Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 159 | November 16, 2021
Difficult Conversations About Breast Cancer
Dr. Michele Blackwood
Director of Breast Surgical Services at Rutgers Cancer Institute of New Jersey
Welcome to Difficult Conversations with Dr. Anthony Orsini. Even though October is Breast Cancer Awareness Month, breast cancer should be on our minds all year round. I can’t think of anyone more qualified to talk about breast cancer and the many difficult conversations associated with this diagnosis than my special guest, Dr. Michele Blackwood. She is currently the Chief of Breast Services at RWJ/ Barnabas Health and the Rutgers Cancer Institute of New Jersey. She also serves as the Northern Medical Director of Breast Services and joined St. Barnabas Medical Center as the Medical Director of Breast Health and Disease Management in 2009. Michele has appeared on national and local media programs, including Fox Five, “60 Minutes,” CBS’s Early Show, and Good Day New York. Even with all her credentials, it is her reputation for the compassionate manner in which she practices and her ability to navigate the many difficult conversations that make her special. My Co-host today is Liz Poret-Christ, who is our Director of Programming at The Orsini Way and a patient of Dr. Blackwoods.
Dr. Blackwood tells us about her career. She shares the many ways the breast cancer field has evolved dramatically and how survival rates are so much better. Dr. Orsini reveals some incredible statistics about breast cancer. They talk about how healing can begin when you first hear the diagnosis and how medicine is about relationships, and not about the surgery. Liz shares how her conversation went when she found out she had breast cancer. Michele takes us through her approach, her plan, and her thoughts on how she has the initial conversation with a patient. We learn how Michele handles each patient’s situation, forms that special relationship with each person, and how she gives them options and guidance. Liz tells us more about how grateful she was with Michele letting her know the best path for her to take with her diagnosis. Michele explains more about physicians evolving in their style over time and how her style has changed. She also explains how she addresses a lot of things with her patients so they will be in sync with her to have a better outcome after surgery. We find out how Michele approaches her most difficult conversation with faith, comfort, and quality of life. We end with Dr. Orsini, Michele, and Liz sharing their words of wisdom, with this being Breast Cancer Awareness Month. If you enjoyed this podcast, please subscribe on your favorite podcast platform.
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Dr. Michele Blackwood (1s):
Breast cancer. The field has evolved dramatically those first 10 years in the 1990s to the 2000’s where you saw changes in surgery. We saw changes in reconstruction. We started to see survival rates that were amazing, that hadn’t happened ever in the history of surgery or in the history of that. We were keeping track of the medicine. So I was still my father. I think I joined just like he joined infectious diseases in the sixties when all the new antibiotics and immunology came out. Well, I joined the breast cancer field and sort of the same way as you know, thankfully and Liz knows survival rates are amazing. Women and men can move beyond breast cancer. It doesn’t have to be their whole identity anymore.
Dr. Michele Blackwood (43s):
We don’t look at five-year survivals anymore. We look at full lives up until the age of 90 after 90, I guess we’re kind of on our own.
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini, Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members, or someone who just wants to learn to communicate better this is the podcast for you.
Dr. Anthony Orsini (1m 38s):
Well, hello and welcome to another episode of Difficult Conversations: lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I’ll be your host again this week. Well, I’m very excited about today’s interview and about this incredibly important topic that we’re about to discuss. Now, today I’m recording this episode toward the end of October and as many of you know, October is breast cancer awareness month. So although this episode will probably not go live for several weeks, breast cancer awareness should be on our minds all year round. Well, I can think of no one more qualified to talk about breast cancer and the many difficult conversations associated with this diagnosis then Dr. Michele Blackwood. Dr.
Dr. Anthony Orsini (2m 18s):
Blackwood is currently the chief of breast services at Robert Wood Johnson, Barnabas Health and the Rutgers Cancer Institute of New Jersey. She also serves as the Northern regional director of breast services and joined St. Barnabas Medical Center as the Medical Director of Breast Health and Disease Management in 2009. Previously, she served on several leadership positions at Nyack hospital in New York and Stanford hospital in Connecticut, Dr. Blackwood earned their medical degree at the medical university of South Carolina and was a global scholar at Harvard university she’s well-published and highly respected in her field to say the least she has appeared on national and local media programs, including Fox Five, 60 minutes, CBS’s Early Show and Good Day New York.
Dr. Anthony Orsini (3m 4s):
But even with all those credentials, it is her reputation for the compassionate manner in which she practices and her ability to navigate the many difficult conversations that occur when breast cancer happens. That is the true meaning of medicine. So I’m very, very excited to have Michele here with us today. We also have another guest that I’ll tell you about in a moment, but Michele for now, thank you so much for being here. We really appreciate you taking your time out of your very busy schedule.
Dr. Michele Blackwood (3m 32s):
Thank you so much Anthony, I’m thrilled to be here. I have to say, I think this is my first podcast.
Dr. Anthony Orsini (3m 37s):
Oh, that’s awesome. So it’s a lot of fun. We’re going to really have great time and we’re just going to let and see where this conversation goes. But as you know, the topic is Difficult Conversations, and I really want to get into that. Full disclosure, Michele and I grew up one town over from each other, Northern New Jersey, and it is certainly a small world, right? I think I went to high school with your sister, played basketball against your brother. Your father is a noted infectious disease specialist. So you come from a family of medical doctors. And then for those of you who know about the Orsini Way and have listened to this podcast before Liz Poret-Christ is our director of programming at the Orsini Way and a good friend for the last 10 years. And we also have Liz with us today and Liz among many other things.
