[00:00:00] Adam Walker: From Susan G. Komen, this is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.
This is Real Talk, a podcast conversation where we’re digging deep into breast cancer and the realities patients and survivors face every day. We’re talking openly and honestly about just how difficult breast cancer can be. From being diagnosed to selecting the right treatment plan to living day to day with metastatic breast cancer and life after treatment ends.
In today’s episode, we’re talking about advice. Naturally, we want to help and support our friends and family when difficult situations arise, but sometimes our advice can have the opposite effect of what we intended. Without knowing, we can create doubt or confusion by telling someone going through breast cancer what we would do if we were diagnosed.
Valerie Engel is a French American and was treated for breast cancer in the United States. She heard from some in France that surgery wasn’t safe and she wasn’t making the right choice. Valerie felt she had made the right decision with the input and guidance from her care team, but the opinions of others didn’t make an already difficult time any easier for her.
Dr. Miggins is a medical provider who works with her patients every day to make the best choices for their treatment. She wants her patients to feel confident in the choice they make, knowing the options they have based on their personal breast cancer diagnosis. Valerie, why don’t you tell us about your breast cancer diagnosis and the treatment plan you chose?
[00:01:32] Valerie Engel: So I got diagnosed in December of 2023 and I got the bilateral mastectomy with immediate reconstruction and a sentinel lymph nodes and the MRI showed that the tumor was too close from complex. So we choose to remove everything.
[00:01:50] Adam Walker: And, Dr. Miggin’s, the relationship between a patient and doctor is so important.
You want to reach a decision together. So how do you work with your patients to make sure they’re happy with the decisions that they make?
[00:02:02] Dr Makesha Miggins: That’s a great question. I think for me, it’s so important first for me to, make sure the patients understand their diagnosis and also the treatment options that are available to them.
In addition, I like to make sure I understand what is important to the patient. What do they hope to achieve outside of just becoming cancer free? What do they hope to achieve for a long term effect? Meaning, do they want reconstruction or not? Those types of things are very important. And then together, I try to help them see why one treatment or, another might be better for them, or why they might have all the options available to them so that they can make the best decision for themselves.
So for me, it’s really important to have shared decision making. So Valerie, please, why don’t you tell me more about how you were, how you made your decision for what treatment was best for you?
[00:02:55] Valerie Engel: So I was really torn because, I’m from France and, I live in the U S since about seven years. So for me, my home is Miami now because all my family’s from here, but my, family is in France and the French system and American system is very different.
And, the French, so I saw doctors in Miami and I was seeing doctors in France through FaceTime and they were giving me a completely different opinion on what I should do. So it was really difficult. And you obviously get a lot of people talking around or like trying to give you advice when you go through this.
So it was really difficult for me. I was very torn on what I should believe, what I should listen. If I should go back in France to go and get treated with my family or if I should take my own family going there or just stay here. So I ended up making my decision because I’m, I think I’m pretty opinionated.
I have my own opinions and I knew from the start what I wanted to do. And I know that, like having cancer is like not something that’s easy. You said not like a hip surgery where you like get the surgery and you’re like, thank you. Bye. You still have so many checkups and appointments after this.
And I felt like removing both breasts would give me the choice of not having more mammograms or ultrasounds, which was something out of the way. And I like this.
[00:04:20] Dr Makesha Miggins: How did you go about, I guess facilitating a second opinion? But also being able to determine what information from those two different, very different, it sounds care teams that you were going to, use to help you make a decision.
[00:04:35] Valerie Engel: I overdose myself on Google, first of all, in every possible language I could understand, which is definitely not the best and gives a lot of wrong information also, but I also felt like the doctors I would see in France, which were basically my mom, like very stressed out, making me see on FaceTime and like talking to.
I was not seeing them like in person. I felt like they were not knowing me like the doctors I would see here in Miami. So I ended up having two options in Miami and I don’t think I would have taken two options if it was not from my husband, who was also trying to make me get another option here in Miami.
