CONSERVATION OF MASS(ES) | Evelyn Potochny
The first time I made cancer disappear was in the spring. The tumor was a roughly three-centimeter mass in the head of her pancreas, most assuredly a death sentence for the 65-year-old woman. I had stayed well past 7 o'clock on a dreary night in March, raindrops speckling my office window as I reviewed cases, when the cells began to move. Eye strain from the artificial light, I assumed. And they moved not like ciliated protozoa swimming in a droplet of water, but a reverse metamorphosis of a butterfly under time-lapse photography. The lavender fjords of the malignant glands disappeared, leaving swirling tufts of magenta fibrosis in the microscopic landscape. I wondered if the penetrating light of the lens had caused an optical illusion. But I pressed on and reviewed the rest of the slides for her case, including those containing the tumor and its relationship to various margins that would be important to her surgeon. All benign.
Of course I anticipated a call from the surgeon two days later. There’s no way that was not cancer. Mislabeled slides? A specimen mix-up? But no other pancreatic tissue had been submitted that entire week. I went back to the specimen container and fished the tissue from the formalin. The tumor was gone. I sent off a tissue sample for DNA testing: definitely the correct patient. Cured of cancer before she’d even had such a diagnosis.
The second time it happened was in June. An irregular mole on the right calf of a 52-year-old man that kept getting larger and darker and eventually bled. Notes in his medical record said he was an avid sailor who spent weeks at a time on his sailboat, drank an occasional rum and coke, and had a brother with melanoma. Well, so did he, by clinical description, by his biopsy three weeks ago, and by the rather large skin excision I pored over that day. I gathered the slides from his excision along with those of the original biopsy so they could be sent for a second opinion. I would soon learn we had consensus: no skin cancer of any kind. Another tumor erased.
I scoured my brain and jotted notes in a journal. What did I remember about that day, from the time I woke up until I looked at his slides and made it disappear? What had I eaten for breakfast? When I walked the eight city blocks from my apartment to the hospital, had I felt any cold bursts of air like I’d walked through a portal? Scrambled eggs with two slices of tomato and whole wheat toast, no butter. No mysterious wormholes, just a heightened sense of smell of a rotting Big Mac on Poplar and 7th, two blocks from the emergency room entrance. Was it the heat, maybe? Yet the second time it was cold and rainy. No, I couldn’t explain it, not enough to prove it and certainly not enough to harness it at will and replicate it.
Pathology was not an obvious choice for me. I thought I would become an intensivist. I liked putting the big picture together with every additional laboratory test and algorithmically eliminating the diagnoses that did not fit the differential. And I liked the pace of rounding on patients and trying to bring them back from the brink. Until I didn’t. Why did I let some patients infiltrate my psyche more than others? Why was it easy to objectively discuss end-of-life care with one family, but I would feel an emotional charge with another, clouding my judgment, leaving me questioning whether I was biased in pushing for unnecessary heroics? Too draining. My marriage crumbled near the end of my first post-fellowship year, and that’s when I course-corrected—to a place where I could shut the door on one world and dive into another one, a world I could only access with high magnification and a light-source, sans suffering faces to haunt me.
With the pancreatic tumor, the conclusion was a misdiagnosis from the beginning—that fibrosis from her autoimmune disease mimicked a mass that should never have required surgery at all. The disappearing melanoma case was much more of a head-scratcher. The lesion was well beyond the confines of the biopsy specimen. It should have been present on the excision as well. There were high-resolution photographs of the irregular multi-colored lesion on his otherwise olive skin. And now, not even the remnants of a benign nevus remained.
When things don’t make sense, I seek data. I read recent articles, old manuscripts from Sir William Henry Osler, even claims of miracle cancer cures on Reddit threads. Had other pathologists mentioned anything like this—cancer disappearing before their very eyes? Nothing quite like this in the literature, but I was drawn to a few papers on qigong, a Chinese medicine therapy I’d been exposed to in medical school.
