Daniel Zarca, exclusive breast cancer surgeon

"When Sonia * came to consult me, I had just left the Institut Gustave-Roussy, in Villejuif (Val-de-Marne), and I was starting my Paris business. The consultation had been long and painful. Nobody had ever mentioned cancer in front of her. I had first to provide him with the diagnosis, then to announce to him the only therapeutic possibility: a mastectomy. Sonia was out of there hostile and closed. Later, she sent me a letter accusing me of wanting to remove her breast rather than the only tumor to make more money. Mortified, I told her by mail that, since she seriously questioned my integrity, I refused to take her in charge and suggested that she contact a colleague. I have never heard of her again. "

"His story stayed in my memory. Which of us had missed each other? The injured and hurtful woman or the surgeon sure of the correctness of her decisions? I should have understood that she was appealing to me for help , an awkward invitation to resume an ill-engaged, ill-prepared dialogue. It would have been necessary to recall her, to see her again, and not to write to her. At a distance from the initial shock, the discussion would probably have been appeased. Confusing honor and pride, I had frozen his behavior and mine by the solemnity of my mail. "

" Eight years later, the same scene was played with another patient. This time the offensive words were said and not written. I was again accused of preferring mastectomy for pecuniary interest. This stuttering of my story symbolically gave me another chance. I listened for a long time, then explained everything again. As I always do, I offered this woman another opinion ; the stakes are too important to never leave room for doubt. I therefore organized a second meeting at the Institut Gustave-Roussy. She returned very quickly, accepting the mastectomy without even consulting another doctor. My explanations and my listening had convinced her. The aggression that hovered over the first interview was not directed against me but against the disease. This woman's reaction was healthy. One could channel his violence and use it to help him heal. This is what we have been doing together for years. "

Finally, Émilie * was my lesson in courage.

"With a lot of guts, this 30-year-old sportswoman had agreed to have her breast removed. In full chemotherapy, when she had no hair and one breast, she had persuaded - "forced", she said with a big smile - her husband to make love to her. Thanks to this tour de force, the sexuality of his couple remained satisfactory despite the hardships. She always is. Émilie had found the resources to no longer suffer the rhythm of the disease but to impose hers. Before meeting her, I was often satisfied with being a technician, with my radios, my tumor markers, my scintigraphies. Today, I always leave a window open on the couple. The surgeon who performed the destructive act must help the reconstruction in its physical and mental aspects. Sexuality should not be forgotten or considered incidental by oncologists. "

(*) The first names have been changed in all the testimonials to preserve the anonymity of the patients.

Claudia Bossi Bigard, psychologist at the Pitié-Salpêtrière hospital (Paris)

These women have turned my life upside down.

" I'm no longer a woman, I'm nothing. " Juliette had been taken off a breast. She was desperate and angry. She felt dispossessed of her identity. It was useless to say to her: "But madam, you are not summed up in a pair of breasts." Her doubt was abysmal, she was close to depersonalization. Sophrology and relaxation, beneficial for others, were not enough for him. I advised her to reconnect with her body by taking care of her: relaxing baths, massages all over her body, etc. She told me that until then she did not even know she had feet. She had so surinvesti her chest that the rest of her body remained a forgotten wasteland. I offered him gifts. An action unthinkable for her: she did not deserve them, let alone now. I continued with her supportive psychotherapy. She showed me that even the most hostile women to do good could yield to benevolence and listening. "

"Laurencia *, 32 years old, in chemotherapy for two years, taught me something else. She explained to me that she was in mourning. I asked her, "Did you lose someone?" She said, "I lost a breast." She said that she had lost her father to cancer, and therefore thought that her own cancer breast was tantamount to irretrievable loss. Thus, the mastectomy is experienced by some as the loss of the loved object and which has been loved by the other. With each patient, I try to see where she is from this point of view. Has this loss reactivated other more unconscious losses or injuries, does it show narcissistic failure? "

"On a personal level, these women have turned my life upside down, and the word is not too strong. It is not because we work in the hospital that we bought the right not to be sick. I savor every second. When these women thank me, I am very embarrassed. I thank them. "

Breast cancer: Annie Bisseret, nurse in surgery and senology at Institut Curie (Paris)

It is nothing the pain of a breast, it is in the head that it does not go.

