The Chemo Conversation

January 16, 2009

Today at 9:20 am, I had an appointment with my oncologist to review the results of my latest CT Scan and bloodwork. I had last seen her a month ago and we had agreed that I would take a month off--go have fun with my kids, play in the snow and enjoy life. I had done just that but was now feeling the effects of increasing fluid in my lungs and a clear knowing that I was going to be having the long-awaited and rejected chemo conversation with her.

Just to back-track for a moment: I was first diagnosed with locally-advanced breast cancer in 2000. I had all sorts of treatments--allopathic and complementary. Really you could say that I had done everything except that is for chemo.

Okay, so back to today. Karen was her usual caring, compassionate and no-nonsense self. The tumour markers were up and there was disease progression. She recommended chemo and she presented a couple of different options. I asked her what she would expect my prognosis to be if I did nothing and I did not like the answer she gave me though it would make for a good book title--actually it's already the title of a book.

I told her that my highest priority is to live and die with dignity and that my greatest fear is to undergo treatments that rob me of that ability. We agreed that I would investigate the chemo option further by talking my trusted coterie of heathcare providers and spiritual inspirers and let her know.

My naturopath agreed that I needed chemo and had all sorts of great arguments for why I should do it: the best time to do chemo is when the cancer is really active, never having done chemo increased my chance of a response (something my oncologist had also said), the chemo could act as a catalyst to make all of the complementary treatments work even better, there were all sorts of ways to mitigate the unsavoury symptoms of chemo etc. etc. etc.

I spoke with to my counsellor friend who has devoted several decades to supporting people living with and dying from cancer. Knowing how much quality of live means to me, she pointed out that I could embark on chemo one step at a time, assessing at each phase whether I wished to continue.

I spoke to my spiritual mentor. I told her that as far I could tell I wasn't scared of dying (though I definitely have some apprehension about pain and suffering) and that I don't really believe that choosing one treatment over another is what will prolong my life. The oncologist had said that she didn't want me to end up having regrets at the end of my life and that she wanted me to be there for my kids. I have the same desires though perhaps not the same ideas of how to accomplish that. My mentor mostly listened as I worked my way through my biases.

As I spent the afternoon taking in all this input and trying to digest and assimilate the situation I was in and the choices I was facing I started to think about how rigid my point-of-view is to allopathic medicine. It struck me as funny that I had never before considered that one could "embrace the unknown" via cyto-toxic therapies. My oncologist had suggested that this was a possibility but it took me a couple of hours to be able to even grokk that what she was talking about never mind contemplate this notion. There's also the desire to be able to tell my kids that I did "everything I could" and for them not to be vulnerable to conventionally-minded well-wishers who might at some point indicate to them that it sure was too bad that I had never done chemo. Finally, I got to thinking that doing chemo would be a good way to practice dying with dignity. I may be pleasantly surprised but I have the sense that there will be times during chemo that my body will feel like it is dying and I will get to see what my mental response is and get to practice having the response that I wish to have down the road.

So I decided "Yes" and am waiting to hear when I will begin.