I think I would just have just gotten my doctor that I ended up choosing from the beginning because I liked him from the start and he put me at ease on my decision. it was like, it’s when you get a diagnosis, there’s just so much going on that you just have to follow your own instinct and how you feel your inner voice.
So I think this is what you have to do and filter so much of what everybody tells you all around you.
[00:05:38] Dr Makesha Miggins: And it also sounds like you had not only doctors and care teams giving you opinions, but also your family, both in Miami and in France giving you opinions. How did you filter the information?
How did you know, to stay true to yourself, if you will?
[00:05:54] Valerie Engel: So I think you have to separate it in two parts. First, you have the people who found out you have cancer and they are very uncomfortable and they try to make conversation. They try to say something and my God, these people get to make you the most incredible comments or say the most incredible things.
Not that they mean it wrong, but they really say things that they should not say. So I feel like these people, you have to take it through one ear and make it go out right away. So take them out of the way and then you have the family opinion, which is you obviously have to take it into consideration, but the people around you, like the family, is not the ones driving the boat because you’re like, the cancer patient is in the boat and you’re driving in your direction and in your boat.
Listen to what they have to say. And I think you have to research after this, take it into a consideration, but you still have to stay true to whatever you feel inside,
because the decision at the end of the day, it’s from the start, it’s very difficult, but throughout after a year, I know that I knew my decision from the start.
[00:06:58] Dr Makesha Miggins: Yeah, that’s, really good advice about, you as the patient being the one that’s driving the boat. And, I think you did something that a lot of people sometimes struggle with being able to filter through the information and filter through, the feelings of people who are very close to them and their perception of cancer in your own.
I think it’s so important for people to realize that ultimately it truly is. Although it sounds very cliche, a very personal decision on how you choose your treatment. So what do you think was probably the best advice you got from your care team and also from your family and friends?
[00:07:39] Valerie Engel: Well, from my care team, it’s at the beginning, I was really not aware of, I started my diagnosis and I met a doctor like two days after, and I had no idea of what was going on. I had no idea what was going to go after this post the surgery, because in my case, I needed the surgery to know what was coming after.
So I think that someone telling me, my doctor who told me, after this, there will be like treatment, or then after you’ll have to do a lot of followups. It was a great advice because I had no idea that, I had no idea that I was stepping into the cancer life and this was like going to stay for me.
This is a label I have on my skin and I don’t think it’s going really far away from me anytime soon. So that was a great opinion. And then from my family, I guess that I don’t know, because they put me in so many doubts and every direction in every country and everything, probably like this actually helped me make more of my decision and, dig more into so much information and read everything.
So it was not the best on the moment, but I really don’t regret my decision now. So I think it was probably good to go through it.
[00:08:49] Dr Makesha Miggins: So what I hear you’re saying is that it’s very important for your care team to let you know up front what the long term investment is in your decision and in your diagnosis and treatment plan.
And then also that sometimes, having family that is, very involved can also help drive you to seek out the information to help you make the right decision. Although it seemed like from the very beginning of your story, that it was a lot
of, overwhelming the input from everyone, but it also helped you to really hone in on what was important to you. Am I understanding you correctly?
[00:09:28] Valerie Engel: Yeah, it actually confirmed my decision, and it’s something that I knew from the start. And actually, till the day of my surgery, I was, so my doctor didn’t press me and pressure me on any decision, and they had told me, Okay, you have till the day, the week before, you just have to call us and tell us what you want to do.
But actually till the day of the surgery, I had not told my doctor what kind of surgery I wanted to get. And once I made my decision, which was like, maybe less than a week prior to my surgery, I decided to keep it for myself. I didn’t tell my family or anything. I didn’t want them to go back and reopen all the topics.
So I just went into the surgery day. I didn’t tell anyone, even my husband with me. I didn’t tell him anything. I just saw the doctor and I went for it.
