prepare yourself for some righteous indignation, because I've been stewing in it all night

The ambulance report: a 56 year old female, chief complaint is "generalized weakness and depression." We roll our eyes at each other, certain that we know what we'll see when the patient rolls through the door. And sure enough, it's a 56 year old woman with messy gray hair, in a dingy old bathrobe, smelling faintly of pee. And so I sigh, and follow the street medics into the room, and get a look at this woman's face, and my god.

You know in horror movies, when the hero and heroine come across the skeleton that's kind of half decomposed? you know, with the skin so taut across the skull, bones jutting out everywhere? That was this lady's face. And I'm listening to the medic tell about her medical history--none, except for cancer in her humerus decades ago, and a history of mild, unmedicated depression, and trying to fit that in with the way her face looks. And then he mentions the bilateral pitting edema in her lower legs.

Sure enough, it looks like all the weight from her face and upper body slipped down into her lower legs. And then she starts telling us how she's been depressed, and so she went to a psychiatrist two weeks ago, and was so weak she couldn't make it out of the car, so he came down from his office to the car (how kind, you're thinking, but no, keep listening) and crouched down beside the passenger side and scribbled a few scrips--two for antidepressants, one for a benzo since, in this psychiatrist's opinion, the weakness was not a physical but a psychological issue, and, regardless of the fact that her face looked like a skull upholstered in jaundiced leather, she was obviously suffering from anxiety that prevented her from leaving the car. Uh huh.

So the nurse and I keep asking her questions, and we find out that for the last two months she's had to use diapers and a commode, and although she eats the same amount of food as she always did, she's lost over half her body weight. She's afebrile, she denies pain. Just too weak to get around on her own anymore, she says. I help slip the bathrobe off, and suddenly there's this horrific smell. The bedsore smell. Except it's coming from her chest, and the dark green flannel nightgown she has on is saturated with what appears to be blood and pus. So I peel that off, gingerly, and find that what she has on one side of her chest is an enormous bloody and oozing hole where one breast used to be, and a dried, brownish flaking mass that still kind of resembles a nipple on the other side. Her WBC came back at 34, in case you were wondering.

Yeah. 34.

That is what breast cancer looks like, people. And yes, she should have sought help sooner--she didn't because she was disgusted and embarrassed, and her husband was so respectful of her and her wishes that he didn't insist. I doubt she would have told us about that gaping wound if we hadn't found it. But that psychiatrist, a medically trained professional, saw her edemetous legs and did nothing. Nothing, except throw prescriptions at her like candy.

Isn't it funny--and I want to slap myself for this--but when I've thought about breast cancer before, it's always the survivors who've had mastectomies and stand tall and proud that I think about--you know, the ones who look like Amazon warrior women who cut off their breasts so they could shoot an arrow straight and true. And maybe that's a good thing, that I think about these survivors as strong and fierce. But among women in the US, breast cancer is the most common cancer and the second-most common cause of cancer death after lung cancer. Women in the US have a 1 in 8 lifetime chance of developing invasive breast cancer and a 1 in 35 chance of breast cancer causing their death. So for every 34 Amazon warriors, there's 1 woman in a hospital bed with a rotting breast.

I will never, ever forget the way that looked.