Dr. Anthony Orsini (4m 21s):
Not only does she teach compassionate communication medicine, but she was also a patient of Dr. Blackwood. So Liz, thanks for joining us. And you’re going to just chime in whenever you feel fit, we’re going to hear it from both sides here.
Elizabeth Poret-Christ (4m 34s):
Absolutely. My two favorite people on a podcast, how could this go wrong?
Dr. Anthony Orsini (4m 38s):
You’re so nice. So Michele, let’s start off with, you know, I always believe in building rapport and building trust. So let’s start off with you just telling the audience a little bit about yourself, your professional career, how you got here, but also, you know, we talked about where you’re from, but just tell us about yourself. So our audience can get to know you.
Dr. Michele Blackwood (4m 56s):
So I am a breast cancer surgeon, as you said before. I always knew I wanted to be a doctor since I was eight years old. I had an illness that took me out of school for a year. My father, as you said, was a well-known physician. And I think my illness was very tough on my parents. And even my siblings, four out of the five of us did become doctors. Only one went on to something other than medicine,
Dr. Anthony Orsini (5m 19s):
Probably the smart one.
Dr. Michele Blackwood (5m 20s):
I was going to say the smart one or the successful one.
Dr. Anthony Orsini (5m 22s):
I mean, that is pretty amazing how many people went into medicine. And the first thought I have now that I have children that are through colleges, boy, that was very expensive for your father.
Dr. Michele Blackwood (5m 32s):
And so I don’t know how they did it. I have had three also through college and it is daunting. I tried to fight being a doctor for a long time. I went to Georgetown and undergrad and took all the pre-med classes. But my father, as you know, is a very influential physician. Very smart man, saved many, many lives. And I had rotated with him in the summers and worked at St. Michael’s in Newark and loved it, but also thought there’s no way I could measure up to that in my lifetime. So I tried everything, but to become a doctor. And so after I graduated from undergrad, I took a year off. Then I worked on the commodities exchange in New York.
Dr. Michele Blackwood (6m 12s):
I worked in retail. I was the best gift buyer in Hilton head island, South Carolina you’ve ever seen. I didn’t know anything about buying by the way, I still don’t. I was a merchandise manager. I had the best wardrobe of my life, but something was missing and I really felt a true calling. And you both probably understand this when you’re trying to figure out what you want to be in life. And I decided I really did want to be a doctor. So I applied to medical school and was thankfully granted admission. And I knew the day I started medical school, I was in the right spot. I just knew in my heart of hearts, I was where I was supposed to be.
Dr. Michele Blackwood (6m 54s):
I enjoyed medical school as difficult as It was, it was for history major to go to medical school. I really loved it. And I loved anatomy, physiology, pharmacology, embryology. I still think about those things every day. And then when I was getting ready to rotate through my rotations, I actually, as you know, Tony, your third year of medical school, basic five basic rotations, my first rotation was psychiatry. And I liked that. I was actually, that was my first one. I was at the VA hospital and I was fascinated. And it was just the time when they were starting the meds like that were groundbreaking in psychiatry. Then I went on to pediatrics, knew pediatrics was not for me, but then I went to internal medicine and I thought I was going to become an infectious disease specialist like my father, but I put surgery last in my rotations because I thought there’s no way I’m going to be a surgeon back then women were not surgeons.
Dr. Michele Blackwood (7m 49s):
And why would I ever want to be a surgeon? And all of a sudden, my last rotation, it all clicked. And I thought, wow, this is what I want to do. I want to fix people. I want to fix them relatively quickly. So then I became a general surgery resident, much to my father’s chagrin. And that’s a five-year road, as you know, back, at least back then. And while I was a general surgery resident, I was the only woman. And I rotated as many of people in the New York area to through Memorial Sloan Kettering cancer center. I rotated there as a medical student. I rotated there for almost a year as a fourth-year resident, and then I rotate it. And then I thought about becoming a GYN oncologist, but suddenly the world of breast cancer surgery was changing and evolving and was fascinating.
Dr. Michele Blackwood (8m 36s):
And I thought, wow, this is something I could do. So I went to Memorial Sloan Kettering. I can’t believe I still do this as a chief resident. And I said, I want to do a fellowship in breast surgery. And they said, oh, okay. Not sure what that would involve, but great idea. So I was their first fellow of breast cancer surgery at Memorial. I was hired by Dr. Kinny and then I worked under Dr. Borgen and Dr. Patrick and Dr. Sherit, it was a great, great year. And I became my passion and I felt like I had something different to offer than most general surgeons.
Dr. Michele Blackwood (9m 15s):
And I really wanted to help mostly women, but I help men as well. Breast cancer. The field has evolved dramatically. Those first 10 years in the 1990s to the 2000’s, we saw changes in surgery. We saw changes in reconstruction. We started to see survival rates that were amazing, you know, that hadn’t happened ever in the history of surgery or in the history of that. We were keeping track of in medicine. So I always tell my father, I think I joined just like he joined infectious diseases in the sixties when all the new antibiotics and immunology came out. So I joined breast cancer field and sort of the same way it’s evolved. As you know, thankfully and Liz knows survival rates are amazing.