[00:10:14] Dr Makesha Miggins: Wow. So that’s a very different approach that you made your decision, held onto it. Of course, let your doctor, your surgeon and everyone know, but didn’t really share it with your family.
Is there a reason why? Alright, go ahead.
[00:10:28] Valerie Engel: They were, too stressful. My mom couldn’t be in the US because we had some issues with her visa, so she was really like stressed out and my sister came here. It was a whole drama and it was better for me to just keep it for myself.
[00:10:44] Dr Makesha Miggins: Wow. Well, I applaud you for that. I think for some people it’s so hard. It’s like how people find it’s hard not to like in the situations, but when people have gender reveals and they just try to keep the secret to themselves into the last, moment. And it’s such a big deal. Did you feel like doing that, but, more stress on you or actually alleviated your stress?
[00:11:05] Valerie Engel: Less stress on me. It was much better to just go for it and not have to reopen the book of my family. Tell me this and this and that again.
[00:11:13] Dr Makesha Miggins: How did your family feel about that?
[00:11:15] Valerie Engel: Well, they had to go with it. There was not really any other options.
[00:11:19] Dr Makesha Miggins: Point well taken. I again, I commend you for that because it’s not very easy, for a lot of cancer patients, to be in a situation where they are facing a life changing diagnosis, life changing treatment plan, and to decide to really make the decision, if you will, in isolation.
And recognize that it’s their decision, their body, their choice, and that no one else really has that much input, although it sounds like you did take some consideration from the things they share to you, but you chose your own piece. And, well being over the probably satisfaction of others, which is not always very easy for people.
[00:12:03] Valerie Engel: Yeah. But you have to remember that you’re the diagnosed person, you have cancer, which is like already very hard. So you have to drive the boats.
[00:12:12] Dr Makesha Miggins: Yeah, absolutely. I think that’s a good recurring theme from you that you are in the driver’s seat as the patient. And it really is. You’re choosing the destination and you are really responsible for your own decision making and people have to either decide to join in with you or stand alone on the banks if you will.
[00:12:34] Valerie Engel: So I would love to know how you earn this confidence from your patients.
[00:12:39] Dr Makesha Miggins: That’s a really good question. People sometimes ask me this, and I really just try to approach the patient as if it were someone who’s very close to me. Now, I think the first thing as a surgeon going in the room is that you realize that you’re meeting someone at their most vulnerable point in their life for a lot of people.
It may not always necessarily be the hardest thing they’ve ever had to overcome, but it’s the hardest thing at the moment. And, I just try to approach everyone with kindness, it truly is a privilege and an honor to be able to take care of patients. And once you realize that, and you lead with that, then it’s, in my opinion, somewhat easy to develop that rapport and trust with them.
I address the patients by name, not their diagnosis. I talk to them as if they were, someone who I care for, because I really do care for them, and I want to see them do well, and I want to see them, of course, ultimately cured from cancer. For me, it’s very important to, establish a very open line of communication with the patient, to be very honest, I think that sometimes people feel like their team might be holding back information from them. And no, I never would want to
do that. And also I listen now, I would I can’t say that I listen more than I talk because I do have to talk to them and I have to share a lot of information.
I try to pick up on the verbal and nonverbal cues that they’re giving me and try to address and understand any barriers they may have to the treatment plan that we’re trying to come up to.
[00:14:15] Valerie Engel: How do you know they trust you?
[00:14:16] Dr Makesha Miggins: I feel as a sense that they do. And they say that I have, never had a patient tell me that they did not trust me.
I never had a patient, tell me they regret choosing me as their physician. Most of the time at the end of the first appointment, the vast majority of my patients tell me that they feel more of a sense of peace and comfort. And I think it’s because I sit down, I literally, probably am a little bit intrusive or invasive in their space because I really am literally eye to eye with them. And I include, I talk to them directly, whether they’re 23 in the room with their mom, or if they’re 95 in the room with their children or grandchildren, I talk to them directly. And then I include the people in the room into the appointment. So what I’m saying is I will ask the patient, I get the information from the patient.
