A Breast Surgeon’s Day: Blood, Sweat and Scared Women’s Tears : Medicine: It takes more than skill with the scalpel to do what he does. It takes stamina, courage and human understanding.
“ Surgery is like an armed savage who attempts to get that by force which a civilized man would get by stratagem. “
--John Hunter, 18th Century British anatomist and surgeon
He thinks of himself as “an armed savage,” this doctor with a knife whose duty it is to cut out the rogue cells and rid the body of its untidiness.
Nearly 52 years old now, Dr. Anthony A. Goodman has been invading other human beings with his scalpel for a quarter of a century. It is the fulcrum of the man, this surgical skill he carries. It has been the one continuum through three marriages, two children and countless personal journeys to far ends of the earth and deep recesses of the mind.
Being a surgeon is not just what Tony Goodman does; it is what he is . And now, after all the years of different kinds of cutting, he has brought all his gifts to bear on the specialty he believes is most important, both to him and his patients.
He is a breast cancer surgeon.
The sterile room is cool, almost cold. Tchaikovsky plays on the radio, not too loudly, not too softly. The gowned and hair-netted figures wait, checking charts and monitoring machines. The woman on the table stares at the ceiling, saying nothing.
The double doors swing open and Goodman backs in, hands in the air in front of him. Nurse Helen Caliguiri and scrub technician Dee McDonough tie his smock and briskly, efficiently, pull his gloves over his sanitized fingers, stretch the rubber back and fasten his sleeves around his wrists so germs cannot creep up the arms. He walks, in his Dutch clogs, the four steps to the patient’s head. He bends over her with a cheerful smile.
“How do you feel?” he asks the 32-year-old single, childless woman lying before him on the operating table.
In a barely audible voice, the frightened patient says she’s “OK.” Her doctor says: “Good. You’re going to be fine, so just hold onto that thought” as he imperceptibly nods to Dr. Armando Mendez, the anesthesiologist.
In two seconds, the young woman on the table is unconscious. She will wake up to find out whether she has breast cancer. She went to sleep believing so because the disease runs in the maternal side of her family like a poisoned artery, carrying pain and death from one generation to the next. She found a lump. It is Goodman’s job to open her body and remove that spot so that others--pathologists, X-ray technicians--can scrutinize and analyze it.
If the team, each member a specialist, finds that the shadow on her mammogram is a carcinoma, Goodman and his young patient will meet again, on another day, for a lumpectomy or a mastectomy, depending on what they decide is best for her long-term survival.
“Ready?” asks the surgeon, glancing around the table. It is a rhetorical question, for in this operating theater Goodman is the conductor, they are the players, and it is part of their job to be ready when he is. Still, for courtesy and reassurance, he looks at their masked faces and reads their solemn eyes.
Then, his body unwittingly tense, his neck rigid, he leans over the iodine-stained breast, the only flesh visible among yards of sterile green cotton sheets. He presses the knife hard into the skin. Harder. Harder. He makes a single half-moon cut around the nipple. The operation has begun.
“She’s young and single. Let’s keep this scar as invisible as possible,” he says to no one in particular.
There is little blood because Dee McDonough is at his elbow, suctioning it away almost as quickly as it appears. Once the skin is parted, Goodman uses other instruments to dig into matter which resembles, incongruously, buttercup-yellow chicken fat.
Reading the X-rays just above his head and probing deeper, studying the photos again, the surgeon abandons his tools to use his fingers to feel for the tumor. Although he cannot tell exactly where it is because it is so small, he senses that he has found it.
“Under a microscope, cancer is ugly and disordered and violates the symmetry of nature,” Goodman will say later. “When you cut normal breast tissue it looks rubbery and soft, and it feels like you are cutting a steak. When you cut cancer it is dull and feels like you are cutting an apple. It is like what the French say: ‘It cries when you cut it.’ ”
Excising a section of the breast about the size of a breath mint, he lifts it onto a glass slide his nurse has waiting. Then, as she rushes the slide to X-ray so technicians can take a close-up photo of the alien mass, Goodman waits. Less than 10 minutes later, the lab reports back to OR: the tissue removed from the body matches the suspect area on the mammogram. He got it.
