Wednesday, November 30, 2011

Is there an oncology end-of-the-month bonus, or something?

That was the question a friend of mine asked today over lunch after I told him about my breast surgeon check up this morning.

As usual, a doctor in residency came in to do the pre-talk and check in before I saw my surgeon.
I filled him in with my background and all the details with my meeting with the radiation oncologist. I quoted the numbers of the faulty study that led both of us to the conclusion that radiation was not needed, told him why redoing the surgery was not an option for me, and made sure he knew that I had no "attitude" about cancer treatment, but that I felt the tumor board should be made aware of the study in question, since the assertion that a woman had a 25% chance of reoccurance if there were minimal clear borders on a full mastectomy with DCIS was just not true.
He tried to defend the whole paradigm, but I was sweetly & calmly unmoved.

A few minutes later, when my surgeon came in, he had obviously been fully briefed on the conversation I had just had with his colleague and may I be so bold as to say he was not pleased.
He greeted me, got the Reader's Digest version from me and then launched into a rapid fire overview of the four major studies that they use for statistical verification.
He was tossing out the names and case numbers of the study (I was internally impressed that he had all of that at his mental fingertips) but at the first deep breath I gently inserted "But two of those studies are dealing with lumpectomies, so they are not applicable to me."
(You need to put on your "fast listening ears" when doctors do that. I always carry a pair with me.)

He didn't miss a beat or have any visible reaction, but I could feel a definite shift in his energy.
Let's just say I won't be getting a Christmas gift basket this year...

On to tactic #2.
He asked for a detailed recapitulation of my conversation with the radiation oncologist.
I did, word for word, practically.
My surgeon then began what can only be described as a sales pitch for radiation, becoming more and more insistant. I wasn't irritated but I wasn't changing my stance either.
Then he brought out the big guns.
He claimed that the radiation oncologist had told him that I was a good candidate for undergoing treatment.
I slightly tipped my head to one side and asked calmly "Really? Why would he say such totally different things to you and I?"
To which he said, ever so slightly raising his tone, "I don't know. I will call him right now." and left the room.

I was smiling at FaceBook status updates when he returned and without batting an eye backpedalled on the whole thing.
Yep. The radiologist had told him (&, props to my surgeon,that he admitted it) that it being on the left, there were serious cardiac considerations, that the study was a "soft study" (so diplomatic!) and that the borders were probably fine given that it was DCIS and not a tumor.

But he wasn't through yet!
There was a new medication that studies have shown (blah blah blah) and if it were he or a family member he would take it (Charlie Brown's teacher's voice) and it was called (whatever) and would I be interested? It is a five year protocol...At which point I interrupted: "Oh. So it's a new type of Tamoxifen or Arimidex-like drug?"
"Thanks, no."
He tried three (!!) more times and I just kept saying "I'm not so interested.~~Nope, thanks.~~Thank you, no.", until, finally, which just ever so slightly the disbelief creeping into his voice he asked "Well, what are you planning on doing regarding the risk?"
I smiled and said "I will continue to boost my immune system and get on with my life."

I guess they don't hear that very often...

So, he made a check up appointment for three months and reminded me that if I changed my mind about the drug I could call him any time.

But my style is so very much more sitting across from Morpheus, wearing a long leather duster, and gulping the blue pill as the lightening flashes.


SBloom said...

Skye, You are too, too much. You put those medical people in a tail-spin, which they need. I'm glad you are so intelligent and literate and stalwart in your journey. These medical dorks can learn a thing or two or a thousand from you. Thanks for sharing. This is encouraging for us all to take charge of our bodies. Love ya

Jeanne Jakle said...

I'm hoping I'd have the courage, if it came up in my life, to just say know to the drugs and treatments as well. Bravo, sistah! Love, Jeanne

Jeanne Jakle said...

I meant "no." too early:(

d smith kaich jones said...

you know, you could charge money to just let people come watch your magic show. i would pay to see it and bring popcorn. love you!!!!

mrs mediocrity said...

me, too! i love that you stand up for yourself like that, but it makes me sad and angry that you have to.
i'm not sure when this shift was made that doctors are the ones in control. i expect guidance from them, not commands. i want options, not dictation.
ah, well, don't get me started....
you go, girl!

Linda Teddlie Minton said...

I'm in awe, as usual. Love the Morpheus reference, too! Big hugs.

Anonymous said...

I am blessed by your journey. All of it. I learn about what is possible in the hearing of others experience. May we all be each others teachers.