A Ghost Story

Craig Hildreth, MD

“’Tis some visitor entreating entrance at my chamber door-

Some late visitor entreating entrance at my chamber door;-

This it is, and nothing more.”

-The Raven

I confess that solitude, that most antisocial of choices, provides refreshment to this weary laborer upon his return home, not to mention a dodge from tedious queries centered around unfulfilled promises regarding leaf-raking and such. The opportunity to slip away into a sanctum sanctorum, a chamber restricted to four-legged visitors only, has sufficient rewards to justify disappointing the rest of the household, clamoring for face time with the Master, unless there happens to be a crucial video pending on You Tube. If one were to peer into the window of our cottage on some inky night, one would discover this writer in his library, nestled in a chair glowing from the light of a solitary lamp, slowly digesting the contents of a scholarly work on the evolution of Australopithecus species, or perhaps a Zits compilation. Preschool teachers revere this “quiet time” for good reason. It is a sacred rite of a gentleperson’s evening off, which makes it all the more distressing to relay an incident that occurred last month, on the last dreary day of October, while I pondered weak and-you get the idea.

Sitting in my usual corner, halfway through “The Fall of the House of Usher,” I must have quietly slid to sleep. After some time the light bulb fizzled out, and as I lolled in my chair I awakened to the faint swish of a door opening.

Although the room was dark, the moon streaming through the windows cast uneasy half-shadows on the carpet. The only sound was the rhythmic ticking of a mantel clock. As I peered in into the gloom I was startled by a thin woman, wrapped in lace, standing across from me.

“Do you remember me?” Her voice seemed to arise from the other side of the sea.

“I do. We met after your mastectomy.” (We oncologists are not easily rattled, but I would like it to be known that I don’t exactly make it a habit of seeking out conversations with denizens of the great beyond).

“I had breast cancer, and I came to see you. You told me that I didn’t require chemotherapy, that my risk of relapse was low.” Her face was hidden in the shadows as she spoke. The air in the library stifled, yet her garments undulated from some unknown breeze.

For a moment I lost all thought, but then I remembered the rest.

“As I recall, your breast cancer was HER2 positive, but your tumor was tiny. The guidelines clearly state adjuvant treatment is not mandatory. Remember I said that there weren’t enough patients with small primaries in the clinical trials to determine if there is a benefit using adjuvant chemotherapy and anti-HER2 therapy.”

She floated closer and sat on a loveseat, holding her pale hands politely in her lap. I recoiled when I saw that her eyes were missing.

“You knew.” She formed a malignant smile. “You knew that even small HER2-positive breast cancers carry a higher risk of relapse.[1] If you would have given me adjuvant treatment I would be alive today.” She began to rock back and forth, and I heard a soft wailing, like a wind high in the pines.

My skin began to tingle. “But the research is incomplete…we don’t know if adjuvant treatment is effective for small tumors! You can’t blame me for following the standard of care,” I cried.

She slowly leaned over me. “You were wrong. When will you learn that science always outpaces bureaucracy? When will you learn? When?”

Before I could open my mouth she rushed to me and embraced me. I felt an unbearable heat penetrate to my core, and I screamed.

Well, you can probably guess the rest. I jumped awake, book crashing to the ground, sweating under the heavy quilt I had covered up with earlier. Across from me on the loveseat, bearing an amusing expression seen only in homes where the owner is a certified dope, sat my faithful dog.

Tomorrow I see a woman with newly diagnosed triple-negative breast cancer who needs preoperative chemotherapy. Her insurance has denied approval for carboplatin, and knowing what we know about this important topic,[2] I’m going to give it to her for free. After all, it won’t be long until once again I find myself in the pursuit of some quiet-alone, please, and with sweet dreams.

References:

1. Joerger M, Thürlimann B, Huober J. Small HER2-positive, node-negative breast cancer: who should receive systemic adjuvant treatment? Ann Oncol. 2011;22:17-23.

2. Addition of Carboplatin Beneficial in Neoadjuvant Treatment of Triple-Negative Breast Cancer. ASCO Daily News. June 13, 2013. Available from: http://am.asco.org/addition-carboplatin-beneficial-neoadjuvant-treatment-triple-negative-breast-cancer. Accessed November 21, 2013.