INERTIA: A Therapist's Thoughts

May 31 2014
The Adjective

Language is a cracked kettle on which we beat out tunes for bears to dance to, while all the time we long to move the stars to pity.

-Gustave Flaubert

"That's scary, Doc."

I looked up from my notes. I had reassured him that everything was fine. His thyroid tumor had been non-cancerous and he would need no further treatment. His surgery and postoperative recovery had been smooth. He had nothing to worry about. What could be so scary?

"Do you want to run through things again? There is nothing of concern at all."

He looked down and bit his lip. "I just keep thinking about my dad. His cancer treatment was hard on him."

I was still confused. "Tell me what you are thinking."

He picked up the pathology report that I had handed to him. "There," he said, pointing to where I had circled the diagnosis. "You said I had a follicular adenoma, right?"

"Yes. That's what the tumor is called. It is benign. Not a cancer."

"They told my dad at first that his lymph nodes weren't cancer."

He paused.

"My dad died of a lymphoma." He looked at me. "A follicular lymphoma."

Ohhh, I thought. Wow.

"I understand," I said. "You are concerned that your thyroid follicular adenoma might be associated with a follicular lymphoma, right?"

"Isn't it?"

"No, not at all. They are completely unrelated. This is an example where two completely different things have been described with the exact, same word based on how they look under the microscope. Something is 'follicular' when it appears to be an organized, circular collection of cells or looks like a small gland under the microscope. Believe it or not, there are even more instances where we use the word 'follicular' in medicine beyond thyroid masses or lymphomas."

"That's confusing."

"Yes," I agreed. "It is. Our friends in pathology do a marvelous job describing what they see but there are only so many words at their disposal. I can assure you, though, that the mass that we removed from your thyroid has nothing to do with the follicular lymphoma that your father had."

He smiled, finally. "Well," he said, "I still don't like that word."

"Nor should you," I agreed. "There are plenty of other words we can use. We won't ever speak that particular one again."


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