When my father was 14 years old, instead of dangling a fishing pole with his father on Saturday mornings, he dashed downstairs to assist him with tonsillectomies. Light fastened on his forehead like a coal miner, he peered past the tonsillar arch into the long tunnel leading to the
enigmatic interior, confirming what he had known since he was 5 years old: he too wanted to be a surgeon. Inquisitive, he questioned his father about the purpose of their mission. This was Brooklyn in 1935, a time when removing the tonsils was believed to be a prophylactic measure that would deter downstream health crises.
The tonsils were conceptualized to be the repository of streptococcal bacteria, the ubiquitous source of rheumatoid arthritis, nephritis, and rheumatic fever. To be a responsible physician meant helping patients to avoid harm. Consequently, two generations lost their tonsils to good medicine. Because the only indication needed for a tonsillectomy was an occasional sore throat and the presence of tonsils, business boomed for my grandfather in those Depression years. Mrs. Derringer, the nurse, made a salary of $8 per week, while the removal of each pair of tonsils cost $15. (This globally included the surgical fee, home-office operating room, anesthesia, and 6 hours in recovery.)
More than a dozen of these procedures were performed each day in my grandfather's basement clinic. The standard of care was plain and clear: the surgery relieved patients of otherwise anticipated pain and suffering, kept doctors in their position of useful service, and constituted a procedure that the profession had learned to do well. By the time I was 4 years old in 1950, my grandfather, by then at Long Island College Hospital, removed my tonsils. Today tonsillectomies are no longer believed to confer any protective benefit against degenerative disease. The original theory has been disavowed and the rate at which they are performed has plummeted.
Standards of medical practice are established by well-intentioned authorities first and, ideally, validated by science later. At this moment, Sally's head is covered in peach fuzz, though her chemotherapy ended 4 months ago. A 38-year-old mother of three (Billy, her eldest, is not yet 9), Sally joined the 184,000 women last year to be diagnosed with breast cancer, hoping not to become one of the 46,000 to die of the disease this year. She did not hesitate to comply with the advice of her doctor to undergo a mastectomy and the removal of a sampling of the lymph glands under her arm (to track traces of the disease that may have spread beyond the breast). When Sally awoke, still groggy, she asked, "How did it go?" Her physician replied confidently, "Don't worry, we got it all," and Sally, relieved, believed him.
Although there is no ambiguity on Sally's part about wanting to do whatever may be required to stay alive and raise her children, there is a woeful gap between our collective wish for a remedy for breast cancer and medicine's ability to furnish one. There is a further schism between what we know and what we do--a split that could be mended. Incongruities, misconceptions, and illusions surround the prevailing rituals employed in the management of breast cancer. Perhaps doctors, rather than being a syndicate of sinister conspirators, are prey to the simpler motive of wanting to rescue and redeem; and women, in their eagerness to be saved, are willing to surrender and endure, by any means necessary.