Dr. Michele Blackwood (9m 58s):
Women and men can move beyond breast cancer. It doesn’t have to be their whole identity anymore. We don’t look at five-year survivals anymore. We look at full lives up until the age of 90, after 90, I guess we’re kind of on our own, but you know, when I was a fellow, if we had five-year survivals, we were thrilled. Now we’re not settling for that. We’ve gone so far beyond that. You know, at first we escalated all our care in the 1990s. Then we literally in the 2000’s personalized care and now we’re deescalating care. So I see this as an evolution and I enjoy being part of that process.
Dr. Michele Blackwood (10m 40s):
Love my patients, whether they’re my friends or not like Liz is I like helping someone through a very difficult time in their life. And I like having them move beyond that, to where they’re living full and happy lives. I love running into a patient at the grocery store or in church. And they have no idea who I am, but they know they know me. And I like that idea that, you know, at one point, all they thought about was breast cancer. Now sometimes when they go for their mammogram, they even forget which side they had it on.
Dr. Anthony Orsini (11m 7s):
And that really is your reputation. You know, parallel universe is here. So I meet Liz probably 10 or 12 years ago. And Liz and I have been teaching physicians how to communicate for 10 years, not even knowing this at the same time, Liz is friends with you. And so there’s these two parallel universes going on. And then Liz, she could tell the story. So Liz finds out that she has breast cancer tells me she’s going to. And I said, well, I think I went to school with her sister and I know her and she’s wonderful. And so, and now we’re all here together. So then we’re going to ask Liz about some of those conversations too, but I looked up some statistics before I got in. I did a little bit of my homework.
Dr. Anthony Orsini (11m 48s):
One in eight women in the US will develop invasive breast cancer over the course of her lifetime. 43, 600 women in the US are expected to die in 2021 from breast cancer. Even with all those advances that you talked about, but the overall death rate from breast cancer has decreased every single year from 2013 to 2018. And that is really a testament to medicine and how we are getting better and how we are specializing. But here today, I want to talk about really, you know, it’s been said by me and others, that healing can begin when you first heard the diagnosis and medicine in, this is what Liz and I are all talking about.
Dr. Anthony Orsini (12m 30s):
Medicine is about relationships. It’s not about the surgery, although that’s extremely important, but it’s about those relationships that you talked about when you meet somebody in a grocery store and how they say hello to you, but I’ve not heard the word cancer with respect to me. I’ve been very fortunate. Thank God. But Liz has, and Liz found out. And first of all, I want to ask Liz about her experience when you first, and that was a little different cause you’re going to a friend already, but how did that conversation go, Liz? And you talked about it a little bit in your last podcast, and then I’m going to ask Michele how she approaches that conversation.
Elizabeth Poret-Christ (13m 6s):
So breast cancer was not foreign to me, as a child I lost two aunts that I was very close to from breast cancer. And as an adult, I lost two friends that I was very close to from breast cancer. So it wasn’t foreign to me, but I went for my annual mammogram. Now to back up a little bit, I had already been diagnosed in 2016 with a blood condition that is considered a blood cancer. So I had already heard the word cancer in relation to my own health and kind of navigated that terror earlier. So when I went for my mammogram, I was having some pain in my breast and it was weird. And I went to the doctor and she said, well, you’re due for your mammogram.
Elizabeth Poret-Christ (13m 49s):
Do you want us to do a sonogram? I think it’s really unnecessary. And I said, yes, I think I would like that. I don’t understand why I’m having this pain. It’s come on very suddenly. And it’s concerning to me. So I went for my mammogram, they did the 3D mammogram and the radiologist tech comes back to me and says, you don’t need the sonogram. Your mammogram is clear. And I said, I’d really still like to have the sonogram. So they do the sonogram and the radiologists in that practice, they give you your results right away. So they said, please come to the radiologist’s office. She’d like to speak with you and I’m walking and you kind of start negotiating with God on your way into that room. Gosh, I hope everything’s okay. But there’s that nagging feeling in the back of your brain?
Elizabeth Poret-Christ (14m 31s):
That it’s not. So I walk in her office, I sit down and she says,Liz, I’m concerned. And I start thinking of all the training that we’ve done with physicians, it’s now 2018. I’ve been working with the Orsini Way for many, many, many years. And I know when a doctor says that they’re concerned or worried that there’s something wrong. So she said, I’m really concerned. I think you need to have a biopsy. Here’s the name of two surgeons and please go do that right away. I don’t think this is nothing I said, okay. So I just picked the first card that she handed me called and made an appointment and went and had a biopsy. I don’t know why I did it that way. I had been friends with Dr.
Elizabeth Poret-Christ (15m 12s):
Blackwood for years. She was a good friend. I know what a wonderful person she is, but I think I was just in shock and
Dr. Michele Blackwood (15m 18s):
You have my cell phone.
