Metastasis

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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