I’m doing “better.” Which is to say, I’m no longer dying. I’m not sure it’s humanly possible to feel worse than I did this weekend, but I’m not terribly interested in finding out. “Better” in this case means I can’t really get up or eat much. But I guess it’s better than the alternative.
The slightly more optimistic way of looking at things is this: I’m done. I’m done with cancer treatment, hopefully for good. I’ll get around to being excited about this at some point in the future, hopefully after I become a functioning human being once again. But for now, my focus is on fixing my more acute medical issues.
Anyway, the developments on the cancer front: I spoke with Dr. Ambinder twice last week, on Monday and on Tuesday. I called Hopkins on Monday because I had a pretty terrible weekend last weekend (before my worse-than-terrible weekend this weekend). I was all set to head up to Baltimore to do some stuff when Dr. Ambinder gave me a ring to discuss the situation. He had two thoughts. First, he didn’t think dragging me up to Baltimore and doing IV hydration/caffeine would be any more effective than going out and buying some Red Bull (his honest suggestion), and second, he thought powering through the last 3 treatments was not the best idea in this situation.
The second recommendation bothered me. For a number of reasons. I mean, I’m just a competitive person to begin with. So when a doc tells me we’re going to do 5 injections, I’m going until I hit 5 injections. If I don’t, I have failed. But more importantly, in any battle between short term pain and long term benefit, I’m opting for long term benefit. Saturday night ER visits, as horrible as they are, are vastly preferable to playing this whole game all over again. Cancer is the ultimate “leave it all on the field” game. There’s no sense in playing if you can’t give it all you’ve got.
But as a wise man I once knew (Dr. Anderson) always said, the answers here are not black and white. The battle against cancer is fought in shades of gray. This is particularly true with my battle. If my doctors agree on one thing, it’s that nobody knows for sure how to treat me. That’s unnerving, for sure. But that’s life.
So there comes a time when you just have to put your faith in people and move on. That time is now. And when I spoke with Dr. Ambinder for a second time on Tuesday, I was able to do that. But as you know, I’m not an optimist. I don’t put blind faith in things. I need concrete reasons to feel confident and at ease. So these are my concrete reasons.
First, Dr. Ambinder told me “I had a long discussion about your case with my team, and our consensus is that we shouldn’t go forward with additional treatments.” It was particularly important for me to hear that Dr. Ambinder had discussed my case with others. I was still reeling from Dr. Anderson’s recommendation, and I needed to hear directly that Hopkins was giving my case the attention I needed. This was particularly important since I have only been with them for a month. So if I’m confident that my case was thoroughly discussed by a number of doctors at one of the nation’s top cancer centers, I’m not going to keep myself up at night second guessing myself.
Second, Dr. Ambinder stated that my other tests were “absolutely 100% normal.” In this, he was referring to my scan, my spinal fluid analysis, and my blood work. Across the board, there were no red flags on any of the tests. The decision to stop further treatment was based on these tests, at least in part.
Third, Dr. Ambinder explained that the majority of the benefit from the treatment comes with the first injection. It’s important to remember that this treatment is preventative, not remedial. Unlike the R-CHOP I went through in the fall, we’re not trying to kill a certain number of cancer cells. I mean, we are. But nobody has any clue how many (if any) cells are present. If I only got two cycles of R-CHOP,that would be a problem since that wouldn’t be enough to eradicate all the cancer cells. But here, because docs have not found any cancer cells at all, it’s likely the two doses of intrathecal chemo have taken care of any potential problems.
I pinged Dr. Li to get her take on things, and she agreed, writing, “No one really knows how many LP is enough for prophylaxis and potential benefit from additional LPs probably is not worth the headache [Ed: Is this a pun? Are my cancer doctors using puns?] so I'm comfortable with the decision.” Which, of course nobody knows how many LPs are enough. If anybody knew what the f*ck to do about my cancer it wouldn’t be my cancer. I should have just fired some darts at a cancer-treatment dartboard back in August. Would have saved me a lot of stress.
In all seriousness, though, if Dr. Ambinder is calling my tests 100% normal, if he discussed the case with his colleagues, and if Dr. Li independently agrees with the decision, then I’m ready to throw up the deuces and finish this chapter. I can sit here all day and think, “What if?” But I’m not. It’s not productive. I’m not substituting my concocted nightmare scenarios for the reasoned judgment of very good doctors. And I won’t let this shit take any more of my life than it already has.
Plus, no matter whose figures you run, my chances of never having to deal with this again are somewhere in the realm of “very good.” In the post-cancer world of new perspective, I’ll take those odds.