Elizabeth Poret-Christ (15m 21s):
and I had her cell phone. So I just wasn’t thinking I just was in shock. I think I just honestly was in shock. I knew that the words worried and concerned meant something. So I went to somebody I’d never met before I had a biopsy. And he said to me, Liz, I wish I could tell you this is nothing, but it’s not, but I can tell you everything’s going to be okay. It’s very small. It’s very early. It’s actually a miracle that anybody even saw this it’s watermelon seed tiny. So whatever it is you’re going to be okay, but I’m telling you it’s cancer. So my husband and I are like, okay, so at 10 o’clock at night, I get the report from the portal, the biopsy report from the portal that our hospital system used.
Elizabeth Poret-Christ (16m 5s):
And I decided to text it to Michele. And I say, here, look what I got. She calls me and I was half asleep. Cause I go to bed early and she said, why didn’t you just drive to me from the radiologist’s office? Like, what are you doing? And I’m like, for someone that knew how to navigate the system, that already had a complex medical condition, I just was in shock. So my husband and I went to Michele’s office, well, my blood condition complicates matters. I was always one of those people and watched both my aunts have double mastectomies that said, if this is ever me, this is what I’m doing. And then all of a sudden there was a complex complication that said, maybe you can’t do that.
Elizabeth Poret-Christ (16m 48s):
It’s not the best thing to do. So because the biopsy was done by another surgeon, we went to that surgeon’s office. And I said, well, what do you do to prepare for someone that has the blood condition that I have? And that surgeon literally said, I’m not afraid of a little blood. And then that was it. And told me what he was going to do. And we left and we got in the car and we had an appointment with Michele the next day. And I said to my husband, that answer doesn’t work for me. I’m a very medically knowledgeable patient. It’s what I do for a living. I write medical cases for actors. Like I’m not new to this. I have a child with a complex medical like that answer doesn’t work. And then we walked into Michele’s office and she had the genetic lab on the phone with what kind of biopsy we were doing.
Elizabeth Poret-Christ (17m 34s):
She had already spoken to my hematologist. There was already a plan in place. There was already a plastic surgeon picked out and I literally felt like a red carpet had been rolled out for me with the plan with the map. But more than that with the compassion to hold my hand and tell me that everything was going to go be okay. And that she had me and I it’s like that. I’ve got you and I’m not going to leave you. And we’re going to get you to the end of this journey was so incredibly comforting to me. I don’t know if I would have been as strong and as focused without her.
Elizabeth Poret-Christ (18m 14s):
It just was a miracle.
Dr. Anthony Orsini (18m 16s):
And that’s when the healing starts. So Michele, take us through your thought process when you have a patient is coming in and you have that initial conversation because as you and I know, and I know that you, you do this from, you know what Liz told me and, and your reputation, it’s all about building trust and forming that relationship. And we know that how you break bad news and you, how you have that initial conversation. Like Liz had that conversation with the other surgeon who said, I’m not afraid of blood. And she’s like, I’m out of here. Tell us what your approach, your plan and your thoughts on how you have that initial conversation. Because there’s going to be many more after that, but at least the initial one for now,
Dr. Michele Blackwood (18m 52s):
By the way, Liz, thank you for sharing that. It’s important for us physicians to hear those stories too, because you had never know how you come across to someone. Right, Tony. I mean, first of all, I think when I see a patient who’s a friend or not a friend, I always need to know where they’re coming from, what’s going on in their lives. Where do they live? How do they work? How do they make a living? Have they been through a lot in the past year or two? And I’ll be honest with you. I see a lot of patients who come in with a newly diagnosed breast cancer who have had some sort of tragedy or loss the year before, two years before. And right now we’re seeing an overwhelming number, as you can imagine.
Dr. Michele Blackwood (19m 32s):
I think I always see some of my office lately. And you know, we were hit by COVID early. A lot of people have lost someone to COVID in their family in the past year. And some, one of my patients lost eight members to COVID. And again, we were hit early here in New Jersey and we were just hammered by the way, it never gets easier to have that conversation with a patient. Did you know that ?
Dr. Anthony Orsini (19m 55s):
It doesn’t get easier, but we always say, once you get good at it, then you’re proud of that skill you have, as opposed to many physicians who don’t take the time to get good at it. And it’s always a task and they get nervous. So, but yes, it’s always hard, but it’s not hard because you don’t know how to do it. It’s, it’s hard because you’re a compassionate person. So,
Dr. Michele Blackwood (20m 12s):
So one of my professors who, he was a stoic guy from Kentucky, he used to say to me, if it ever gets easy for you to tell someone they have breast cancer, you probably shouldn’t be doing it anymore. So the other day I had to call a couple of patients to tell them what their biopsies were. And it’s never easy phone call. I used to make patients come into the office to have those discussions first. But the reality is I don’t want them coming alone. I want them coming with a family member, somebody who loves them, we could be a second set of ears. So one of the first things I do is I try and find out how they’re doing. They’ve had the diagnosis, they heard it maybe the day or two before, where are they in that? And I’ll be honest with you now that everybody wears masks in my office, the patients and myself included, it’s not as easy to read their faces.