During a holistic medicine introductory workshop, a qigong practitioner described and later demonstrated to our student interest group how he cultivated energy between his hands, like a ping pong ball of heat going back and forth from palm to palm, before he redirected it at the therapeutic target: during the demonstration, he directed that energy at a classmate with tense back muscles. My classmate stood shirtless, his taut back toward us roughly 10 feet from the qigong practitioner. Slowly, he tilted backwards while the practitioner pulled his extended open hands toward his own chest. It appeared as though he was pulling our friend with an imaginary tether until he was held on the diagonal to a point beyond which gravity should have dropped him on his back. Within minutes, that medical student said he’d felt like he’d had a deep tissue massage, without the practitioner laying a single hand on him. We were flabbergasted.
Before closing the session, the practitioner mentioned something about using “that which is within us,” and “manipulating matter.” However, he explained, wagging his pointer finger and lowering his voice for emphasis, he had to guard against too much compassion and set limits, for fear he could tip the balance of his own qi, rendering him incapable of protecting the energy field he required to appropriately care for his patients. And with that, he dismissed the clamoring medical students who wished he would enact more miracles.
While the events of that day felt like a parlor trick, I now wondered if that might be the explanation. Was I manipulating energy, not between the palms of my hands, but between my eyes and the slide, using my understanding of histopathology and all that energy to redirect the cancer cells toward benignity? And somehow, was this process benefiting the patient in vivo?
I decided on a two-pronged approach to cultivate more of whatever this was. First, I booked an appointment with my optometrist. Could there be something occurring physiologically in me that would be evident on examination? I didn’t disclose anything about these otherworldly experiences to her, but couched my visit under the guise that I was developing headaches. In the end, my visual fields, depth perception and pupillary responses were intact. Retinal scans showed a slight thickening of both optic nerves, although still within the upper limits of normal. I didn’t even need a revised prescription for glasses for my nearsightedness.
Two weeks later, I flew to Maine and rented a cottage near Sunday River for some R&R, part two of my plan. I would foster my possible superpower. I hiked. I read the classics, thrillers, but also books about cultivating intuition. I meditated, booked a hot stone massage, and spent hours trying to channel energy from my eyes to various materials before me. In short, I tried to set a notepad ablaze, unsuccessfully. I returned home relaxed but eager to sign-out cases and see if I could command more cancer-expunging miracles at will.
The third time it happened was the last. A coin-sized lesion in the left lower lobe of the lung of a 55-year-old smoker. Lung cancer on the slide that regressed to a small focus of chronic inflammation. Seriously, again?
Was it something personal that allowed me to procure a curative energy for these individuals’ diagnoses and not for others? I had never made a habit of looking in the patients’ charts or social media sites after I’d rendered a diagnosis, but after the third case, I did it for all three. What was Katherine doing after she learned she probably didn’t need to have a chunk of her pancreas removed, and mercifully didn’t have cancer? A retired nurse, she understood how these things could happen and did not sue. Instead, she started swimming at the YMCA and lost 25 pounds—not unintentionally—and bought a summer home on Hilton Head Island. And Ken with the scar on his calf? He dipped into his savings and enrolled in a sailing camp on Narragansett Bay and slightly upped his intake of rum and coke. Lyle continued to smoke and work as the executive chef at a Zagat-rated Thai place in the city.
The following May was when I first noticed something. It itched a little when I wore stockings. By June, my fatigue had doubled and my skirts had a little more room at the waist. I’d lost 15 pounds in the last three months and developed an irritating non-productive cough. Because of the cough, my doctor wanted to start with a chest x-ray, but I suggested a full body scan. I had my reasons. He acquiesced.
“Stef, your CT shows you have two masses. One on the lung, another on the pancreas. These might be unrelated and benign—hamartomas maybe. But obviously, you know what comes next.”
“The mass on the pancreas—was it in the pancreatic head? Maybe 3 cm?”
He flipped through his paperwork. “Yes,” he said, sitting up straighter and furrowing his brow.
“And the lung lesion—left lower lobe?” I asked.
Another pause as he scanned the report. “Yes,” he replied. “How did you know?”
My stomach flipped. My hands ached and turned chalk-white. I breathed slowly and leaned farther forward so I wouldn’t faint. I had known this was coming. I still hadn’t learned how to develop boundaries. Was it Einstein or Lavoisier who’d figured it out? Each tumor had to be going somewhere.
“Doc,” I said, “you’d better take a look at the mole on my calf, too. It’s on the right.”
Evelyn Potochny is an associate professor of Pathology and Laboratory Medicine at Penn State Health Milton S. Hershey Medical Center, Hershey, PA.