Decisions, decisions...

Having choices is a wonderful thing; making a decision is the hard part.

We met with the hematology oncologist on Friday.  Let me start off my saying that the new Gayle M. Jacob Cancer Center at Allegiance Hospital is beautiful (what little we've seen so far) and the staff are incredibly friendly and kind.  It made this whole experience far less frightening, intimidating and overwhelming.  When I randomly burst in tears while filling out paperwork, the receptionist gently asked if I was okay, and seemed genuinely concerned. 

We met with our assigned doctor who, for a couple of reasons will not be our long-term oncologist.  He was pleasant and accommodating, asked several questions, did a quick exam of my surgical sites, and then got down to business.

He recommends (note that word; it becomes important later on) chemotherapy.  As he points out often, the choice is mine (another important word to note).  When pressed, he tells us there are many reasons why he makes this suggestion:

1.  The size of the tumor (great than 1 cm, in my case 1.3 cm.  It doesn't sound like a lot, only about half an inch, but it's a factor when deciding treatment.  I never realized the true size of my little lump until I physically looked at a ruler).

2.  The rate of growth.  I found my little lump for the first time at the end of August, when it was barely detectable.  By the time it was removed Nov. 17 it had grown significantly.

3.  My age.  This is the only time in my life when 48 will be considered "young."

4.  The location.  My lump was found at "10:30" on my breast.  It was also deep in the chest at the muscle wall.  Both of these factors are significant in the potential for recurrence.

5.  The receptors.  My lump is ER+, making it a good candidate for hormone therapy.

6.  The grade.  My lump was graded on a number of factors, including differentiation (how pretty it is) and the rate of mitosis (how quickly the cells are dividing).  On a scale of 1 to 3, mine is a 2. 

He gives me statistics on recurrence rates, and tries to explain them.  By now my head is spinning and I really just want to throw up.  Initially we thought chemo wouldn't be required, but after our meeting with the surgeon earlier in the week we were somewhat "put on notice" that it was a possibility.  But really, I wasn't prepared.  I thought I was.  Really.  But then I'm looking at bar charts and graphs that are supposed to be representative of my chances of recurrence, given my age, tumor size and histological grade, and I finally find my fear.

So I look at these numbers and realize that they're "statistically significant" (thanks to that wonderful stats class I took last year), but are they significant enough for me?  

Since the moment our surgeon told us he was "concerned" we have been researching breast cancer.  We have traveled to Breastlandia and learned the new language.  By the time we meet a doctor we are able to have a true, interactive conversation with them about my diagnosis, prognosis, treatment, options, side effects, outcomes, and potential for recurrence - and we understand these conversations.

So I ask the doctor, "What do you suggest?"  And he tells me, "Well, the choice is really yours."

I'm used to doctors saying, "Oh my, you have an ear infection, take this antibiotic and you'll be better."  No one ever gives you a choice about that, you just do what you're told.  Have a hernia?  Need an operation.  Break your arm?  Let's put it in a cast.  

But now we're talking my life, the chance of recurring cancer, and he wants to give me a choice?  I'm supposed to make the decision?  Seems like a no-brainer, right?  

He tells us about the treatment they'll use and the length of time it'll take. He introduces us to a very nice woman who "schedules" me (finally - I have my own personal planner!!) for a "welcome" session next week, at which time I'll get a tour of the new cancer center, meet the staff, and learn more about the process.  My first chemo appointment is scheduled for January 6.

I've told several people that I "start" chemo on January 6, but in some ways I'm still working on making my choice.  And that's the other piece of this whole "choice" crap - it really has to be my choice.  I don't take this choice lightly; it's the most important choice I'll ever make in my life, and there is so much to consider.  The Oncotype test was sent out on December 14 and the results will be back before treatment is scheduled to start.  I say that could be a part of the final decision, depending on the score, but really, unless it's a 0, does it matter? 

Some days, I look for a way out.  I don't care about my hair, I don't care about throwing up, I don't even care about being too tired to care.  Surgery was, well, surgery - I've had surgery before and it "fixes" things, so my brain isn't completely comprehending the enormity of what this surgery did not fix.  Treatment will be an in-my-face constant reminder that my body has betrayed me.  

In the end, I know what the decision will be.  But I'm just not quite there yet.