Dr. Jane Mendez, a breast cancer surgeon at Boston Medical Center, has bad news for her 60-year-old patient, Delores Bayez. Two years ago, Mendez removed cancer from Bayez's left breast. As part of a clinical trial, Bayez elected not to have post-cancer radiation treatment. Now Mendez has to tell Bayez - a native of Puerto Rico, Mendez's birthplace - that her recent mammogram showed calcification in her breast. Bayez's cancer may have returned.
Mendez delivers the news in Spanish, leaning against the wall and casually crouched in a submissive position. Bayez's daughter Elized Elizer, 37, and granddaughter, Vianca Caban, 8, look on in silence as Bayez resists Mendez's request to remove the calcification with an operation. Bayez explains in Spanish that a doctor once told her she had colon cancer, but it turned out to not be true.
As Bayez speaks, Mendez rises. When Bayez is finished, Mendez looks directly into her patient's eyes and clearly tells her that her decision to opt out of radiation may have caused the breast cancer to return. After a bit of prodding, Bayez agrees to the surgery.
"We're just worried," Elizer says in English, reacting to the news after Mendez leaves to set up the ap pointment for Bayez.
Every Monday and Wednesday at Boston Medical Center's Belkin Breast Health Center, Mendez shares her expertise with women who don't have insurance, sometimes speak foreign languages, and often have little understanding about breast cancer. About 60 percent of her patients are Latina, and many of her other clients come from countries such as Vietnam, Cape Verde, or Haiti. Mendez strives to be culturally sensitive, realizing that certain aspects of breast cancer are taboo in various cultures. Mendez speaks French and Spanish, and she knows a handful of words such as "pain" and "thank you" in Vietnamese, Mandarin, and other languages.
"If they're not going to comply with what I recommend, because of cultural issues, cultural biases, or because we can't communicate, that's half the battle," Mendez says.
Mendez, 41, earned her undergraduate degree at Harvard University and her medical degree at Mount Sinai School of Medicine. She completed her surgery residency at Mount Sinai Hospital and her breast fellowship at New York's Memorial Sloan-Kettering Cancer Center. "She could be making two to three times the amount of money," says Dr. Henry Kuerer, director of the breast surgical oncology training program at Houston's M.D. Anderson Cancer Center, who's known Mendez since doing their surgical residency together in 1992. But Mendez believes "knowledge for the sake of knowledge is useless." She uses the information she's learned to help the less fortunate.
"In my training," says Mendez, "it was frustrating for me when the doctor wouldn't speak the language, for example Spanish, and all of the sudden they didn't take the time to really find out what was wrong with the patients. . . . It really bothered me that they would label the patients as ignorant and they wouldn't really attend to what they needed."
It was Mendez's surgical skills and her experience working at New York's Metropolitan Hospital, where she interacted with poor African-American and Latino patients, that impressed Dr. Michael Stone, Boston Medical's chief of surgical oncology. "I think she's a gem that much of the city doesn't know about," says Stone, who hired Mendez three years ago. "She's terrific with the patients. They leave her office feeling like they've been treated with great respect. She carries herself such that they understand that she knows what she's doing, and yet they feel like . . . they can talk to her."
Dr. Arthur Aufses, a professor of surgery at Mount Sinai Hospital whom Mendez calls her "surgical father" because of the guidance he's given her since she was a student, says, "She's smart, intelligent, has good judgment, good technical abilities. She's humanistic and compassionate. That's a real doctor; they don't make too many like that anymore."
The spoils of the positive way Mendez treats her patients decorate her office across the street from the Belkin Center: a sculpture and vase from Haiti, vibrantly handpainted espresso cups from the Dominican Republic. Mendez tells stories about women in their 60s who arrive at her clinic for their first mammogram. A Cape Verdean patient had a mass removed from her breast in Cape Verde but never received a diagnosis. Two years later she tracked down the results and was told to get treatment in the United States. By the time she arrived at Boston Medical Center, she had cancer in both breasts.
Defying expectations
Mendez grew up in Hato Rey, a suburb north of San Juan. Her mother once worked as a dietitian; her father is a retired manager who turned around troubled hospitals. "When I was working," says her father, Manuel G. Mendez, "I would take them, all of my children, to the hospital."
By the time she was in high school, Mendez knew she wanted to be a doctor. She chose surgery, she says, because "I can do things with my hands. And also I liked the fact that I could do something. It was not just waiting for medicine to work." Breast cancer surgery soon became 75 percent of what she did. But Mendez wanted to be the best. Five years into her job as an assistant attending at Metropolitan Hospital, she made the unusual decision to take a significant pay cut and loss of power to learn the latest techniques at Memorial Sloan-Kettering.
According to Aufses, it was a good decision. "She was at Metropolitan Hospital. You're not dealing with the best part of society in NYC. . . . Her ability to speak Spanish stood her in good stead, but it's an environment that doesn't allow her to blossom. Now she's in one that does. She's being appreciated in Boston much more than she was appreciated in New York."
Mendez caught Aufses' eye as a student, when she presented a case "magnificently," he says. As a student, Mendez says she pushed herself to excel. "I was there doing the work even if I hadn't slept all night or eaten. And most of the time I would do it with a smile on my face."
While other students bummed around in wrinkled clothes and hair askew, Mendez always looked stylish. "I hated her," says Kuerer. "Oh, I hated her. . . . She would be up 36 hours straight, would have her makeup on, hair done, groomed clothes."
She remains a well-put-together presence. During an interview at her office, she wears patent leather black stiletto penny loafers, black pants, and a frilly blouse. The high-heeled black mules she wears during clinic hours look infinitely more stylish than the usual comfortable shoes favored by medical staff.
It's Mendez's small way of staying true to herself while also pushing the traditional boundaries of Latinas. In an October profile in Latina magazine, she acknowledged that many people consider her a jamona, Puerto Rican slang for spinster. If her weekdays consist of the taxing job of telling women they have breast cancer, her weekends are for her siblings and her boyfriend, Scott D'Andrea, who lives in Annapolis, Md. After living abroad for several years, her brother, Manuel O. Mendez, a medical engineer, is now based in New Jersey. Her sister, Laura Posada, wife of Yankees catcher Jorge Posada, lives in New York.
Mendez has no regrets about her status. She reconciled herself to that long ago, says her father. "I told her, 'Jane, surgery is for males. It's very competitive. Any time of the day and night, you get calls. It's difficult to be a surgeon, be married and raise a family,' She said, 'Dad, that's what I want, and that's what I'm going to do.' "
