Decisions and more decisions.
The American Cancer Society estimates there will be 1,660,290 new cases of cancer in the United States in 2013 affecting both males and females. They estimate in North Dakota there will be 3,510 new cases. All these numbers mean is that there will be several million people affected by this disease.
Among those affected will be wives, husbands, partners, sons, daughters, employers, doctors from different disciplines and close friends of any one who is diagnosed with some form of cancer. Some of them will play a part in the decision making process regarding treatment, as will the disease itself, however the main player will still be the patient. If the disease dictates what kind of treatment is needed, at least the patient gets to decide where that treatment will be done. That control gives something back to someone who feels as if something dear is being taken from them.
Making any decision on health care or treatment of any serious disease is never an easy one, and you will find that every time you make one decision, it is replaced by the demand that you make another one. While all of this may seem mundane, I assure you it is not. Decision making regarding every aspect of a disease like cancer exacts an emotional toll, on both the patient and the caregiver. It is also something that is inescapable. At this point in the process, the immediate question demanding an answer was where Joanie would have the radiation. There would be other questions, depending on how that one was answered.
We had a good idea of what was in store with the radiation therapy as proposed by Dr. Dusenbery at the University of Minnesota Hospital. Joanie and I understood there was the risk of possible damage to her bowel, bladder, vagina and ovaries with the radiation, but that was about the only option at this point. This was one of the times when the disease dictates the decision on the course of treatment. Dr. Dusenbery had been very clear and thorough about what the radiation would entail. We also knew that the procedure would be much the same if she did it in Bismarck.
The decision on where the therapy would take place was now in Joanie’s hands. We went to the appointment with the radiologist in Bismarck, and it was obvious they were prepared and familiar with Joanie’s case from the records they had received from Dr. Dusenbery and Dr. Carson.
It was now getting close to decision time, since if we were going to have it done in Minneapolis we would have to leave on Sunday. I knew the uncertainty about this question was placing an undue amount of stress on Joanie, and it had to be settled. I didn’t try to dictate where I thought it should be, even tough I had an opinion on that question. I told her it was her decision, and whatever it was, we would make it work. She, after all, was the one who needed to be comfortable with the decision, not me. It was her body and her life at stake. My job was just to be there and see that she got what she wanted and needed.
At the meeting with the radiologist he explained the procedure in much the same terms we had heard from Dusenbery, and while she didn’t make a decision after hearing from him about the therapy while we were in the office, I knew, in my mind, before we left the room what it was likely going to be. The statement, “They do more of these down there than we do,” caught our attention, and while those words were not the determining factor, and were not taken by either of us to mean they couldn’t do the job, and do it right, it was something we did talk about afterward. That statement along with the fact there was also a slight variation in the procedure from what was described by Dr. Dusenbery, did not do much to contribute to our comfort level.
There was no doubt in my mind they could have done the therapy in Bismarck, but it all had to do with her comfort level. I remember thinking when I heard the statement about “they do more of these down there than we do,” that they would be doing another one. You can see by that where my comfort level was.
We left the office, and before we got to our car in the parking lot she had made up her mind. She was going to take her treatment with Dr. Dusenbery, in Minneapolis. Katie, it seemed to me, had instilled a feeling of confidence in Joanie that was really important. When Katie had outlined the procedure for the external beam radiation, and the precision demanded in doing the implants, it had given me a level of confidence as well. It was also the place where Dr. Carson, now her primary doctor was, and she knew both of them were intimately familiar with her case, especially after the surgery where they were both involved.
After we left the hospital Joanie and I went for lunch, and I could see in her face and demeanor that she was relieved this question had now been answered, and while the disease may have dictated what the therapy should be, at least she felt she had some control over where it would be done. It was really important for her to feel as if she had some control over what is going on with the treatment of the disease that had invaded her body rather than just feeling like a helpless victim. It’s a feeling that every caregiver needs to reinforce for the benefit of the patient.
We ordered lunch and a glass of wine, and began to talk about getting things in order before we left on Sunday and how we were going to get it all done. She said she would call both Dr. Carson and Dr. Dusenbery and tell them we would be back in Minneapolis on Monday. She said she would call her sister, Ginny to let her know when we’d be coming down. Ginny’s generous offer to have Joanie stay at her home in St. Paul while she was having radiation made the decision for her to have the treatment in Minneapolis easier, but Joanie was still a bit concerned about being an imposition, especially since it was going to be a six week period. Ginny and Ed were wonderful in making her feel otherwise. Without their graciousness and hospitality, it would have been difficult for us to have Joanie down there for that long, since insurance doesn’t pay for food, lodging or transportation.
We solved the transportation problem by driving the Volkswagen down on Sunday, and after she had her first session of radiation on Tuesday, I would fly back to Bismarck, leaving the car with her. When I would come down to see her after that, I would use our other car
For the first time in almost a month, she seemed relaxed, and though she wasn’t looking forward to what lay ahead, wasn’t looking forward to being gone for six weeks and wasn’t looking forward to the two hospital stays, she was ready to take it on, and take it on in her terms.
With that we raised our glasses and toasted to a positive outcome that would put this unpleasant situation behind us.