Marisa greeted her colleague Dick. Nancy couldn’t stop crying.
Dick watched as Marisa, too, teared up, and he thought, Jesus, for her it’s personal. Dick had never seen that before in a doctor, not so immediately and intimately.
But then, suddenly, Marisa switched gears.
“Let me tell you, you’ll be fine,” she told Nancy. She had already reviewed her chart and knew the prognosis. “And you are going to live to see your grandchildren. We will get you to the other side.”
“It was like being slapped in the face,” Nancy Schmidt says now. “Marisa has tremendous strength. ‘We will get you to the other side’—that was huge for me.”
In one fell swoop, Marisa had empathized with her patient, then took control. “Most doctors,” Dick Schmidt acknowledges, “become callous to a certain degree — it’s the only way to do it for a long period so you don’t get eaten up.”
Nancy Schmidt is doing fine now, but sometimes the result is different. Once when my wife went to see her, Marisa talked a little about patients she had lost, and cried a bit.
She is well-rooted in this area, having attended Penn Med, and she’s practiced here for 25 years, so she can’t go anywhere without encountering a doctor’s wife or her children’s friends’ mothers or a neighbor she has treated. “Over the years,” Marisa says, “I’ve been very involved in many people’s lives, sometimes right to the deathbed — and years after that.”
And now a lot of people, she knows, are watching how she deals with her own cancer. She has a new tool: She can share with patients what she’s been through. But this is touchy business. “I had been very aware in the past — and I’m more acutely aware now—that people hang on every word you use to describe something or explain something,” Marisa says. She is, by nature, so open and direct, but some patients have a desperate need to know what treatment she got, as if they must have the same. It doesn’t work that way — breast cancer is far too complicated by type and a patient’s genetic history and psychology for a one-size-fits-all mentality.
Marisa won’t share, for public consumption, the particulars of her treatment, because of that danger of other women foolishly copycatting her. But she’s had significant surgery, with a lot of physical changes — as only Marisa would put it, “My playground has changed.” She’s working with a medical oncologist and a physical therapist. She’s chased down her family’s genetic history to determine her risk. Breast cancer is an individual puzzle.
Her physical prognosis is excellent. The psychic battle seems corralled. “I have always defined myself by my intellectual function and my role as a doctor,” Marisa says. “I enjoy the fact that I have a nice figure and I can make myself look good — but I’ve never defined myself by that.”
And as a doctor, it’s not just about saving lives — that’s not nearly good enough for Marisa. She wants to preserve the whole nine yards of how we live. But you wonder about the cost to her.
Dahlia Sataloff, Marisa’s Pennsylvania Hospital surgeon, had a partner who got breast cancer and had to leave the practice — she had a hard time dealing with recurrences, with separating patients’ plights with the risk of her own. In fact, she left medicine and went to art school.
Nobody, especially Marisa, thinks that will happen to her.
“But she’s going to have to dissipate the emotional load,” Dick Schmidt believes.“Somehow.”