Dr. Michele Blackwood (20m 57s):
You know, usually I’m pretty good at reading a room or reading someone’s face. It’s much more difficult now. And we really have to use our words in a much more emphatic way. So obviously I’ve seen the paperwork, right? I know what kind of cancer it is. I usually know how big the cancer is. I can pretty much stage the patient clinically before I meet them. I’ve seen their films already, but I need more. And I always need to know, do you live alone? Do you live with a partner? Do you have a significant other, do you have children? Did you just lose your job? Are you working from home now? That’s a big deal. Of course. Are you in a safe situation? Are you at all, have any instability with your food sources or where you’re getting your food from?
Dr. Michele Blackwood (21m 39s):
That’s been a big deal this past year and a half. Some of my older ladies, you know, they live alone. They haven’t been able to see their families. Their families have moved out of New Jersey. You know, I find out sometimes that they’re not eating healthfully. You know, I need to know how big or how little we can do surgically for them so that we’re not hurting them. You and I took an oath, do no harm. I take that very seriously. I never, ever, ever want to hurt someone. So I need to know where they are emotional. I need to know where they are physically. Where do they live? I need to know what their home situation is. I need to know what their education level is.
Dr. Michele Blackwood (22m 19s):
I mean, obviously Liz knows everything there is, and it is a daunting prospect to take care of your friend who is watching every word you say and I adore her and Liz has helped me.
Elizabeth Poret-Christ (22m 32s):
You get an A+
Dr. Michele Blackwood (22m 33s):
So, and it grieves you as a physician to take care of a friend, to be honest with you, your heart hurts. Not that it doesn’t hurt to take care of everybody, but when you know someone you love is going through this, it sucks. That’s a terrible word, but it’s harder in many ways, but yet I also know that I’m going to make sure I do everything possible that she’s going to be okay. Liz is a complicated lady.
Dr. Anthony Orsini (23m 13s):
Tell me about it, I work with her every day!
Elizabeth Poret-Christ (23m 15s):
Ok, this is not a roast.
Dr. Michele Blackwood (23m 17s):
Liz can’t do typical genetic testing on her bloodstream. Like I do with my other patients. I’ve been doing genetic testing for years and years because I think it’s important. And now, you know, the American society of breast surgeons agrees with me. So Liz can not do just blood work and have a gene test. We actually had to do on the fiberblast out of her tissue. And in the operating room, I had to have a separate piece of tissue to send it for that, which is a totally different type of genetic testing. Unfortunately it only tests for a few genes when you use fiberblasts, because they actually have to grow her tissue out into a culture. And then do the gene testing on that.
Dr. Michele Blackwood (23m 56s):
I have since Liz it as texted me recently about doing more gene testing and I have literally called friends from mass general all the way down to Charleston to see what their thoughts are. And it is complicated. It’s a complicated complication is a complicated story. And as a physician, you have to think outside the box. But in general, when I see a patient, the first thing I have to see is how they’re doing. I also have to see their eyes. I need to look into their eyes and see are they comprehending anything because 90% of the time, and this has been proven out by many journals when you hear the word cancer and it’s associated with you, your cognitive skill goes down by 40%.
Dr. Michele Blackwood (24m 38s):
The first month after diagnosis. And Liz will tell you she’s a very educated consumer and a very smart woman. There’s no way you can remove yourself from that diagnosis. I’ve seen it with my own family members. Every time one of my family members had to go to the doctor for a cancer diagnosis. I was there to help interpret those because they don’t hear
Dr. Anthony Orsini (24m 59s):
The statistically only about 10% of what someone hears after they hear the word cancer is actually retained. And so it’s really important for you to get what you need to get in as far as information from the patient and information to the patient. Before you say that word, because as we say, you’re actually redefining that person, right? They went from a mother and a wife or a father or whatever, to a breast cancer person, a person with cancer. And you can imagine that their whole world is turned upside down. So let me ask you about that relationship and getting to know the patients. So, you know, I’m not a breast surgeon, so I don’t know, but I know that there’s different options as you go through that diagnosis.
Dr. Anthony Orsini (25m 43s):
So, you know, lumpectomy, mastectomy, there’s different surgical options, but everybody’s different, right? There may be some people have more anxiety about, you know, maybe a lumpectomy would be appropriate, but maybe there’s some, somebody who just can’t handle that stress or the unknown. And so how do you work through that with maybe you think a lumpectomy might be appropriate, but this person’s more anxious or vice versa.
Dr. Michele Blackwood (26m 3s):
So the first thing I do is I try and simplify it. Like you said, there’s basically two surgical options, lots of variations under those two surgical options. But I basically say there’s a lumpectomy and radiation or a mastectomy with, or without reconstruction. And then we move on from there. And then I say, so first of all, there’s a couple of things we need to do as homework. One is a lot of patients, I do an MRI on who have a dense mammogram. Liz knows this, and the MRIs are very helpful at just finding really how big the tumor is, what the lymph nodes look like. It gives me a peek into the lung tissue, the bones, the liver. It really helps clinically stage the patients.
Dr. Michele Blackwood (26m 44s):
So are they really a stage 1? And I have to say, since the use of good breast MRI, I don’t really have many surprises at surgery. Thank God. It’s not perfect. No test is, but it’s very helpful. Second thing is we need to do some sort of gene testing because to your point, some people get anxious because if they keep their breast tissue and they do a lumpectomy, they have a chance of recurrence in their life. If they have a gene mutation that caused that breast cancer, they might have a higher chance of getting a recurrence than somebody else. We need to define that role. I think giving patients options is a great thing. So know that I feel that way, but I think patients need guidance.