I asked them their opinion. I asked them if they have any questions. And then I ask the people who are with them if they have questions. I think I always try to lead with the patient is first. And I try to I think the other thing is that I do my best not to destroy their hope. You can be very honest with people and you can tell them that their outlook might be bleak, even in a sense a situation where someone has a cancer that’s incurable but you can do that in a way to not, take away their hope because I think hope is so very important. So for me, I just do the things that I would feel comfortable with someone doing for me, being honest, speaking to me by name, allowing me the opportunity to ask questions and showing that I respect and value their, their input is how I build trust with patients.
[00:16:06] Valerie Engel: So it sounds like you have a good psychology. It sounds like you really try to understand your patients and navigate through the story with them. How did you learn this? How did you get to go through this?
[00:16:19] Dr Makesha Miggins: I don’t know. I think some of it came from, just my own family life. And growing up is that, I grew up in a family environment where individuals matter. So even as a child, I mattered and my thought mattered. Now, I didn’t necessarily get my way. So I think the same with patients, right? They don’t necessarily always get their way.
But, there was a I was, it was inbred in me to have a genuine respect for people. but then also as you learn to communicate with patients, through all of our medical training, medical school, residency, you learn more about people and become more open to how people function. people aren’t just, Type A and type B, as we hear people talk about type A, type B personalities.
In fact, someone with a cancer could have been a very type B person, if you will. And now, all of a sudden, they’re very detail oriented and fixed on it. Because the situation has changed. So I think. I just always have had a respect for, people and I’ve always been a very good listener.
And probably when I was in deciding to choose breast surgery as a field, that was something that people, when I was a resident actually always picked up on. And so it just seemed right, for me at the moment. So I think it’s just very important to be able to, be open.
And, once you have an appreciation for people, it’s easy to be able to communicate well
[00:17:45] Valerie Engel: So how do you guide them throughout the, cancer and making their, surgery choice?
[00:17:51] Dr Makesha Miggins: So I start with just the facts, which I think is very important. the things like your stage of cancer, the size of the cancer relative to the breast and what treatment options are available to them. And I find that patients with an earlier stage cancer usually have the hardest time because they really do have a lot of autonomy in their decision making.
And then I try to determine what is important to the patient. So for some people saving their breasts, if at all possible is the most important thing to them, when I say most important as in second to, curing their cancer, it’s, that’s very important to them for some other people.
It might be, they might really express a strong fear of having the breast on their body, even if they no longer had cancer in it. And so I really just tried to get a sense for who the person is, which is hard to do, because I’m meeting them for the very first time. I don’t know anything else about them.
And, in fact, likely their true personality isn’t really on display because it has been modified by a cancer diagnosis. So I, also try to discourage the patient from making a definitive decision about their treatment the day that we meet each other. Some people are very clear and very sure of themselves and that, that is fine.
But other people are often really just making a decision, that is fear based. And so if I get that sense from them, I’ll say to them, why don’t you take some time to think about it? Or maybe do you need to discuss it with someone else? Because some people really do, require that kind of validation or having someone, very close to them that they can bounce their ideas off and have some discussion.
So I encourage that, but I also try to remind the patient that their cancer is not the same as their next door neighbor, as their great grandmother. there’s so much difference, with cancer treatment between now and 20 years ago, even five years ago. So I tried to, help them through that process.
And then I try to ask them, For those patients who are on the fence, I feel like I should get rid of my breast, but I really want to keep it. But I don’t know, because I’m afraid of this. I try to encourage them to, in those cases, sometimes do. The breast conservation surgery, because then they get in, they are able to.
See how they feel with the breast. I’m not saying that I encourage a second surgery for people who, are on the fence, but some people really are on the fence about what they should do. And if you’re really and truly on the fence, then I tell them that either take the time they need within reason to make a good decision for themselves.
