Monday, January 23, 2012

Important Worrying Inadvertently Delayed

I am delighted to report that meditation teacher Eugene Cash was back with us last night, almost four months to the day since his bicycle accident and traumatic brain injury.

At the beginning of the evening, he introduced himself, then introduced himself again a few moments later, and then said, “I’m not sure if I said this already: I’m Eugene Cash. I think I might have said that.” But that was literally the only thing that revealed what his poor head had gone through. While he had much to say about what he’d experienced, remarkably, he sounded as lucid as ever in recounting it. He spoke about the sudden loss of his accustomed identity, to which I could relate, and about realizing that his long-practiced habit of mindfulness was continuing post-crash as if on its own, without his conscious effort, and how helpful that was.

(His wife reported on his Caring Bridge page that, early on, when a doctor asked Eugene if he knew where he was, he promptly and correctly answered, “Here!”)

Today I had lunch at Henry’s Hunan with Alan, Carolyn and Jim, who were in my first group at the company I’ll be leaving soon. I was fresh from two years of temping and showed up in a wool skirt, which I wore frequently at first; it was probably the only garment I owned for the lower half of the body that constituted business attire. Then one day my eye fell squarely on Alan and I realized he was wearing jeans, a t-shirt, and tennis shoes—my sartorial hero! “Then why do I have to dress up?” I thought, and that was the end of that, so he saved me a tremendous amount of time and money.

After lunch, I went to see medical oncologist Dr. W. and learned that I’ve been obsessing about the wrong thing for all these weeks. The thing I should have been worrying about (though I guess there’s still time) is a brand new cancer, for which my risk is now doubled or tripled, depending whom you ask.

Dr. W. joined me 40 minutes after our scheduled meeting time and apologized for the wait, which I appreciated, but it was downhill after that. He asked if I’m planning to have radiation and when I told him I’d already had intraoperative radiation (IORT), he said, “Really!  Interesting.” He obviously hadn’t been able to find 10 seconds to open my chart, whereas every other doctor I’ve seen lately was fully conversant with the pertinent details before our first meeting. It would be one thing if Dr. W. didn’t know what my maternal grandfather died of, though that’s in there, too, but my having completed radiation treatment already is fundamental. He does seem to consider IORT to be equivalent to external radiation, which is good.

To quite a number of my questions, he answered, to paraphrase, “Dunno.”

He said I’ll need a doctor to follow my case. I asked if that could by my ob/gyn. He said, “It’s your choice.” I said, “Is the person people sometimes choose their ob/gyn?” He said, “It’s your choice.” I said, “Is an ob/gyn a reasonable choice?” He repeated his answer, but by now with his teeth gritted and looking like he wanted to murder me.

At $500 for 45 minutes, and after waiting 40 minutes to have this conversation, I think a clear answer was a very reasonable expectation, something more along the lines of, “No, people don’t usually choose their ob/gyn; they usually choose their [whatever],” or, “Yes, you can choose your ob/gyn, and in fact, most patients do just this.”

He went on to make a strong case for tamoxifen—he thinks my risk of a recurrence is 5% over five years, twice what my surgeon and radiation oncologist said, and he said my risk of a whole new breast cancer is 13% over five years, which seems absurdly high, but that if I take tamoxifen, this would go down to 8%. He pointed out that since I’m only 49, I have a long time in which to get cancer again, a gloomy thought I have fairly often myself.

Dr. W. did say that other kinds of cancer don’t have any bearing on breast cancer and that I’m not doomed to die of cancer because all four of my grandparents did. He also doesn’t think I should have my ovaries removed to reduce production of estrogen.

Given that this was the oncologist my surgeon billed as evenhanded, meaning that the other would push even harder for the tamoxifen, and also given the sizeable deductible I now have, I’m probably not going to seek a second opinion, so my company’s diabolical plan has worked to dissuade me from “overusing” services.

Before leaving for lunch, per the weather forecast, I’d suited up completely for rain, as if I’d left one item off, it would have poured. Thanks to being fully prepared for precipitation, I made it downtown, to Dr. W.’s office, and home again on my bicycle without encountering a drop.
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