The Promise

Cervical cancer is almost entirely preventable. The Pap smear, introduced in the 1940s, reduced the death rate from cervical cancer by more than seventy percent in countries that implemented routine screening. The HPV vaccine, introduced in 2006, has the potential to eliminate cervical cancer entirely. And yet, every year, approximately 4,000 women in the United States die from a disease that should no longer exist.

Melissa was one of them. She was thirty-one years old when she was diagnosed with stage IV cervical cancer. She had never had a Pap smear. She had been uninsured for most of her adult life, working part-time jobs that didn't offer health benefits, earning too much to qualify for Medicaid and too little to afford insurance on the open market. When she finally saw a doctor — because she was bleeding between periods and experiencing pelvic pain — the tumor was already advanced beyond the point where surgery or radiation could cure it.

I was Melissa's gynecologic oncologist. I performed her staging surgery and delivered her prognosis: months to a year, with treatment focused on palliation rather than cure. She listened quietly, asked questions about what to expect, and then said something that has stayed with me for the rest of my career.

"Promise me," she said, "that you'll tell other women about this. Tell them to get screened. Tell them about the vaccine. Don't let my death be wasted. If one woman gets a Pap smear because of me — if one mother gets her daughter vaccinated because of my story — then this won't be for nothing."

I promised. Melissa died eight months later, at home, with her mother and sister at her bedside. Three weeks after her death, I started a cervical cancer awareness program at our hospital, funded initially by a donation that Melissa's family made in her name. The program provides free Pap smears and HPV vaccinations to uninsured women in our community. In the five years since it started, we have screened more than 2,000 women, detected precancerous changes in over 100, and, I believe, saved lives.

I kept my promise. But Melissa was the one who made it possible. She was dying, and she chose to spend her remaining months not in despair but in advocacy. She gave interviews to local newspapers. She spoke at community health fairs. She told her story, over and over, to anyone who would listen, until she was too weak to speak.

I have taken care of thousands of patients in my career. I have learned something from many of them. But Melissa taught me the most important lesson of all: that even in dying, you can save lives. And that the most powerful thing a physician can do is not to prescribe a treatment — it is to make a promise and keep it.