But if they still feel uncertain, once we remove the breast, we can never put it back exactly the same. And for some people that’s very important is that they want it to be just like it was before exactly the same. And so I say, well, what for you, what I would then recommend is that we do a lumpectomy.
If you find yourself very unhappy after having this lumpectomy, then we can consider a second surgery if you need to. Some of those patients never come back for the mastectomy because they felt like they were doing it out of, fear and not because they really thought it was the best decision for them or because someone else told them to, and for other patients, they are very strong and sure of themselves that they want a mastectomy.
And so I’m open and available to do that for them. I think for me, it’s just very important for people to understand their options. Understand the long term impact that comes with the options. And then just like you did, determine what is most important to themselves and what reigns true to who they are.
And then from that point, it’s just my job to facilitate that for them.
[00:21:47] Valerie Engel: But do you think that people or like your patients trust you more because you’re a woman? for example, my surgeon was a man. And he did tell me once or twice, I don’t know, I’m also not a woman. So you also have to think more about your decisions.
So I feel like maybe because you’re a woman, you understand more the impact of the surgery.
[00:22:08] Dr Makesha Miggins: I think that some of my patients find value in the fact that I’m a woman, but also I’m a woman who’s never had breast cancer and I tell them, yoday I’m sitting here on the stool, not diagnosed with cancer. So my decision making is not necessarily going to be identical to if I was sitting on the exam table and had cancer, because we do know that the diagnosis, impacts people differently as far as how they feel psychologically, about their disease process and then about their breast.
So I tell them, you have to take my just what I think I might do with a grain of salt in this situation because I really don’t have cancer. I don’t think that really impacts them. I think there are people who do feel comfort in feeling like they could be more vulnerable with someone of the same gender.
And so I think that sometimes, really impacts the patient. More so than the fact that they think because I’m a woman, I understand the disease process or I understand the outcome better. I think it’s more so they feel like they can relate woman to woman and be more vulnerable in that situation.
[00:23:14] Valerie Engel: And coming back to that trust, because it seems like you put a lot of effort in putting your patients at ease and have them trust you and all this.
Most of the time, I’m assuming that you have to see these patients over and over for probably a couple of years, if not more. Do you feel like they still trust you throughout the years and would you feel offended if they actually end up changing doctor?
[00:23:38] Dr Makesha Miggins: So yeah, some of the patients I do see throughout the years and some patients even after I no longer see them still reach out to me about questions or even questions from a surgery standpoint, questions from something that may be the medical oncologist or the radiation oncologist or even plastic surgeon may have said to them, or because they have a family member or friend or someone they know who now has a diagnosis, but they want to know if I’m willing to see them. They do keep in touch with me, or sometimes just to pleasantly just to tell me some good news, which I always welcome is that they want to tell me something great that’s happened in their life. We have, my chart messaging through our, our hospital, patient portal. Sometimes they call and just ask would I give them a call back or they will send me, a card or a letter sometimes with, good news, which I think always makes sense.
The physician feel really good to just hear something positive is going on in their life after we’re no longer involved in their care. So that, but also, I think you asked me what I’d be offended if a patient. No longer wanted me as their doctor. No, I would hope that if it was something that we, had a disagreement about, or we didn’t really see eye to eye, I hate to call it disagreement.
That was a conflict in the care, relationship that they would be able to let me know, or be able to let one of our physician, our patients, sorry, advocates know so that they could communicate that to me. But no, I don’t take offense to that because as I, in fact, as I often tell my patients is that, because people may remark that, oh, everyone’s so nice to us here or everyone’s helpful.
And to me, my response to that is that everyone should be. I cannot imagine having a cancer diagnosis or any diagnosis for that matter going to get care and people are, the people who are supposed to, I’m supposed to trust with my care are rude to me or dismissive of me, would be really type of hard for me to handle.
And so I tell them if anyone, is offensive to you or negative towards you, please let me know. And if it’s me, if you don’t feel comfortable telling me, please tell someone so one that maybe I can correct that behavior or we can help facilitate them seeing someone that are going to be more comfortable with because it’s not about me.