The surgeon carefully, delicately, begins to stitch the wound. Tiny, self-dissolving threads slowly close the gap that, minutes before, revealed the deepest of hidden mysteries.
Suture by suture, the patient is put back together. Simultaneously, the elixir for pain is withdrawn. She is coming back to the surface world, moving her toes, fluttering her eyelashes.
Finished, Goodman leaves the surgical theater as the woman is wheeled into the recovery room. Her job is to wake up; his is to study the chart of the next patient.
Today there will be only two biopsies. Some days, nine women may come before him for lumpectomies, mastectomies and biopsies. He operates every Tuesday and Thursday; every day is different.
When it’s busy, Goodman and his team move, round-robin, from one operating room to another at the outpatient facility where he performs most of his surgery. Although he also practices at several hospitals in the Ft. Lauderdale area, he believes most breast surgery can be safely performed at the clinic across the street from his office.
There he sees patients every Monday and Wednesday. Sometimes, he says, his waiting room “seems like Job’s parlor.” By the time a woman is referred to Goodman by her family doctor or gynecologist, there is suspicion that she has cancer. After examinations and, if necessary, biopsies, Goodman is able to tell about 75% of them that they do not have the disease.
Their gratitude and outpouring of spontaneous affection are counterbalanced by the rage and fear he sees--and is sometimes the target of--in women who must be told they have the disease, which strikes about 175,000 a year.
“When Dr. Goodman told me I had cancer, I lost it, I refused to speak to him,” said Gayle Adaschik, 45. “On the operating table, I started to cry and he put his hand on my head and said: ‘It’s going to be all right,’ but I didn’t believe him.
“Later, I would say to him: ‘I hate you! I hate what you did to me!’ And all he would say is, ‘I understand.’ Around the house I called him the ax murderer because he gave me my mastectomy.
“It took me a long time to understand his kindness and caring. He’s got to deal every day with women who are in mental and physical pain, but he never once raised his voice or walked away from me. He has courage, too, just like us.”
Goodman understands the outbursts, and tries not to take them personally.
“They can’t get mad at God, because that’s not smart,” he said. “They can’t get angry at their husband, because they need him. Their GP or gynecologist sends them to me because ‘the lump stops here.’ So I’m the one who delivers the diagnosis, deformity and disfigurement. Some days, I’m not a real popular fella.”
Often, after surgery, Goodman walks two blocks down the street to practice karate, to rid his mind as well as his body of the stresses of his job. The night he got his black belt has become local legend: He took on 10 challengers, one at a time, but when the ordeal was over he had a broken nose, a broken rib and a broken foot.
“He wouldn’t give up. It was horrible,” said his wife, Maribeth, also an experienced martial artist, who witnessed the 10 competitions.
Tenacity is Goodman’s hallmark. Working with two assistants, he never breaks for lunch and often sees 45 women a day in his office. Barbara Kimble, who has worked with him 15 years, says he has a caseload of about 3,000.
Although compulsively punctual, he never wants a patient to think he is rushing her.
“I tell them right away they’re not going to die, because we cure three out of four,” he said. “A lot of doctors try to paint everything real black to protect themselves. I once heard a guy dictate ‘could result in death or worse.’
“I asked him what was worse--not having insurance?”
That is Goodman’s little joke: Outraged at the cost of medical malpractice premiums, he dropped his coverage four years ago. A notice posted in his waiting room--required by the state of Florida--announces that he is uninsured. He said he never has been sued for malpractice.
“I never get upset about going into surgery. I never lose sleep over it,” he said. “I get up in the morning, look at the list, and then go. Every day, I do the best I can, but that’s not what people want any more. They want perfect, and I don’t do perfect. I just do the best I can.”
Every patient gets a copy of his two books. He wrote “Never Say Die” in 1980 with breast cancer survivor Lucy Shapero, and recently revised his handbook, “Breast Cancer: A Woman’s Guide.” The books can help patients get to know him without a lot of personal involvement.
