I have probably written and read the phrase “S/P mastectomy” innumerable times during my medical career. The S/P in medical lingo is Status Post. We doctors are into status, as in, “What’s the current status?” The here and now, the current medical status is of utmost importance. That’s what dictates the flow of oxygen, the rate of the I/V, the setting of the ventilator, all of it. We are trained to appraise the here and now with precision and respond precisely to the “status” of the patient. Status Post is past that is relevant to the present. I am status post mastectomy too. But even though I had written it many times in the past, only now do I understand the weight of being a status post.
We doctors write Gravida and Para in OB charts. Sometimes there is a mismatch, more gravidas (pregnancies), less para (births). Sometimes it’s just getting the full history and moving on to the need of the hour and being required to not feel the pain of the lost pregnancy that the person sitting across has dealt with.
Loss is an ongoing theme of medical career. You lose some, you gain some. If doctors got stuck on losses, they would never be able to function. We value little battles that we win, and draw strength from them. A baby delivered without complications, a surgery without post op infection, a patient wanting to live despite heart-wrenching clinical depression, all fuel our desire to fight on. We somehow muddle through the losses. A lost patient life is usually countered by the thought that we did everything we could, or she is comfortable now. Or even, look at how many I have saved. It’s an ongoing journey of doing good and convincing yourself that you did good so you can move past the losses. Human life is fluid and unpredictable. We gradually get good a maintaining distance from our patients’ emotional trauma, for if every time a surgeon putting the first incision would think how much it would hurt when the patient wakes up, he couldn’t do the job. It’s a double edged sword of compassion and self preservation.
So I have written the words “S/P mastectomy” as a doctor many times. Those times, to me it indicated that this person has endured a major surgery, has been under anesthesia, has the ability to recover and has a scar from the surgery. Likely the culprit is breast cancer which was the reason for the mastectomy in the first place. So my note would document presence or absence of metastatic disease and “current status.”
All from the distance, that doctors maintain to function. Of course, we aren’t robots, the humanity always trumps the situation. We cry with patient’s families, have tears of joy with a patient who fights off death successfully. But we are also very primed to wipe those tears and walk into another patient room, where yet another unexpected emotional challenge may be waiting. We do it somehow.
I was recently reviewing the chart of a new patient that I haven’t seen yet but records had arrived ahead of time and my gaze stuck on the sentence, “S/P Mastectomy.” I know what Status Post Mastectomy means. No, this time, I really understand what it means to be Status Post Mastectomy.
S/P Mastectomy means having lost a body part that defines you as a woman.
S/P Mastectomy means having been wheeled to the OR knowing you will wake up disfigured.
S/P Mastectomy means taking pictures for one last time when you can wear a regular bra.
S/P Mastectomy means having a 5 inch long scar across your chest and being able to feel all your ribs
S/P Mastectomy means always having to wear a prosthesis. Having to travel with it, having to swim with it.
S/P Mastectomy means feeling utterly frustrated if you can’t find your prosthesis because you can’t leave the home without it. You can sometimes under a heavy coat, but off balance.
S/P Mastectomy means feeling envy at another woman’s low neck blouse.
S/P Mastectomy means remembering cancer every time you change or shower.
S/P Mastectomy means wondering if you are still attractive or still a woman.
S/P Mastectomy means feeling incomplete when the prosthesis comes out at night.
S/P Mastectomy means to feel complete enduring a series of multiple painful surgeries, should you choose it.
S/P Mastectomy means being on the watch out for lymphedema for the rest of your life.
S/P Mastectomy means losing a sensual zone of your body.
S/P Mastectomy means a life changing experience that not everybody understands.
Fortunately, for my patient and me, we will go over the history in a way that only few understand. I look over the line again and smile, ” Status Post Mastectomy.” I know what that means, I really do.