Text messaging and breaking bad news

It all began with a routine screening mammogram squeezed in over the lunch period between breast assessment clinics. As I watched my films slide out of the processor, there it was in my left breast: a tiny spiculate smudge. I asked my rather bemused radiographer colleague to do further views of my left breast. It didn't go away. I sneaked into the empty ultrasound room and, with one eye on the door, quickly placed the ultrasound scanner on my breast through a small modest window in my clothing. I thought I could see something. Then again perhaps I couldn't. Any breast clinician will tell you that ultrasonography is not normally performed under these conditions.

I then sent my first text message of many to my friend and colleague. “Hi, I think there is a small breast cancer on my mammogram. Can I see you before clinic tomorrow? Mammos are on your desk. M.” As is typical of any doctor who becomes a patient, the diagnosis was not easy, and eventually, after a highly suspicious magnetic resonance image, I had a core biopsy done 40 hours before I was due to fly to France for a skiing holiday.

“Can you text me my result?” I asked my colleague. She looked horrified

“Can you text me my result?” I asked my colleague. She looked horrified. As breast radiologists and clinicians working in the screening service our most difficult job is to give bad news. But by text? Suddenly with black humour we could imagine the headlines, “Patient receives diagnosis of breast cancer by text message.” Surely the ultimate cruelty. And so we shied away. Even though I felt fine about it, it was not fair to ask my colleague to do that.

The biopsy was rushed through by another colleague in pathology, and on the evening before I was due to fly I had a provisional result given in person, face to face, at my home: “Probably malignant, probably grade I with a good prognosis.” It was enough. I was upbeat. I told my children and reassured them and the next morning flew to France to ski.

Text messages were my lifeline while I was away. Every so often there was a comforting buzz and jingle in my ski jacket pocket as the messages came through on chairlifts, on the top of mountains, and in mountain top cafes. The messages, which I could read at leisure, were mostly short but sweet, and comforting words were used that are not always easy to say face to face. I kept the messages on my phone, and in the dead of night when a few tears would fall I would reread them.

“Can we discuss you at the multidisciplinary meeting?” said one. I tried to imagine being discussed at the weekly meeting I regularly attended. “Yes, I think so,” I replied. I wanted to play safe and go through the same channels as everyone else. I was careful not to ask my colleague any leading direct questions by text, yet I wanted to know if my “probably malignant” diagnosis was now definite. “I hope the diagnosis is now definite. Much easier to deal with,” I wrote. She was able to reply, “Yes but no worse than you are expecting.” I understood.

I thought of nothing else during that half term ski break. Luckily my 16 year old son was scooped up by our friends, and his days were spent in wild, off-piste skiing. I will be forever grateful to them for this. My husband did not leave my side.

“Surgery has been arranged for next Friday. Thought you would be pleased.”

“Delighted. Thanks for everything,” I replied. It was so good to hear that things were moving.

On my return, before and after surgery, text messaging remained an important part of my life. My family, friends, and colleagues continued to text me messages of support.

My husband, having fought steadfastly against the mobile phone culture, eventually succumbed; and the messages from him were the sweetest. While in hospital I have to admit that I received and sent a few illicit text messages under the bedclothes. My non-medical friend was bemused by “Peeing blue dye and have a blue nipple. Don't ask, M,” sent after sentinel node surgery.

I have remained upbeat. My breast cancer was grade I and node negative, with an excellent prognosis. Working as a breast clinician has undoubtedly helped me to stay positive and to know that I am lucky—not only to have had this small, low grade tumour but also to have knowledge of my condition and wonderful colleagues and friends as my carers.

And text messaging? Breaking bad news by text? I think not—and certainly not in the foreseeable future. But for me it was a marvellous comfort to know that things were moving along while I was away. I am now a texting addict, but unlike my children I still need to look at the keypad. I still mostly spell and punctuate correctly, and what's more I can't do any of it without my reading glasses.