Left to Right, John Stehlin, M.D., 75 and Peter de Ipolyi, M.D., 53, cancer surgeons, Houston, Texas, Lin Mills, 49, interior designer,

"My cancer was discovered in a routine mammogram. My doctor sent me to the oncologist that he thought was best. I remember when I went in there I was hoping for the best. The doctor said that the only possible treatment was a radical mastectomy, and no reconstructive surgery, would be possible.

I was in a state of shock, vulnerable, and upset. I had a lot of questions, but he didn't seem to want to answer them fully. He kept pressing me to make decisions about treatment before I felt like I had all the information.

I left that doctor and went to five others, looking for someone who I could communicate with. They all offered sympathy but did nothing to assuage my fear. Instead they focused on the cancer and killing it. I left their offices feeling more afraid. I kept thinking about this friend of mine who wound up having a double mastectomy, and when it was all over her doctor was offended by her lack of gratitude.

"I waited a long time, at least an hour, past my appointment time the first time I saw Dr. Stehlin. But I didn't know that during that time he was looking at my, charts, meeting with a radiologist and a surgeon and going over everything. When we met, the first thing he said was, 'Sweetheart, I'm not worried about you. You are going to live a long life.'

"All of a sudden I realized that I had become clinically detached from what was happening to me and how serious it all was. He invited a whole team of people -- I think there were seven of us -- to go over my records for an hour. I suggested the idea of reconstruction, and he said, 'I think that's a wonderful idea.'

"The whole approach made me feel like I was part of a big team that was going to do everything possible for me. But they also treated me like I was a client, a valued person, and that I had the ultimate authority in every decision. It made me feel wonderful. Dr. Cohen, my surgeon, pledged to me that he would do his very best work.

"Immediately before my surgery Dr. Stehlin came to see me. I had told him that I didn't want Valium before the surgery because I wanted a clear mind. I said I would use meditation to relax instead. When he came in he gave me a big hug and said how proud he was of me and my relaxed heart rate. Then when I got into the operating room I looked around and saw all these faces of familiar people. They were the people I had picked to be there. It was like they were friends there to help me, and they did."

"All of a sudden I realized that I had become clinically detached from what was happening to me and how serious it all was."

Mary Epperson, Patient
Ipolyi. Stricken by breast cancer in her mid-twenties, she was determined to learn every option available to her. She sought and found a doctor who would help her obtain a full cure that also left her body and her life as whole as possible.

I had just gone through a change in insurance companies when I discovered the lump myself. I had to rush over to see a doctor I had never met before. I wanted to know if it was cancer and if it was, what we were going to do. He just took out this list and began going through the names of oncologists. He gave me the name of a doctor, but when I called they said I would have to wait six weeks for an appointment.

I had worked as a massage therapist before, and I had some clients who had been through breast cancer. I did not want to wait and wonder for weeks about what was going to happen to me. I'm not that kind of person. I read up on things, I'm very interested in medicine. I take action.

I had heard about Dr. Stehlin and Dr.de Ipolyi so I made an appointment. But when I got there, my insurance company hadn't yet approved payment. So I got on the phone with them right there. I could see Dr. D. waiting in the hallway for me. I could hear him tell the staff, 'Just send her back here. I want to see her. I don't care about the insurance. We'll work that out later. Send her back.'

"That impressed me. But what impressed me even more was that he and I immediately began working together on this. I said I wanted a needle biopsy. He said, 'When do you want it?' I said I wanted it right away, and he said he would schedule it for that afternoon. That told me that he knew what I was going through. He understood and he cared.

"Hearing him say that he didn't care about the insurance and that he just wanted to see me was very important, but something happened as I was leaving the appointment that made an even bigger impression. He followed me out and into the hallway and we stopped for a minute to talk about how to handle the insurance problem. I leaned back against the wall with my hands behind my back and put a foot up behind me, against the wall. He leaned against the wall the same way, even putting the same foot up and putting his hands behind his back too.

"What he did was unconscious. It's called mirroring. And it shows someone has real empathy for you. I've read that 85 percent of communication is body language and I believe it. By his body language he was letting me know that he saw me completely as a person. He was interested in me as a person, not just a disease."

Doctor
John Stehlin authored one of the first articles on psychology and cancer care ever published in a major medical journal. In the thirty years since, Stehlin has continued to explore the doctor-patient relationship. He has paid close attention to the doctor side of the equation, focusing on the effect that a physician's expectations and motivations have on patients. Stehlin says an unusual opportunity -- a grant that funded psychotherapy for him when he was a young doctor -- began his lifelong interest in the psychology of medicine. Thin and a bit stooped with age, Stehlin speaks slowly, choosing his words with care.

