From the monthly archives:

December 2009

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I leave Dr. Weary to meander through the bowels of the hospital until I end up in its basement.  “Radiation” reads one arrow pointing down yet another hallway.  Around that corner another door:  “Environmental Services.”

Toxic waste? Then I realize it is only a euphemism for the janitor’s office. Around the next corner from the janitor’s closet a sign reads: “Radiation Oncology.”

The ceiling is low, the tiny waiting room has a few wooden arm chairs, all empty, and a floor to ceiling aquarium with what looks to be salt water fish. The receptionist is heavy set, slow, none too friendly. She waddles off to make a copy of my pathology report before she sends me next door.

Inside the door, a figure, slightly bent forward, comes steaming towards me in the dark hallway,  walking with a bit of a limp. Hip injury? Knee? Still, Dr. Alpha looks fit and tall, dressed in a short sleeved silk shirt, well fitting slacks and a cool belt. Hugo Boss?

At first glance, I expect him to be “a man’s man” and a bit full of himself, someone who talks “at” women, or above their heads.

Wrong.

Dr. Alpha pulls up a chair, right next to mine, by the large conference table. He  is informal and attentive,  seems sincere as he immediately engages me. He asks how I discovered my cancer. We chat about my oncodx test result? What about my visit with Dr. Weary? Like Dr. Guru and Dr. Weary, Dr. Alpha carefully probes my neck. I dare barely breath as his large hands searches for a swelling or a node perhaps missed by the others.  But without as much as a glance at me, he sits back down and again checks the “shared decision chart” that I just received from the oncologist.

“I don’t want chemo,” I tell Dr. Alpha.

“There is this study from your neck of the woods,” he says. “It shows chemo at your stage to be of very little benefit.”

“From the Karolinska Institute?”

He nods.

Like with Dr.Weary, I have no sense that Dr. Alpha’s “patient time management clock” is ticking, even though I have been dropped into his schedule without much warning.

“Do you happen to have your pathology report with you?” he asks.

Although his receptionist just copied it for him, I fish out my own copy from my purse which by now is an ambulatory file cabinet. Dr. Alpha adjusts his reading glasses. In one nano-second, he is hung up on the “less than 1 mm margin all other sides free of carcinoma” issue,  the one issue that bothered me for weeks, the one issue  I just had given up on.

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Dr. Weary piles on the good news about his chemo regimen:

“You will not suffer for five months straight. Only for six week-ends. You may have your treatments on Fridays so you can recover over the week-end and be at work by Monday. Maybe by Tuesday.”

“Great.”

“We give you medication to control nausea. You will not feel so hot, but it is bearable. You will be able to function. “

One thing he does not mention is this statistic: a large percentage of women who receive chemo loose their memory, and not insignificant: many can never again experience orgasm. It seems to me that this would be as important to mention as the hair loss, more important since hair grows back. But Dr. Weary does not bring these subjects up. Perhaps he thinks:. Death is the ultimate loss of both joy and memory.

While I am processing the thought of having chemo and  I try not to fall apart before his eyes,  Dr. Weary brings up a new National Study.

“Thousands of women are in it,”  he says as if there were safety in numbers. “Women with oncodx score lower than 11 get hormones only. Everyone with a score between 12 and 24 gets assigned by a computer at random to receive chemo or hormone blocking medication only. Everyone 25 or higher gets chemo. Of course, once you agree, you have to accept what the computer chooses. The decision is not yours,” he says.

My score of 23 is uncomfortably close to those who MUST have chemo. I feel faint. I try to divert his attention from chemo to hormone therapy. Which one would it be? Tamoxifen?

Dr. Weary waves his hand dismissively. No, his hormone blocker of choice is Arimidex. “Much better stuff,”he says

We talk about the study at length. He seems to have all the time in the world, no concern with the “patient time management schedule.” But I am anxiously aware of the clock on the wall behind him.

I hear myself tell Dr. Weary that I feel I ought to participate in the study for the sake of my two daughters. But I am really uncomfortable with the randomness. The Russian roulette aspect of the computer choice. I am terrified of chemo. After a long silence I ask Dr. Weary point blank:

“Would you let your wife take part in the study?”

He stares at his desk for what seems to be an eternity. Finally, he looks up.

“I’d like to think that I would be brave enough to let her do that,” he says softly.

I decide to make it easier for him:

“What about your daughter.”

“Chemo,” he says without the slightest hesitation. He shuffles the papers in my file, reads my score over and over. “I am puzzled by the high oncodx score given the profile of the tumor characteristics in the pathology report,” he tells me.

Eighty percent of my cells are well differentiated, strongly ER and PR positive, not HER/2 positive (25% of women are.) I am stage 1, excellent general health. But something in my tumor put me at intermediate risk for distant recurrence.

Distant recurrence is doctor speak for Stage IV, about which Dr. Susan Love in her breast book writes: “Take care of your affairs in the time you have left.”

“I will support you in whatever you decide,” Dr. Weary says with a sigh. He wrings his hands, stands up, only to abruptly sit down again.

“I don’t know,” he says, almost as if talking to himself more than to me. “This breast cancer thing, you just never know. It has a way of sneaking up on you, of surprising you. I suppose I have over prescribed, but it is so hard to see someone come back. It is so hard.”

Dr. Weary looks tremendously sad as he speaks. And his sadness fills not only the room, but me as well. People have told me about him, how he will come and sit and talk to patients while they are getting their chemo. I think about M. who asked him to keep her alive at stage IV as long as possible so her daughters would be older when they lost her, more able to care for themselves. I can not even begin to imagine the emotional difficulties of Dr. Weary’s job. I also imagine that without chemo, he would not have much of a practice.

“I used to give everyone chemo,” he says. “It was probably overkill, but I did not know it then. My colleague over there,” he points at the wall, towards the office next door. “He has been in this game for 30 years and he gives chemo to everyone.”

I laugh nervously and manage to make some comment about how “I will be sure to avoid him.” We agree that I will also consult the oncologist at the University Medical Clinic.  He does not seem the least offended that I like to have a second opinion. “She is the chemo lady,” he tells me, then, noticing my startled expression, he corrects himself: “No, she is the hormone lady. Well, I don’t know. You will find out.”

“Get a second opinion, then, decide. Some of my patients have gone to her.”  Dr. Weary  seems quite insouciant.

Just as I am about to leave, he asks if I wanted to meet with a radiation oncologist. “Might as well,” he says. “Either you will start radiation right away or in January when chemo is over, so you consult with him now. I will check if he is free.” Dr. Weary picks up his phone and tells the person on the other line that he will be sending over this “very nice lady.”

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