Foreword

When Dr Faris called me this summer and in a very matter-of-fact Faris way said, “ I have breast cancer,” I was initially speechless. I thought she was calling me to talk about our research project, residents’ wellness, or any other 28 things on my mind. Despite my experience dealing with major illnesses during my career, I foolishly told her, “It will be okay.” She said, “No, it will not be okay, but I’m going to get through it.” Reflecting on our 1.5-hour conversation, I concluded the conversation with, “What I meant to say was that you will struggle, but you will survive and find your new normal because you’re a warrior, you’re loved, you a are skilled and respected surgeon, and you’re not alone in this. What can I do to help? I am here for you.”

This article is a must read for everyone. Dr Faris shares her authentic experience dealing with a life-changing journey navigating through breast cancer treatments without losing herself. It’s heartfelt, honest, and full of valuable advice including administrative pearls planning leave, applying for disability, maintaining medical credentials, and remaining involved in their academic practice. Those of us who share her struggles with health issues would admit that although the majority of our colleagues are supportive, there is still some perception of a surgeon’s being “weak” if they take time off while they appear “physically okay.” This perception feeds into our already existing imposter syndrome, which is more common in women surgeons. When Dr Faris asked me for some advice, I recommended ignoring the perceptions and murmurs.

It’s not surprising that it can become burdensome to cover for sick colleagues, especially if there is no definitive “stop time” to the illness. Furthermore, women surgeons are not naïve to fertility issues and pregnancy complications. Some of these health struggles are not easy or comfortable to share with our colleagues. We fear career repercussions and worry about our job security. These fears are amplified if we are dealing with the mental health issues. I doubt those are uncommon, considering current burnout statistics.

None of us choose to get sick. “Doctors don’t get sick,” “Surgeons don’t take leave,” “Surgeons don’t cut their hours.” The truth is that we are all human, and we do what we must to find “the new normal” during our treatment and recovery process. What we don’t do well is ask for help. We spend years preparing to match in urology, then years training to become urologists, followed by many years establishing our practices. Being a surgeon becomes intertwined with our personal identity and defines our position in the medical world.

Dr Faris navigated her warrior’s journey with grace, vulnerability, and honesty that few of us possess (Figures 1 and 2).

Larissa Bresler, MD, DABMA
Loyola Stritch School of Medicine, Chicago, Illinois Hines Veterans Administration Medical Center, Chicago, Illinois

As physicians, we study illness and treat patients, but much of it is in the abstract. As many of my patients stated, “you can’t be sick, you’re a doctor!” We rarely think of physicians getting sick because we are the caregivers, but there is no denying it when it happens.

This fall I was diagnosed with breast cancer. As a mother, wife, and surgeon the diagnosis affected every aspect of my life, including my personal identity, on a fundamental level. On top of the medical appointments, treatment decisions, and emotions to grapple with, there were also practical decisions to be made regarding navigating “being sick” as a surgeon. How do you tell everyone at work? Do you tell everyone? Who do you tell first? How much do you tell colleagues? Patients? How do you navigate FMLA (Family and Medical Leave Act), sick leave, paid time off (PTO), vacation, short-term disability (STD), and possible long-term disability (LTD)? What is going to happen to my career? To say that this is an overwhelming time is an understatement.

I am going to share my path and reasoning in the hopes of helping others who are undergoing cancer treatment or medical leave and trying to figure out what to do. The most important thing to say is that there is no wrong decision. This is likely to be the most challenging time in your life, both for you and your family, and you have to do what is right for you. This journey is personal, and everyone will handle it differently. To those who are friends, colleagues, or chairpersons, hopefully this article will give you ideas on how you can be helpful and supportive.

From a decision standpoint, the first month was like drinking from a fire hydrant. There are tests to be performed, results to be interpreted, decisions about treatment plans and which physicians you want to guide your care and where you are going to receive treatment. Some people elect to go outside of their institution for anonymity, others want the comfort of a place they know well and where they are also well known.

Another decision is who, when, and how you tell your workplace, which includes your boss, faculty, residents, staff, and patients. For my personal journey, I elected to be as open as possible with family, friends, and work. However, each time I told someone new about my diagnosis, I found it emotionally difficult to relive the diagnosis experience over and over again, and challenging to relive the shock and emotions of those who care about you as they learn of your diagnosis for the first time.

