The lesion’s curse

A frightened Diane called me today.  She was in big trouble.  Her primary doctor’s office had called with terrible news.  The MRI showed Diane had a lesion.  Desperate, she reached out to an Oncologist for help.

A lesion?  Yes, a lesion.  What could that mean?  What did she need to do?  What was going to happen?  With trepidation Diane asked, “Do I have cancer?”

Medicine prides itself on accurate, specific, scientific analysis.  We have delineated more than 50 sub-types of lymphoma.  We measure toxin in parts per million.  We use complex Latin based terms like hemoglobinopathies to describe red blood problems, or ER positive Her-2 negative lobular carcinoma in situ with microinvasion to define a tiny breast cancer.  We adjust drug flow in micrograms per kilogram per minute.  Thus, you know we have a very specific delineation for “a lesion.”

Nahhhhhhh…. there is no absolute definition for “a lesion.”  In fact, if there ever was a useless, confusing and therefore frightening term, it is “lesion.” Perhaps Aristotle said it best, when he explained, “ To say of what is that it is not, or of what is not that it is, is false, while to say of what is that it is, and of what is not that it is not, is true.”   Certainly clears things up for me.

The MedicineNet dictionary defines “lesion” as “almost any abnormality involving any tissue or organ due to any disease or any injury.”  The emphasis being on “any.”  Farlex notes that a lesion might include any “pathology, tubercle, ulcer, wound, harm, hurt, injury, trauma, stigmata, abrasion, excoriation, scratch, scrape, gash, slash, slice, cut, laceration, or (and this is my favorite), bite. “  I suspect that my Aunt Hilda qualifies as a lesion.

The point is this.  The term “lesion” fills in the blank in any medical sentence for “not normal.”  However, most of us when we hear the term lesion, we think cancer.  This is not what lesion means. We use this vague term when we are too apathetic to be precise.

Therefore, the next time someone (i.e. a doctor) uses the word “lesion,” go into action.  Raise one eyebrow, lean forward, raise a finger and say, “I do not know what you are talking about, you must be more clear.”  The speaker owes you an exact explanation and not this lazy descriptor. Obviously, most “lesions” are not terrible disease, and they often do more damage to psyche then body.

Oh, and Diane?  She is fine. Her “lesion” is a 1.2-centimeter pocket of cartilage in the bone next to her knee, known as an Endochondroma. She has carried this benign change in her fibula from childhood.  It requires no medical care.  This is fortunate, because the anxiety of the word almost gave Diane a real lesion, like a heart attack.



  • don winslow
    Thank goodness Diane talked to a Doctor who got an A in Compassion 101. I wrote this poem in 2005, after recieving treatments for my Prostate Cancer. Although this was a personal poem, it reflected some of the tales told by members of my Support group. I was fortunate to be asked to address students at the Robert Wood Johnson Medical School in 2006 and 2007, at their Transition Ceremony. As the Patient's Advocate on the program I tried, by my poetry and fellow survivor's experiences, to make the budding Doctors aware of the need for compassion. I'm sure Diane would agree. Compassion 101 Do Doctors take Compassion 101? Are they taught how to treat us with kindness? Can Considerate Cancer Care be instilled from without? Compassion must come from somewhere, but where? If Doctors do take Compassion 101 Do they get marks from the teacher? Are there A students and B students? And what about the dunce of the class? Three doctors knew my prostate well, One said, "Call me at anytime!" The second said, "Daytime or nighttime!" The third said, "Do you realize how many patients I would have to call?" Should I feel lucky to have had two doctors with A's and only one with an F?
    • James Salwitz, MD
      Remarkable poem. Thank you very much for sharing it. We have a ways to go. jcs

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