Online care helped save this woman’s life

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Sara Black McCulloch was diagnosed with—and treated for—a rare form of cancer over the phone

“In March of 2020, I was experiencing extreme abdominal pain, like I had something pointy poking at my insides. I figured it was indigestion. I had to go to a shift at my retail job later that day, and I thought the pain would subside. But 45 minutes before my shift, I realized it was getting worse. The pain was unbearable, causing my legs to shake and my knees to buckle. Something told me that this was serious, so I took a cab to the emergency ward at Mount Sinai Hospital.

“I was a little concerned about going to the hospital because there were already Covid cases in Canada. Everyone in the waiting room was trying to stay far apart from one another. The doctors thought I might have appendicitis but weren’t sure, so they ordered an ultrasound and a CT scan. After 24 hours in the hospital, they decided to remove my appendix and I went in for emergency laparoscopic surgery.

“Two weeks later, I had a checkup with my surgeon to make sure I was recovering well. Normally it would have been an in-person appointment, but the province had gone into lockdown the day before, so we spoke over the phone. He asked me if I was feeling okay, which I was. Then he explained that around one per cent of appendicitis cases he sees is related to cancer. He told me I had an aggressive, rare form of appendix cancer called goblet cell adenocarcinoma. I thought it was going to be a routine checkup, so I was blindsided. I had to sit down. The doctor informed me I would have to go in for another surgery again as soon as possible—the tumour was quite large, and they wanted to make sure the cancer hadn’t spread.

“It’s alienating and unsettling to get that kind of information over the phone. A good physician can reassure you in person because they have more visual information to work with: they can see if you’re not understanding something, or when you need to pause to cry. I had thyroid cancer when I was 19, and always feared it would come back. I never imagined I’d develop a completely different kind of cancer.

“The doctor understood how bizarre it was to be diagnosed with cancer over the phone and made himself available to answer any questions I had. Before the surgery, I emailed him directly with questions about possible complications, whether Covid could be transmitted via surgical tools, and coordinating to make sure my mother would be able to drop things off for me at the hospital. He always got back to me very quickly and was able to assuage my fears. The surgery involved removing several inches of my colon, and there was a possibility that I would need a colostomy bag—he reassured me about the likelihood of that happening (very low) while also explaining how the hospital would provide training and supplies if it came to that.

“Throughout the process, he really looked out for my mental health. He knew that I lived alone and that my family was in Montreal, so he would call and email once a week leading up to the procedure to check in on me. I wasn’t allowed visitors due to Covid, so he came to see me in the hospital over the weekend and on his days off.

“After my second surgery—a right hemicolectomy—I was able to walk the next day but I stayed in the hospital to recover for five days. When I was ready to go home, my surgeon gave me his direct line and told me I could call him if anything was wrong. I had a virtual follow-up appointment about two weeks later. It was good news this time—I was cancer-free. Within a week, my surgeon had emailed me all the forms for my next CT scan, scheduled a year down the road.

“Throughout all this, I only had to go to hospital when it was necessary: the pre-op physical with my surgeon the day before my surgery, and the procedure itself. Hospitals aren’t the most inviting environments—you’re surrounded by people who are in extreme pain and discomfort. Even in the best hospitals, even with the most wonderful doctors, you’re constantly reminded that you’re a patient and you’re sick. When I talked to doctors on the phone, I felt like I could preserve who I was—a person with a life, not just a patient in a bed. I found that virtual care gave me distance from the hospital environment and the identity of a sick person, allowing me to preserve my dignity.

“My doctors have since confirmed that the cancer did not spread beyond my lymph nodes, and I’m stable at the moment. I’ll be doing annual checkups to monitor the situation. My doctor made a point of saying how he hopes we can do them in person next year.”