A doctor tried her best to be a good patient

Her life began then to assume a surreal quality, she said. Returning from a bike ride, she was changing out of her clothes when she noticed something in the mirror. At first, she thought it was a warp in the mirror. But wherever she moved -- left, right, up and down -- her blemish moved with her, so the next day, after performing her first surgery, Kaelin went upstairs for tests.

The mammogram found nothing, but the ultrasound showed cysts, and when the cysts were discovered to be solid, Kaelin submitted to a biopsy and went home to her first sleepless night. The next morning, the chief of breast pathology came in as usual to review pathology reports, but this time it was Kaelin's report the chief held in her hands. Cancer, said the chief, and "I felt at that point like I was sitting next to one of my patients, and this wasn't happening to me," Kaelin recalled. "It was happening to one of them."

Always she had taken her work home with her, but now her husband and two children would have to live with breast cancer, too. Kaelin took a leave of absence and wrote a letter explaining her condition to colleagues and patients. She was soon enveloped by "a lot of humanity." Her mother moved in ("She's fabulous, just fabulous"). Friends began delivering "wonderful meals." Her patients, who seemed to want to take care of her, sent "bags and bags of mail." All of this was great support, but Kaelin sensed, too, that she was being watched, "yes, yes on virtually every level." Everyone wanted to know what sort of patient the doctor would make, and few who knew Kaelin were probably surprised by her sunny determination.

She told of the experience over the telephone, smacking gum and sounding chipper. The gum was Trident cinnamon, which she said helped to blot out the metallic aftertaste of chemotherapy.

As a doctor, "I had all the inside scoop," she said. She knew more about cancer than her patients and more about cancer doctors. Choosing from among her colleagues, Kaelin considered that she might hurt feelings, but decided "I just needed to do what was comfortable for me," and she selected Eric Winer of the breast oncology center at the Dana-Farber Cancer Institute and Michelle Gaddy of Massachusetts General Hospital.

With the normal bureaucracy cleared away, Kaelin went to work with her collaborators as though on someone else. Emotional as a doctor, she tried as a patient to be infinitely rational -- "A doctor," she said, "going through the data points." At first, her cancer was thought to be a grade one, "wimpy cancer," she said, but again, every day the news got worse.

By the fourth surgery, three tumors had been found, and Kaelin accepted that her fifth surgery would be a mastectomy. Then came chemo. She had never before known fatigue like that, and certainly it was difficult when her hair, which hung below her waist, began falling out.

"I find there's an adjustment period to each of these things," she said delicately, but the boutique at Dana-Farber has "everything you need for appearance adjustment."

Knowing a weight gain during chemo will increase mortality risk by 150 percent, she did as she had instructed her patients to do and -- despite the fatigue -- continually got herself to the gym. Winer, who puts her chance of recurrence at below 10 percent, said Kaelin came through it "very gracefully" and makes "a good role model for physicians facing problems they focus on." Her patients were apparently satisfied, too, for they asked Kaelin to speak publicly about her experience as a cancer patient. So she has talked with reporters, and in November on television's "Good Morning, America."

Tired now of wigs and falsies, Kaelin is looking forward to breast reconstruction and to growing her hair and to "rebuilding a life that's productive and full, and full of joy." When she returns to work some time next year, it is possible, she acknowledged, that she may arrive an even better doctor than she left.

How could she be more empathetic?

One of the lessons she said she's learned as a patient is to listen to concerns that may not be life-threatening, but that are disrupting the patients' quality of life.

"If anyone ever says, `I have a metal taste in my mouth,' that's really going to ring a bell with me," she said. "I'm going to make sure I really do a good job of listening to what the patient's priority is at the moment."