"It's impossible to say that such a patient with breast cancer was my way to Damascus or my electroshock. In fact, it was all the meetings that taught me , all the pains - expressed or not - that transformed me, imperceptibly. At the beginning of my life as a nurse, I imagined that it was enough to be able to quickly and accurately ask for an infusion to be a good professional. With experience, I learned, on the contrary, to take the time, which allowed me to detect in these women details that previously seemed insignificant. "

"I remember Marie *, in her bed at night, bursting with loneliness and saying nothing. The next day began chemotherapy and then the loss of her hair. I sat down, I held her hand, I understood. I did not give an injection, I did not give a seal, I was there, and I could have been in his place. She knew that I knew ... There was also Hélène *, 46, in surgery for a few days, after the complete removal of the breast. She called me several times to tell me that she had a blister on her dressing and it hurt a lot. You imagine: she focused all her distress on a derisory detail. "

"My own sons never had the right to complain for trifles, I always had the backdrop of" real "distress at the hospital. But in senology, the small boils are always very important, they allow not to think of his too much suffering. Many patients express very strong things: " It is nothing, the pain of my breast, it is all that I have in the head that does not go. " I am heavy with the weight of the future of these women, I know that for some, the journey will be difficult because of their illness and what I understand of them. "

Breast cancer: David Khayat, head of the cancer department at the hospital of pitié-salpêtrière (Paris).

I learned to share the treatment decision.

"I was sick, child, and then again with a serious illness at 20 years old. I survived long months suffering, after paralysis with respiratory disease. During my hospitalization, I understood this "perpendicular" relationship between the patient lying down and the doctor standing. There is nothing more overwhelming. I also felt how much we could hope for the visit of the "boss". But the whole system is made to crush the patient and forbid him to ask questions. You're dirty, in pajamas, you've been hurt all night, and the teacher comes in, fresh, immaculate smock, he smells good and is followed by a group of students who collect the good word. When I became head of department, my first step was to cancel the visit to twenty-two in the room, a bit like a matador in the arena. "

"One day, Rachel * appeared. The 28-year-old woman had been diagnosed with 7 cm breast cancer. She had a beautiful breast. I explained to him that he would need chemotherapy to melt the tumor before surgery, and discussed the likely need to remove the entire breast . You imagine Rachel, young and beautiful, with a vertiginous cleavage ... Without saying anything, she untied her hair in front of me and dropped them on her loins. I was telling him that I was going to ruin him completely. She looked me in the eye and said, "There is no question. "

"At the time, with cancer of this size, its probability of recovery was less than 30%. So I returned to the charge, I insisted on convincing her to accept the treatment. At each consultation, it was the same stubborn refusal. She always replied: "Doctor, you gave me all the information, I understood everything, but it's my life, I prefer to live less and preserve my chest." As she wished, we went contented with chemotherapy a few months before taking the tumor (lumpectomy), without removing the breast in its entirety (mastectomy). "

"Medically, it was not the optimal option. During these repeated contacts, I became aware of my feelings of guilt. During the three months that preceded the intervention, I did not sleep. One day, everything changed and I told him of my decision: " From now on, it's me who tells you to keep your breast, it's me who bears the burden of this decision. "On his file, I have corrected my first medical indications and almost medico-legal and I entered the new therapeutic option. This cynical smile with which I could have continued to see her for years to clear me of all responsibility by brandishing the risk she had chosen to take ... "

" Today, Rachel is saved and she has a child. Thanks to her, I realized that the decision of a treatment had to be shared, and that a patient had the right to choose his destiny. Healing hundreds of patients does not allow you to speak for them. Rachel fought for her youth and beauty, she brought down my certainty and my precautionary principle with a pseudo-"zero risk". In reality, the young teacher I was became humble in front of his demand and his cry. "

Yves Otmezguine, chemotherapist and radiotherapist at the Oncology Center at the Porte de Saint-Cloud Clinic (Boulogne-Billancourt)

Every woman teaches me to help others better.

"I treated Aude * eight years ago. She was then 30 years old, a child and a companion. He left when he found out that she had cancer - that's what we call "double jeopardy" . Aude did not want to rebuild her breast, yet there were no surgical difficulties. "Amazon" she was, amazon she wanted to stay, despite my encouragement for breast reconstruction. I saw it last year, for its annual check. She was bright , I was sure that this time she would give way. Absolutely not: Aude had overcome the mastectomy and separation, she had a new companion and wanted a child. "

"Contrary to what I could imagine, the missing breast did not count . What I envisioned as awful mutilation was not a brake on her life. Caregivers are neither gods nor masters, but simple tools available to patients - who are free to choose their treatment. Becoming aware of this changes everything in the doctor-patient relationship. We do not consider things above, but on an equal footing, from human to human. And then, fortunately, all these Aude exist, otherwise we therapists would constantly think that we are the executioners of their femininity. They help us comfort the next ones who doubt and suffer. "

"The disease can also become a healthy moult, a path to the light. I remember that Malian who one day brought me his sixth wife. When Aminata * was saved, she left him. After rubbing shoulders with death, she did not want to be the slave of a man anymore. The disease has been a path of reconciliation with itself, an awareness. When a patient collapses, I turn to all these paintings and talk to him about Aude or Aminata, who opened the way. "