My Diagnosis

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It all started on January 2, 2020. I was in the drive-thru line at Wendy’s at around 11 pm, sitting in the passenger seat of my best friend’s car. I was randomly feeling my neck, not for any particular reason. Like most medical students do, I was just making sure everything was normal. I felt 2 medium-sized bumps, one on each side of my clavicle, that were NOT there last time I checked.

I didn’t think much of the bumps at first, besides the fact that they were new and the size of olives, because I was completely asymptomatic. My mind started to go through the workup for lymphadenopathy in a young adult: most likely due to infectious etiologies, maybe get some labs, pursue further workup if no resolution in 4–6 weeks. But, in the back of my mind, especially because I had bilateral supraclavicular nodes (right above the collarbone, with the highest chance of being malignant out of all the cervical nodes), I knew the worst case scenario was cancer.

With the help of my medical school administration, I had an appointment with a family medicine doctor on January 10. She ordered basic labs and a CT scan of my neck. Labs were stone cold normal — no cat scratch fever or mono here. The CT scan was more interesting: it showed that in addition to supraclavicular lymph nodes, I also had superior mediastinal nodes. Now, the radiologist report said a PET scan may provide additional information, but that wasn’t the way I was taught in medical school to think. I wasn’t going to go through unnecessary radiation if I didn’t even know what the scans were looking for! I wanted a concrete answer about what this was, and the only way to do that was a tissue biopsy.

In February, I met with an ENT who was very to the point. (Again, shout out to my medical school admins who got me into the clinic ASAP). Our initial consult meeting was probably 10 minutes, tops. I appreciated the fact that he went over my CT scan with me and let me look at my images. His working diagnosis was probably something autoimmune, maybe Sarcoidosis, which was #1 on my mind too (besides the “C word”). He said that typically he wouldn’t do biopsies for nodes like mine, which felt pretty benign to him, but that because I had mediastinal nodes, and because I was pushing for it, he would do the open neck biopsy.

On February 26th, the last week of my surgical clerkship, I went under the knife for a left supraclavicular lymph node biopsy. I have to say, no matter how many times I was in the OR, assisting with patients and even suturing incisions closed, nothing could prepare me for being the patient. I was so nervous going under anesthesia, even though I knew exactly what would happen after I fell asleep. Luckily, the surgery went well with no complications. What would come next, though, would change my life forever.

March 8th, 2020. It was the Sunday before medical school started back up after Spring Break. I had just been in Miami with my sister and best friends for my bachelorette party and had one of the best weeks of my life. I had gotten an email notification earlier in the day with my Flow Cytometry results, which said, in a few words, that I had an abnormal ratio of CD4:CD8 T cells. That basically meant it could be anything. I had my follow-up appointment scheduled for March 10, two days later, and assumed I would just hear the final path results then. Boy, was I wrong.

A couple hours later, I was watching Love is Blind with my roommates, who are also medical students. I get another email: “New Test Result — Pathology”. I’ve never been a person to sit on news, good or bad, so I open it. I read it, the words not quite sinking in. Pathology collectively supports diagnosis of classical Hodgkin lymphoma, nodular sclerosis subtype.

The rest of the night was spent in shock. I didn’t even tell my parents until the following day. How could I go to orientation the next day and pretend everything was normal? How was this going to affect medical school and my graduation? What about my Navy scholarship? My roommates and fiancé tried to stop me in vain from frantically searching UpToDate for Hodgkin’s Lymphoma staging, treatment, and prognosis. My whole world was crumbling, what would I do next?

2 days later, I sat in the ENT’s office with my roommates. He entered quickly and I swear he was going to hand me the pathology report without a word to “break the news”, but I stopped him and said, “I already know what I have”. He breathed a sigh of relief and mumbled an apology that I found out via email notification (note to other patients — that should never happen with sensitive diagnoses!) He checked on my scar, which was healing nicely, and sent me on my way with a referral for Moffitt Cancer Center, where I was to take the next steps of my cancer journey.

By Celia Vitale