If I were to be offended or upset about that is me leading with an ego and my ego has nothing to do with their care.
So I really should be leading with a standpoint of that patient doing what’s best for them and finding a team that makes them comfortable. So I think this is probably why I asked you about your second and even third opinion is because for me, I think it’s important for patients to, if they feel like it’s necessary to seek out more than one opinion so that they can find someone that they’re comfortable with.
Because when I think about surgery, not just cancer care, but surgery. When you go to have an operation, you’re in a room with strangers. The actual only
person, most of the time, that you really and truly know in the room is your surgeon. And there, to me, is nothing more vulnerable than being asleep in a room with someone breathing for you, potentially, through a machine, being, naked.
And on a table and being uncomfortable with a person that you have trusted for your care that day. And so I would rather someone seek another opinion or even choose a different surgeon than to be in the operating room where they only know me and be uncomfortable. It’s one thing to be worried about the surgery, but to be actually uncomfortable about your relationship with me, I think it’s not good for the patient.
[00:27:21] Valerie Engel: So you just described how uncomfortable it can be for the patient to be in the operating room and like being in trust with your doctor on that day. But like from the standpoint of me, for example, the patient, how is it for you, you get to meet a patient, you give the diagnosis, then you get to the surgery day.
You operate this person, so you’re in a room and you have this person, you’re about to chop up this person, if I can say it like, in a rough way. How do you get to see all this? Like, how do you, get to still talk to the person after? It just sounds so crazy.
[00:27:56] Dr Makesha Miggins: Oh, well, they’re the person is not their disease process and the person is not the operation. I think it’s about having respect for the person. When I’m in the operating room, before I go to the operating room, I go meet the person, usually in the holding area myself or a member of my team, or even both usually trying to stop by and say hello. Again, because you don’t really know anyone else in the room.
So to see a welcoming face is usually very comforting to people. So I do my best to try to do that. And then when I go in the operating room, it’s not like I’m staring down at the person’s face, but even if I was for the operation, I’m really just focused on making sure that person is safe and that we do a hopefully complication free operation, a operation that’s curative since it is cancer.
And at that moment, it’s not like I’m connecting with them the same way as, we were in the office at that moment. I’m hyper focused on doing a good operation. And when that operation is done and we peel off the drapes, they’re back to being that kind of whole person against me.
And then when I go check on them after the surgery or see them in the post op appointment, I’m no longer thinking about their body that was exposed or the
operation that I was doing. Now I’m thinking about how did the operation impact them? Did I do a good job aesthetically? Cosmetically? Does it look good? And is the person happy with their outcome?
[00:29:23] Valerie Engel: That’s interesting. And then do you keep contact with your patient, like after the surgery to make sure that they’re okay? Or-
[00:29:29] Dr Makesha Miggins: So, usually if they’re, spending the night in the hospital, usually I might see them the next day or a member of my team will, and then I see them at their post surgery appointment or what we call the post operative appointment. And then a lot of patients I might see again in about 6 months, after the surgery, a lot of their care is really being facilitated by the medical oncologist, not so much the surgeon.
And then also if they had any plastic surgery or need any revisions or second stages to the operation, the plastic surgeon is primarily involved. But so I’m not constantly checking up on them, but I am aware of them and do always try to leave the door open for communication.
[00:30:11] Valerie Engel: Okay. And I’m, assuming that for patients who need immediate reconstruction, you work with a plastic surgeon?
[00:30:19] Dr Makesha Miggins: Yes. So the vast majority of my patients get offered plastic surgery in some way. If they decide to, I always let them know what reconstructive options are available to them and that if they would like, I can always, facilitate a consultation with a plastic surgeon. And then after they meet with them, then, they can decide if they want to pursue the route of plastic surgery or not. And if so, then I coordinate the case, the operation with the plastic surgeon.
