wit and audacity. She had clearly found a way to make a startling difficult situation (her breast cancer diagnosis) into an opportunity to get a new set of “boobs”. She was thrilled. She threw her gown open and wanted me to “check them out” and to appreciate her choice (as it were) of bosom and how they were not only beautiful but healthy as well. She had no regrets; she admitted it was a heck of a way to get some plastic surgery done but she considered herself enormously fortunate since she had been diagnosed at an early stage, had her dream of new breasts realized and was feeling well in the face the challenging surgeries.

Beatrice also spoke of the hardships of her surgery and the fears she had faced at the onset of the cancer diagnosis. She told me she had spent time in the beginning thinking a great deal about the loss of her breasts and how worried she was about the potential loss of sexual appeal and femininity. She worried about pain, dying and death. She worried she would always be worried about cancer.

From my perspective, despite her worries, instead of being infused with dread, Beatrice had found a way of finding humor in the travail, health in the face of morbidity and beauty in her scars. I felt so grateful to be with her and learn from her experience. Over the years, as a doctor, I have had to tell women they have everything from cancer, HIV to infertility (for example). There is no “simple” medical diagnosis, since even a pelvic infection takes work and attention to heal. Some women are mobilized to change their lifestyle, alter their outlooks when given a dire diagnosis. For others, illness becomes a defining theme and instead they are overwhelmed and paralyzed by the challenges and emotionally very angry and bitter. I empathize with this emotional array and continue to be humbled by the individual responses.

Cancer in particular demands a level of intellectual investigation and then emotional response that can be particularly challenging. Moreover, persons with a history of cancer never quite escape the diagnosis tending to think about recurrence on a regular basis. That is why Beatrice particularly impressed me; her joy and optimism were inspiring. Humor is not easily found along the path with cancer and yet, she had opted for (at least at the time of her recitation) to find fun and irony in her experience. For me, the healthiest response to a difficult diagnosis takes a person through many different emotions, but remaining genuine and open to this array of feelings often brings that individual to a place of exploration and personal story telling that remains true to their personality and their approach to life.

I am not suggesting that a bilateral mastectomy is the correct or appropriate response for all women with breast cancer- not at all - I am however, clear that this decision is a very personal one. I would suspect some who heard her story might say she had made an extreme decision to have both breasts removed and concerned at her humor and attitude given the serious nature of her cancer. For me, it felt like the most genuine of responses for her – this woman loved living and she wanted to let me know that she had faced adversity with a spirit of adventure, opportunity and courage. As I heard her story and the boundless enthusiasm she had for her health, I rejoiced with her and told her happily, I would examine her new set of “boobs” and as she put it, her "Booby Prize".

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Amy Novatt:
My life as an obstetrician - gynecologist started in Pennsylvania in 1990 working in a community hospital delivering babies and learning the art of gynecologic surgery. As hard as residency was, I realized early on that I had chosen a career that suited me. The practice merged my interest in women’s health, reproductive policy and surgery perfectly. I spent many years assisting woman deliver their babies and then decided to focus on gynecology (only)- appreciating that in most offices, the concerns of adolescents and women not having babies, were often marginalized by doctors. I was interested in creating a professional arena for women to discuss these non-OB related issues. I have worked in a private practice for 14 years in Rhinebeck, NY. I have seen over 10,000 patients during those years. My work includes office GYN and surgical interventions, including advanced laparoscopic surgeries while lecturing both to professional peers and lay audiences.

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