“I have to keep a professional distance, because if I get too close it’s not good. I have to stay objective. They all ask: ‘What would you do for your mother, for your wife?’ I try to give them the ‘Let’s be aggressive about this’ attitude. Denial is my biggest enemy.
“But I also tell my patients the truth as I see it, because if I don’t play straight with them from the beginning, they’ll never believe me again.”
Recently, he had to tell a 79-year-old woman she probably had breast cancer. He gently recommended that she have the lump biopsied. The woman glanced at her stunned husband, seated in the examining room leaning on his cane. She looked back at the gray-haired physician and said:
“Sixty years we’ve been married, maybe it’s my time?”
“No, not yet,” Goodman answered, patting her on the hand.
“Oh doctor, from your mouth to God’s ears, let it be so!”
Next.
A middle-aged woman was convinced she had breast cancer because the lymph nodes under her arm were swollen and sore.
“Do you have a cat?”
The woman looked startled, then nodded.
“A young cat?”
Yes.
“You have cat-scratch fever. Here’s a prescription for antibiotics. But be sure you get your mammogram on schedule next May.”
Next.
And so it goes, patient after patient, about three out of four getting good news. But there’s always the other one, day after day. Goodman estimates he has performed 1,500 mastectomies and lumpectomies, and about seven times that many biopsies.
Between operations he sits in the cramped surgeons’ lounge and snacks on fruit, high-energy muffins and any other vegetarian food he can find. Once a salami-and-doughnut man, he embraced a macrobiotic diet 10 years ago and now rarely eats fish, let alone red meat. He says it helps him keep up with his wife and their 5-year-old son, who is the joy of his life.
Trim almost to the point of gaunt, he immerses himself in strenuous, solitary off-duty pursuits that are direct counterpoints to the team effort required in the operating room.
Besides karate, he is a master of aikido, a Japanese art of self-defense that emphasizes non-resistance. He is a yoga devotee described by his teacher as “not the best student, but the hardest-working one.” He is a rower whose single and double skulls look quaint on the family dock, surrounded by elaborate yachts tied up along the ritzy neighborhood’s canal.
“In my early life, everything was competition,” said Goodman. “I competed to get into the best schools (B.A. Harvard College, ‘61; M.D. Cornell Medical College, ‘65), I trained for nine months as a member of the Harvard crew for just five races at Henley (Oxford University lost and Harvard took home the ’59 Thames Cup). Now, all my competition is with myself. How much better can I do something? How much better can I be?”
This singular drive led him to work on the Project HOPE hospital ship as a volunteer in 1971.
Two years later, shortly after his divorce from syndicated newspaper columnist Ellen Goodman--with whom he has a 23-year-old daughter--he went to Vietnam as a tourist. Recently discharged from the Army, where he’d been chief surgeon on a Maryland post, he wanted to see with his own eyes what was happening in the Asian country that had so absorbed his generation. He’s also traveled extensively in Africa and the South Pacific. His latest sculpting project is a stone monkey, half-finished.
Author of an unpublished novel, he is working on his memoirs--writing about being a medical student on the Navajo reservation, his stint as doctor on a Himalayan expedition, his months on the hospital ship, his first autopsy at the age of a 11, when he picked up a dead bird and took it with him to P.S. 193 in the Flatbush section of Brooklyn, where he grew up.
“I always knew I wanted to be a surgeon,” Goodman said, “but I’m always looking for other ways to apply my talent and intellect, always looking for something else to challenge me. Maybe next I’ll become a teacher.”
Meanwhile, there is a diagnosis to pass on to that single, 32-year-old woman with a family history of breast cancer who had found a lump.
“Wake up, dear, wake up,” Goodman says, still in his green surgical clothes, his mask pulled down around his neck. “Wake up! I have good news. Your lump was benign. You are fine. There’s no cancer.”
The smiling patient begins to cry as she whispers: “Thank you.”
Next.