Dr. Michele Blackwood (27m 27s):
So as a physician, I think you just suddenly, hi Mrs. Jones, you’re a breast cancer and here are your options. Choose, choose from a or B. It’s not like that. You need someone to say, I think this is a safe option. My dad had a great style. He was very paternalistic and people love that about him. And he was really a father to many, in some ways, I’m more of a, a big sister. I want to tell you, look, you’ve got this or you’ve got, this is your option. But I think in your situation, this works for you. I won’t let you do the wrong thing, but I do give you a lot of options.
Dr. Anthony Orsini (28m 2s):
You know, that’s an extra appointment shell. Liz will tell you that when we teach all the doctors for the last 10 years, it is a very common mistake or misconception that some doctors are taught incorrectly. I believe in you believe our job is to provide information. In fact, we’ll ask a lot of doctors, what was your main goal? And let’s say to provide the information and, and Liz, and I will say, why don’t you just give him a Google doc? So here you can, here’s your options. Let me know which one you want. It’s about relationships. And I don’t think it’s very fair to say, pick one. And we, I joke with the doctors and say, Hey, when you go to the mechanic for your car, the mechanic, doesn’t say, well, I can do the alternator. I can do the battery. Which one do you want me to do?
Dr. Anthony Orsini (28m 43s):
You trust the mechanic? And if there’s no trust, and then there’s no relationship. If there’s no relationship, then maybe there should be a different doctor that they do trust.
Elizabeth Poret-Christ (28m 54s):
I was very grateful to have had Michelle tell me what her expert opinion was. And in fact, she said to me, when I walked in, I have the lemonade from the lemons. I’m like, really? I’d like that. Tell me, here’s what I think we should do. Meaning she and I, we were a team. She had my back and I say this all the time. And I have a really good friend who a very short time after me was diagnosed with a very complicated breast cancer and didn’t have options. I was very grateful that I never felt like my options were taken away, but the best path for me was very thoughtful and presented.
Elizabeth Poret-Christ (29m 37s):
And I trusted Michele completely and said, yep, if that’s what you think I should do, that’s what I want to do. And it wasn’t what I initially thought I was doing, but I was very grateful to have had that guidance.
Dr. Anthony Orsini (29m 49s):
And I think Michele, if you don’t mind me saying, I think the going back to what you initially said about getting to know the patient and building that rapport, because that puts you in the position then to say, this is what I recommend. And when you trust somebody, you’ll say, okay. And sometimes they’ll say, no, I don’t want to do that. That’s fine. But it’s just not fair. I mean, we’re still teaching medical students to be a menu, pick one from a and pick one from B. And I’m hoping we can stop that because especially now we need to be able to, as we say, figuratively, put our arms around the doctor’s shoulders and she’s going to lead me to the next step. I trust you in whatever you say.
Dr. Anthony Orsini (30m 29s):
And I think we’re getting better at that, but something that we need to do more in medical school,
Dr. Michele Blackwood (30m 33s):
I think also you evolve as a physician. I’m sure you evolved in your style. My style has definitely changed over time. You know, I had a patient come in recently and I was a second opinion, which is great. I think it’s not a bad thing to get a second opinion. I think if you got a third, fourth, fifth, sixth opinion, you probably are just looking for someone to second. What you think is important. I don’t think that helps you. I think it confuses the situation, but I did say to her, look, you have to be comfortable with your choice of physician. If you’re not comfortable with me for better or worse, there are hundreds of other breast surgeons out there. And I think you’ve got to find who your, where your comfort level is.
Dr. Michele Blackwood (31m 13s):
I think that there are a lot of options in breast cancer that all lead to the same survival rate, which is of course what we’re looking for good survival. But I also think there’s a lot of ways to get there. The choices I have to had patients completely paralyzed by their choices. So when we get to that stage, and if I, if I feel, if I see that look in their eyes and panic, and they just can’t make a decision, or it’s been weeks now, and we’re still not moving forward on this, I call them and say, look, just let me at least get the cancer out or take a pill. Let’s do something to fight this cancer. Cause I don’t want this cancer to metastasize while we’re waiting.
Dr. Michele Blackwood (31m 54s):
And I think that works well sometimes because it takes the diagnostic paralysis and choice out of their hands. I agree with you, Tony, that I think we give options, which sounds like what we’re supposed to do. But I do think over time you learn, like I had a patient the other day, diabetic hypertensive lady, totally sedentary lifestyle, you know, obese, doesn’t walk. She loves her life and she’s happy there. But I said to her, look, what I do to you is to get rid of cancer, but I can harm you by that too. So we need to meet each other halfway. Somehow you’ve got to prepare for the surgery. I prepare for the surgery too, but it’s not me doing something to you, Liz of course is a very healthful person.
Dr. Michele Blackwood (32m 41s):
So she knows what it takes, but I need those patients to be in sync with me and to be a team member because otherwise we’re not going to have a good outcome. I had a patient recently who had a lot of addictions and I said to her, look, your addictions are going to kill you well, before this breast cancer is going to kill you. And so we actually got her into a couple of programs and I got a, I talked to a psychiatrist and now she’s, her addictions are being treated. And I feel like, you know, we have a chance here, but I really do believe it’s a team approach. I think if you think some doctors just going to wave a wand over you and you’re going to be healthy, it doesn’t work like that. You’re not just going to take a pill and be healthy. We as Americans would love that.
