Note: This essay is published out of sequence; it comes before the previous two essays in this series.
I don’t know what to do with the results of my first consultation with my new oncologist. On one level, things couldn’t have gone better. The issue is not the messenger; it’s the message. The doctor turns out to be a companionable, boyish-looking man in his mid-forties with bright eyes and an engaging smile. The interview started out well. He commented that, just looking at me and hearing of my walking one to two miles a day, he would never have suspected that I had cancer, and a very complicated one, at that.
It was clear that he had thoroughly read my entire medical record. He listened closely to me and was sympathetic to my need for coordinated care. He expressed compassionate concern over what he described as the ordeal that I’ve endured. He assured me that I had done everything I could in dealing with this illness — I had made no mistakes. He affirmed that he would have followed the same treatment plan that I’ve just gone through, despite the disappointing results. He told me more than once that he would be honored to take my case.
Then, he asked me to excuse him for a moment; he wanted to go over all my images and reexamine them with a colleague before saying anything more. Finally, after some long time, (probably not so long as it felt to me), he returned to give his opinion about what the future might hold for me. His best preliminary estimate, he said, is that this metastasized cancer, while highly treatable, may not be curable. Because the cancer spread from the colon so quickly following the first round of chemotherapy, he’s doubtful that I would be a good candidate for liver surgery. There’s a high likelihood that if I went through with the major surgery of cutting out more than half of my liver, the cancer still might not be stopped from spreading.
I already knew and he confirmed that the only way to be truly cured of my condition would be to have the surgery, a surgery that, in my case, would probably only make things worse. He was quick to emphasize his commitment to trying many different modalities to slow the cancer’s spread — new chemo treatments based on my tumor’s chemistry as well as immunotherapy, among other strategies. Nothing is quite certain just now, he emphasized. Things will become clearer after he consults with my surgeons once the post-chemo scans scheduled for three weeks from now reveal the latest status of the disease. Without saying it outright, his prognosis was clear: there’s little hope for a cure; I will probably die of this disease.
So what am I to do with this gloomy pronouncement? It’s still a preliminary diagnosis. It may change. Do I sit on this information for a while and tell friends and family nothing? I’m not sure I’m ready for people’s reactions, primarily because I’m not certain of my own response to it all. Of course, I will submit to any regimen that offers the prospect of staving off this killer pathosis. But who knows how much time I’ll have to live and what living will be like as I endure these treatments?
I worry about what this means for Elizabeth; she’s been through this all before with her late husband who died of a rare immunological disease. I don’t know what to make of this interim time with no clear view ahead, no plan of action I can commit to, no roadmap I can unfold to help others understand the path that I’m now on. This is certainly a paradoxical time, punctuated by unexpected moments when I see things with a clear and intense joy and interspersed with long stretches of uncertainty and confusion. Incertitude is a disquieting companion.
Thanksgiving is coming up this week and I’ll be spending it with family and friends. It strikes me that this most admirable of American holidays offers its own inimitable and interim solution for my quandary: concentrate on the many people and things you have to be grateful for and look faithfully to the future without fear and with confidence. That’s the best path I know and the only one I would choose for a time of uncertainty.