Once a protégé of Dr. Stehlin, Peter de Ipolyi, M.D, is now his partner in a busy oncology practice and research center affiliated with St. Joseph's Medical Center in downtown Houston. Dr.de Ipolyi helped pioneer several cancer treatments. His surgical training included work with Houston heart surgeons Michael DeBakey and Denton Cooley. Tall and muscular, de Ipolyi communicates his energy and enthusiasm through a broad, beaming smile.

Stehlin
"I think it's very important to recognize that doctors expect certain rewards, satisfactions, from their relationships with patients. You want an emotional reimbursement. That's not bad. It's just real, a part of the relationship that should be recognized.

"Probably the best specialty for this is obstetrics. You get to build a close relationship with your patients over six to nine months. Then on the night that the baby is born you rush to the hospital, and then you can say to the mother, 'Here's your baby!' It's wonderful.

"In oncology you pour all of your time and energy -- emotional and physical -- into curing your patients. When you finish the operation you feel so good. The patient goes home thinking I'm God almighty. That feeling remains until she gets a recurrence. Then I'm negated. My omnipotence fails. Now what do I do? I realized that what I have to do is set different goals. Be something different that the omnipotent surgeon.

"What I am, really, is a trained friend for my patients. I'm someone who is going to help see them through this time. That's a very important thing. It means building a true relationship so the patient knows you as a person. I tell them right away that I don't have any magic. I am human, just like you. I make mistakes, too. But I do care about you. When a beautiful young person comes in and you discover the cancer and you know what their chances are, they have to know that you are pained too. Don't be afraid to show them your pain, because you care about them."

"What I am, really, is a trained friend for my patients. I'm someone who is going to help them through this time."

de Ipolyi
"This is something John and I talk about a great deal -- The Trained Friend. I first heard about it twenty-five years ago. John told patients then that he couldn't treat them alone. The patient has to be a partner. He has to carry his load. The patient is not an object of the treatment, she is a participant. When a new patient comes in we formally welcome them to our team. The team is dedicated to your care, but you are an important part of the team and we make sure they know it."

Stehlin
"Doctors have to understand that they will have a tendency to turn patients into objects, especially if things are not going so well. I have done this myself. I'll have ten patients in the hospital that I am going to see on rounds. Those that you know are doing well you can hardly wait to see. Those who are not, you put off. I once went to see my patients and then went to have a sandwich, and in the middle of eating realized that I had forgotten to see one of them. Of course she was the one who was not doing so well. I had converted her into an object, a problem, and subconsciously just decided to forget her.

"To fight against this I try to make sure that I really know patients as people. I insist on it. If I can't establish that with someone, I really can't work with them. I remember this one patient, Michael, who flew in from Sacramento to see me. He always came with his wife. But he was one of those patients who seemed down all the time. He would come in and be all slumped over, very unresponsive, very uninvolved. He wouldn't even look me in the eye. I said, 'I can't relate to you Michael, if you don't look at me. You have to be alive. You have to carry on.'

"Michael decided to go to another doctor, and that's alright. But in other cases that approach has really worked. There was this one woman, Peggy, who was in the hospital and doing quite poorly. Usually she was very upbeat. She had a wig, because here hair had fallen out, and she always dressed in a nice night gown and wore here makeup."Anyway, one day I went in and she had had a bad night. She was very disheveled. No makeup. Her hair piece was half on. She wasn't dressed nicely. She looked like she didn't care. Well, I told here, 'I can't work with this crap. Look at you. I won't have you giving up.' And I walked out.

"A little while later the nurses came to me and said, 'Peggy wants to see you.' I went back in and she was changed. Her hair piece was on straight, she had here makeup on and she had changed here clothes. She looked me right in the eye and said, 'Fuck you, John Stehlin.' I stepped back and applauded her."

de Ipolyi
"John is talking about being honest, as a person, in your relationship with a patient. It means sharing how you feel about something, along with the facts. Of course, how you share the facts is important, too. Patients must be told the truth, but you have to consider the tempo at which you deliver the truth.

"For example, after surgery a lot of patients don't even ask what you took out of them. It may seem strange, but it happens fairly often. In those cases you slow down. You give them the information as they ask for it. They will ask.

"The most important thing is to not hide behind the medicine and technology. I saw a patient here this morning who had had a questionable mammogram. I had treated her sister for breast cancer ten years ago. Now she had it. I had to go in and tell here we got a bad report back on her tests. She started crying and I have to say I started crying too. She's only thirty-six years old. She shouldn't have to deal with that. It's awful, and I just had a human response to it. It's not a problem. In fact, I find patients respect an honest reaction to their situation."

Stehlin
"It's important to understand that nothing creates more anger, for the doctor and the patient, than cancer. This is why solid tumor chemotherapists probably are the worst at relating to their patients. Their job is so frustrating; there are so many recurrences, and they often keep their feelings of anger and frustration inside. They are mad as hell, and they don't know what to do with their feelings. It costs the doctor a lot, emotionally, to do this kind of work. You can't do it at all if you don't recognize that.