[00:30:47] Valerie Engel: Okay, but you’re in touch with the plastic surgeon, obviously.
[00:30:50] Dr Makesha Miggins: Oh, yes. Sometimes the plastic surgeon is actually sitting right beside me in the same clinic work room. Other times we are communicating either by phone or even our, my institution uses email a lot, for secured email for a lot of, communication amongst, the teams.
And so I’m actually sending them a secured message to discuss the patient. Anything that is not necessarily what I would consider 100 percent straightforward, usually has some type of discussion with the plastic surgeon. And not always, then usually the day of the surgery, I see the plastic surgeon.
Either it is before the surgery starts, if there’s a question about incision placement, because, I want to achieve two things, I want to make sure that I’m making the operation in a way that I can do a good oncologic safe dissection, but also we need to set it up where the plastic surgeon can also achieve a good reconstructive aesthetic outcome. So that often requires collaboration between the two of us to ensure appropriate incision placement to discuss, if it’s a mastectomy, the skin flaps, what concerns I have, if there are any concerns I have about margins, Where I need to make the incision.
There’s a lot of collaboration, in breast cancer care, which I think is very important and patients need to be aware that it is not just, the job of the, surgeon that you see that day. It is not a care, not care that’s taken in isolation. So usually we need a medical oncologist, sometimes a radiation oncologist, sometimes a plastic surgeon.
It’s a whole multidisciplinary team. And that team needs to have a good open line of communication. It is truly the case where the right hand and the left hand needs to know what’s going on together.
[00:32:33] Valerie Engel: And then once you’re done with the surgery process, do you recommend a medical oncologist to your patients or do they just get transferred or somewhere else?
[00:32:43] Dr Makesha Miggins: It depends. So some patients I see, oftentimes as a surgeon, I’m seeing the patient before the medical oncologist, not every time, but the majority of the time. And so what I try to do either sometimes that same day. When I’m getting the records in for the patient, because often I’m not necessarily the one who’s seeing the patient the day they found the lump and done the workup, sometimes they come to me already with a diagnosis of either an abnormal mammogram or a diagnosis of cancer.
And so if they come to me with a diagnosis of cancer, I usually try to review their records and set up a consultation with the medical colleges early on, if I feel like it’s needed, because maybe they need chemotherapy. They have a cancer that can’t go to surgery first because they need some other treatment.
Or maybe they have a cancer that unfortunately is not curable because it has spread to other organs and they need the medical colleges more than they need me. And then when I’m talking to them, an appointment, and as we’re discussing their surgical treatment options. If it’s someone who has a cancer that needs radiation, and I know that because they’re getting a lumpectomy, then I may just send them to the radiation oncologist in coordination with my post op appointment to try to coordinate those appointments together.
Because at that point, I’ll have the pathology report so that the radiation oncologist will have all the information that he or she may need to discuss their treatment plan. Similarly, if the patient is a candidate for surgery first, I try to coordinate the medical oncology appointment once I have all of the information from the surgery.
So I may do the surgery, see the patient back within two weeks of the operation. At that point, I know the pathology report is back, and then I can coordinate the medical oncology and the radiation oncology appointment at that time. So it really, for me, depends on what the cancer diagnosis is. And if it is one that requires treatment before surgery, or if they can get the medical treatment after surgery to determine how I try to coordinate the appointments.
[00:34:47] Valerie Engel: It’s interesting to hear all the behind the scene after having just done it.
[00:34:52] Dr Makesha Miggins: Yeah, I think that’s one thing that patients sometimes don’t know. And sometimes patients unfortunately have to navigate this by themselves.
So at some institutions, they have navigators, patient navigators, nurse navigators that help them guide the path. Sometimes it is solely the surgeon that’s linking them to the other medical, providers, but it is a very complex, pathway in true good cancer care. It requires a multidisciplinary approach.
[00:35:22] Adam Walker: Ladies, I wanted to see if I could jump in here, to ask a couple of wrap up questions first, but Valerie, man, you are such a great interviewer.
