Postsurgical analysis of my biopsies indicated that the cancer had grown just into my intestinal wall. Pathology said it was a genetically aggressive type, but no cancer cells were found in the lymph nodes that were removed along with much of my descending colon. In addition, no metastases were found during either surgical inspection or imaging.
So, to proceed with chemotherapy or not? There was no evidence the cancer was loose in my body or already in my liver, but there could be no proof it wasn't. And if it was, chemo might kill it.
"It's your patient. What would you like to do?" my attending asked. This question was not meant simply as a test of my knowledge; I was expected to give my opinion as a valued member of the team. A requirement for fourth-year medical students, my acting internship was more "intern" than "acting." I worked alongside residents on the inpatient medicine service, calling consults, updating families and placing orders. There was one difference, however: all of my orders required an MD's signature.
Buoyed by this safety net, I got a taste of the thrilling yet overwhelming influence physicians can have in the lives of their patients. Our everyday decisions regarding diagnostics, medications, and procedures can have profound consequences. In just a few years, I would have to make my own choices, without the safety net. I was and am aware that in some cases, the right decision could end up meaning the difference between life and death.
My first chemo was a year ago today. It had been scheduled to start eight months earlier, when I was first diagnosed with breast cancer, but I chose a different path and had hoped to avoid chemo altogether. My oncologist had initially recommended four months of chemotherapy to shrink the tumor before surgery, but he also mentioned that I qualified for a clinical trial that would use a pill for six months to cut off its estrogen supply.
I thought it would be easier than it was, but it was one of the hardest decisions I ever had to make. Ma had been declining mentally and physically for the previous several years. This once-feisty woman--who'd been able to add up her grocery bill to the penny in her head and work seven days a week at a local children's store while still maintaining an eat-off-the-floor home--had become a shadow of herself. Ma barely ate, rarely wore anything but an old white t-shirt and a pair of torn underwear, and sometimes at night wandered the halls of the apartment building where she and Dad lived.
Dad was worn out caring for Ma during the day and being on guard for her whereabouts and well-being at night. I, who lived two blocks away, was worn out by panicky phone calls from Dad that brought me to my parents' home at all times of the day and night. It was obvious that Ma needed more care, that she required placement in a nursing facility. But making the decision to send her there was emotionally painful.