During my initial workup period I only told those closest to me, including my chair so that he could help me through the next stages of the process. Once I had enough information and a treatment plan, I elected to tell my faculty and residents in person at a grand rounds so that everyone received the same information, as I wanted to avoid rumors and hearsay. While this was difficult, it was also a relief to be open with everyone and to receive their love and support. That same morning, I told my clinic staff as a group, so everyone was on the same page. I found having the support of my staff to be essential, as they bear the lion’s share of work and patient frustrations when having to cancel clinics and surgeries. I was personally okay with my staff sharing my diagnosis, if they were comfortable with it, to help avoid patient aggression and anger for short-notice cancellations. If you are a colleague or the boss of someone who has cancer, I cannot express how much your support means. It is a very scary time where they are facing their own mortality, and if you can help relieve their concerns over their job security and patient care management this is helpful beyond measure.

I also sent out an email with information about my progress to close friends, family, and work colleagues with details on what was happening and how they could help. I was floored by the number of responses I received, and it was an incredibly uplifting experience to receive such an outpouring of love and support. It truly lifted my soul and has helped carry me through this tough time. I would highly recommend doing this with detailed requests for how people can help, because not only does it support you, but people also want to be able to help but don’t always know how. We had requests for a meal train with favorite foods and restaurants, donations towards extra dog walking, hair care after my mastectomy when I was unable to lift my arms, and streaming services, recommendations for good books and podcasts, to name a few. Childcare or help driving to and from appointments can also be very helpful.

Regarding time off and LTD, on a personal level this was one of my most difficult decisions. I struggled to accept my physical limitations, significant exhaustion, and lack of emotional energy. It was frightening to wonder what would happen to my career and everything that I have spent the past years building. It was also hard to admit that I am replaceable, and things will continue to move on without me. So much of my time, effort, and identity have been tied to being a doctor. Stepping away went against my self-identity and questions such as, “If I am not a hard-charging accomplished academic surgeon, then who am I? If I cannot power my way through this as I have everything else, does that make me weak? Will I be judged as weak for taking time off because outwardly I appear ‘normal’?” abounded. However, another very important thing to consider is how well you can deliver care to your patients while you are undergoing treatment and being honest with yourself about your abilities. I knew that taking time off would be hard for me, but I would not be able to forgive myself if I had a patient complication because I was not fit enough to be operating or because I missed an important result. After much introspection and talking with family, friends, and colleagues (who reassured me that I was not in fact weak and it was actually crazy to try to keep working full time), I decided to take time off from clinical work to allow me to give my very limited energy to my family and my own healing. I needed time to be with my young children and support them. Time for my body to heal from multiple surgeries and being poisoned by chemo. Time to learn my “new normal.” Time for my mind and soul to fully process my cancer diagnosis and mortality. All with the goal of coming back as strong as ever. While I knew that this was the right decision for me and my family, I admit that I still often felt the need to justify myself because of fears about perception. As surgeons, we value strength, grit, determination, and tenacity, and while stepping away may look like giving up, for me stepping away took all of my courage.

Regardless of what you decide, I would recommend that you consider applying for LTD right away. The reality is you do not know how you are going to respond to treatments, if you are going to have complications, or need further treatments. For me, I recovered well from surgery, but chemotherapy was like having food poisoning, COVID fatigue and lack of taste, severe joint pain, significant hair loss, and the induction of menopause all at the same time for 4 months straight. Applying for LTD is a process, and your institution can help shepherd you along. I was interested to learn that with LTD you can continue to work part time, have the ability to ease back into work, return to work early, or even elect to not use it at all. But having the LTD ensures that you will be financially sound, which is one less thing for you to worry about. In the end I elected to continue as residency program director (a role I am very passionate about and find fulfilling), continue my commitments to the AUA and the American Board of Urology (Figure 3), and remain involved in research. This has helped keep me engaged with work, my mind stimulated, and been a good distraction so I did not focus on cancer all the time. There is also something to be said for a clean break from work to truly have full time to process. As you can see, the decision to take LTD and how you structure it is a complex and personal decision and will be unique for everyone, especially when considering the cancer treatments necessary and stage of life and career that you are in.

Figure 3. Drs Bresler and Faris at the 2024 AUA advocacy summit.

Other things to consider if you are going to be out for an extended period are your hospital privileges and board licensure, which the hospital and the American Board of Urology should be able to help you with if needed. Regarding research, if you are on full-time leave, as a principal investigator you will need to identify another faculty as the principal investigator until your return. Additional considerations will be for clinical trials, where there will be adjustments to timelines or putting the trials on suspension.

One thing I have learned from the cancer diagnosis is that it affects every aspect of your life, and nothing will be the same afterwards. That being said, I truly believe that once I’m on the other side, I will have learned how strong I can be, and I am going to be a more compassionate physician with a more complete understanding of medical care after such a powerful experience as a patient.