Wow. I was, I’ve been just loving, just hearing your thought process and hearing this conversation. Going back to the topic of advice, we all love to give advice, even when we don’t realize that we’re giving advice. And so for listeners, ironically, I’m going to ask you what advice can you give them about giving advice to others?
I’d love for both of you to share your thoughts.
[00:35:53] Valerie Engel: No, no giving advice, unless you’re really sure what you’re talking about, or you’ve been through it and you think that you can be really helpful. I think it would be no giving advice because you automatically trigger something in the person’s brain that’s going to be put under another question mark.
And going through this, the cancer patient has so many question marks in his, or her head. But it’s not necessary.
[00:36:19] Adam Walker: I want to hear what you have to say, but I also want to ask, what about sharing experience rather than giving advice? Well, Valerie, what’s your gut reaction to that? And then Dr. Miggins, I’d like to get your take on this.
[00:36:29] Valerie Engel: If it’s, again, if it’s an experience that is really, helpful, that I’ve had all sorts of comments, experiences, people trying to help, but they’re not really helpful. It’s just, people get so uncomfortable in a situation like this that unless it’s something which is really helpful, I would say it’s better to just support the person and say if you need to talk or if you need my help, I’m here, take your phone, take your phone, just call me, it will be better than just putting another trigger in the cancer patient’s head.
[00:37:01] Adam Walker: And Dr. Miggins, what are your thoughts about giving advice?
[00:37:04] Dr Makesha Miggins: Yeah, I would in some way, agree with Valerie here in that, it is the natural tendency to want to advise someone. But I think in this setting, it is often better to listen and then see if someone asks you for feedback because really, most of the time, what I find when I’m listening to my patients talk about what they talked about with someone else is that they really went to them to just share. And then the other person took over the conversation with what they would do if they were. And so I usually have to caution people that oftentimes someone is telling you about something that they would do that they have yet to experience.
And they don’t really know. And then similarly, even when someone has experienced it, Most people, you have to be very careful because most people are often advising from a negative space because people will really try to direct you based on their negative outcome or negative experience or what they may have had a regret about, but no two people are exactly alike.
Uniquely, cancer is the same way. Most cancers are not exactly the same and everyone has different goals. So I think people really should, again, listen and see if someone wants their opinion, but also try to share their thought without influencing, which is sometimes very difficult, especially in this world of social media and influencers, everywhere that it really is sometimes difficult.
[00:38:34] Valerie Engel: It’s also difficult for the people around to actually understand how the cancer patient is feeling, because, when you get the
diagnosis, you actually feel very ashamed of yourself. there’s a shameful part where you’re like, wow, this is actually happening to me. And you don’t necessarily want to share how you feel in front of everyone.
So for example, I have two kids and once I got my diagnosis and also post my surgery, I still kept going out and I was not showing anyone what was going on in my life. And for example, someone told me, wow, what you’re at the pool, but I thought you had cancer. Did you actually invent all of this story? And it didn’t come from a wrong point of view, or she didn’t mean to me to be mean, but people just do not get it. And they try to make conversation. They try to make comments, but they just have it wrong.
[00:39:25] Adam Walker: Yeah, that’s good perspective. Appreciate you sharing that Valerie. Well, ladies, this has been, I think an important conversation. I think there’s a lot that all of us can learn about when to give and when to more likely probably when to withhold advice and just offer support. And I really just appreciate you both sharing and being open on the show today. Thank you so much for joining us today.
[00:39:46] Valerie Engel: Thank you.
[00:39:46] Dr Makesha Miggins: Thank you.
[00:39:48] Adam Walker: Thanks for listening to Real Pink, a weekly podcast by Susan G Komen. For more episodes, visit realpink.komen.org. And for more on breast cancer, visit komen.org. Make sure to check out @SusanGKomen on social media. I’m your host, Adam. You can find me on Twitter @AJWalker, or on my blog, adamjwalker.com.