Dr. Michele Blackwood (33m 21s):
I mean, who wouldn’t, but it doesn’t work like that. The body doesn’t work like that. The mind and body also have to be in sync. And I don’t think I appreciated that 20 or 30 years ago. I didn’t realize nutrition was important. I think I had one week of nutrition in medical school. I don’t know about you, but they didn’t give us much. I think it has to be a multi-layered approach too. I think if you think as a physician, you’re going to just fix this person and go on your way. It doesn’t work like that. If they don’t know what to eat before the surgery or after the surgery, if they don’t know they have to stop smoking. If they don’t know that if they could just walk 20 minutes a day before my surgery they will have a better outcome. There’s so many things that we can make small changes in our life and actually have a better outcome overall.
Dr. Michele Blackwood (34m 7s):
So I try and address a lot of this stuff. I can’t tell you I’m perfect at it. But I do know that I’ve had patients with severe anxiety disorders that I have sent them to a good psychologist prior to surgery to try and work on those things. Because your head and you, and I both know this, you don’t function without your brain, but you know, that brain needs to be in sync with what else is going on in your body. And you have to be in the right headspace to heal from surgery. You have to know that you have to be an active participant in this. You’re not just a passive person and that, and I think we’ve gotten away from that. I don’t think we tell patients that
Dr. Anthony Orsini (34m 48s):
Yeah, it really needs to be a partnership. Michelle, the last question that I usually ask all my patients is probably going to be the same question that I’m about to ask you all tied together. So we’ll make it together. Walk us through the conversations that you have to have sometimes when things don’t go well, when you have that patient who options are done and it looks like they’re going to pass away. And I can tell that you have so much compassion. You take that personally, but you’ve had many instances. I’m sure we’ve had to tell patients there’s nothing else. How do you approach that conversation?
Dr. Michele Blackwood (35m 22s):
Interesting. Tony is one of the hardest conversations as you know, you can have with a patient and their family. Within the past year, I had two years out of really one of my favorite patients, just lovely lady developed a secondary sarcoma. And we had to have the conversation about palliative care and you know, the adult kids don’t want to hear it. Of course, I do talk about faith. I do talk about comfort. I talk about quality of life because I think that’s important. You know it with my own family members. I think some of the things I did to prolong their life was probably not the right thing to do. I think when they know that you’re upset by it too.
Dr. Michele Blackwood (36m 4s):
It’s okay to let them know the way I approach it is we’ve run our race. We’ve exhausted all possibilities. I’ve made phone calls. I’ve sent you here. I’ve done a consult there. I try and explain that. We’ve got to start talking about palliative care. Hospice care is a very hard thing to bring up because people feel like hospice care is giving up. I find palliative care is more tolerable for people to hear. And of course, as you know, palliative and hospice is a fine line between them and they kind of meld together. You know, having been through it with my own family members, I have total empathy towards it. I have to say one of the hardest things to have the conversation with is another doctor about their family member.
Dr. Michele Blackwood (36m 44s):
As you know, doctors and nurses, they don’t want to give up. We don’t want to give up on someone, but sometimes you have to say, unfortunately, this is it, but we will make your life comfortable. We will make your time with your family of quality time, as much as we can. And I think that trying to help them bridge that we talked about transitioning before I don’t use that word for this. I tend to use the word quality because I was able to on both my parents’ death bed, be there and speak to them.
Dr. Michele Blackwood (37m 24s):
And there’s not ever closure. I don’t think, but there’s at least peace with what the end should be or should have been.
Dr. Anthony Orsini (37m 32s):
And there’s things that we can do to help people even in dying. And it’s important that doctors take pride in that also or palliative care doctors do, but sometimes people on the front lines like you and me, we forget that. And we feel that it’s a failure. There’s a great story about Rabbi Kushner. Liz has heard this many times, Dr. Rabbi Kushner wrote when bad things happen to good people, love him. And he and I saw an interview with him one time and he was getting ready to do an interview on TV with an evangelical healer. And the healer was one of these guys who said, you know, he put his hand on people’s forehead and he was, they were cured from cancer and, and Rabbi Kushner is like, this guy is such a quack like, you know, he really can.
Dr. Anthony Orsini (38m 13s):
So he said to him in the green room, before the interview Rabbi Kushner goes, do you really think that you can heal people just by touching them on the forehead? And the guy turned to Rabbi Kushner and he said, I don’t cure people. But by doing that, I give them hope. I give them peace. And in my mind, that’s what healing is. And I think that’s what we need to remember as physicians that we may not be able to cure everyone, but in our compassion, in our kindness and our words and, and how we present it, we can certainly heal. And so I think that’s what you were saying. I think that’s where I find the most by doing neonatology. Unfortunately, there’s a lot of sadness and I think neonatologists and many of the NICU nurses do death an dying better than anyone maybe.
Dr. Anthony Orsini (38m 59s):
Cause we see it so much, but also because we understand, so Michelle, before we close, what do you want to tell people today is breast cancer awareness month, right in the middle of it or towards the end. What’s the message that you want to tell people out there, women, men, everything, what they should be doing and any words of wisdom that you can share with everybody before we leave?
Dr. Michele Blackwood (39m 19s):
Well, the, one of the biggest things I think people have to remember is during this pandemic or whatever we’re in right now, please come back and get your screenings done. I, myself am getting my every week I scheduled one more thing to check off my list because I didn’t, I needed my blood work. I just had my mammogram yesterday. You know, you got the women, you still need your screening tests done. And we reached a big birthday this year, my husband and I remind him, we both need colonoscopy this year. How fun. So I do think you got to get back to your doctor’s appointments as you know, and realize, and you’ve done, you know, this people have not come back. They’re still waiting out the pandemic. I get it. Most places are very safe.
Dr. Michele Blackwood (39m 59s):
I do believe in vaccinations. I do want people to get their vaccination. I just had my booster. I think you have to be an active partner in your own healthcare. And I think it’s time to get back, to see your doctors, getting your screenings, get your blood work, come back. We’re here. We’re ready. We’re we’re seeing patients in person. I also think in the breast cancer world, lots of hope so much has changed so much is evolving. It’s continuing to evolve. That’s one of the reasons I love this field. So don’t think if you feel a breast lump, but I have a lot of patients recently who felt this breast lump since March of 2020, don’t feel ashamed. Don’t feel upset that you didn’t get your mammogram for a year and a half.
Dr. Michele Blackwood (40m 39s):
Just come in. We’ll take care of it. They’ll fix it. We’ll figure out what it is. And we have lots of good doctors that are here to do that. And I also think that people need to know that when you’re doing what you’re doing in neonatology or I’m doing what I’m doing, you’ve got to remember that none of this is easy. When you have to tell patients bad news. My father always said, make sure patients know that they have hope. Hope is a very powerful medicine. And I agree with that, but I also think you have to know that a lot of people feel physicians don’t care anymore. That’s just not true. Many, many, many, many physicians, medical students, residents. They do care. We may not be as good at expressing ourselves for patients, but they really do care.
Dr. Michele Blackwood (41m 24s):
I mean, I work with medical students and residents, fellows. They care. It’s just, sometimes our communication may not be as open or honest as we would like it to be. But I do believe that most of us go into this field because we either had a calling or we want to help people. We’re not doing it for any other weird reasons.
Dr. Anthony Orsini (41m 44s):
An important message. There is hope with breast cancer and things are getting better. There’s a very high cure rate now. And I would also as a public announcement say, pretending, something’s not there, it doesn’t make it go away. You know, I had a cousin who had testicular cancer and just refuse to go to the doctor because he did not want to hear the doctors say the word cancer until it was the size of a grapefruit and it was already, you know, grade 4. And he passed from testicular cancer. So I think if you are feeling a lump or it’s time for you to go for your mammography, go because there’s something there, you have people like Michele Blackwood and other great doctors who will get you through this.
Dr. Anthony Orsini (42m 24s):
And Liz is a Testament to that. Liz did great and she’s still helping other people. So that’s, I think really the message that this whole thing that it’s about relationships, it’s about compassion and there’s hope out there. So that’s wonderful. Liz, anything you want to say before we leave Michele, this has been great.
Elizabeth Poret-Christ (42m 43s):
It’s been an odd journey to be on and hear this news, but it’s better to know than to not know because having your plan in place and having a team that supports you and that finds the lemonade from the lemons is the best possible outcome. And you’re going to do better when you believe that everyone’s got your back and I feel incredibly blessed to have had the team that I had.
Dr. Anthony Orsini (43m 6s):
Fantastic. Michele, thank you so much. What’s the best way for people to get in touch with you?
Dr. Michele Blackwood (43m 14s):
The best way is to call Liz. No, She does do that by the way. The best way is my office number. Believe it or not. I still have an old fashioned phone number landline in the office. 9 7 3 3 2 2 7 0 2. Oh, I have a great staff. Kelly de Lascaux is my director of our huge practice. Jen Wiener as my PA rockstar. Yes, exactly.
Dr. Anthony Orsini (43m 36s):
We’ll put all that information in the show notes, Michele, I can’t thank you enough. This has been a lot of fun. It’s really going to help a lot of people. I want to thank you for what you do and how you do it even more importantly. So thank you so much for being on.
Dr. Michele Blackwood (43m 48s):
Thank you for what you guys doing. You’re making a big difference.
Dr. Anthony Orsini (43m 52s):
Fantastic. If you enjoyed this episode, please go ahead and hit follow, download previous episodes. If you’d like to get in touch with me or Liz, you can reach us at the Orsini Way.com. Thank you, Michele. Again, this has been great and I can’t wait for the audience to hear this.
Announcer (44m 9s):
If you enjoy this podcast, please hit the subscribe button and leave a comment and review to contact Dr. Orsini and his team, or to suggest guests for future podcasts. Visit us at the Orsini Way.Com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.
Dr. Anthony Orsini and Liz Poret-Christ
Dr. Michele Blackwood
For More Information:
Difficult Conversations I Learned as an ICU Physician Podcast Episodes
It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini
Michele Blackwood, MD-RWJ Barnabas Health
Michele Blackwood, MD-Rutgers Cancer Institute of New Jersey