“The worst thing about medicine is that one kind makes another necessary.”–Elbert Hubbard
Change during good times can be difficult to handle, but when change comes during bad times it becomes even more difficult. Dr. Carson had been taking care of Joanie since the beginning, and had seen her through some very difficult times, and there was a level of trust and confidence she felt with her. There was also the familiarity with the clinic and hospital in Minneapolis, and it had become almost second nature to be making trips down there when we needed to. That was going to change with this latest development.
After Dr. Carson told Joanie that the chemotherapy could be done in Bismarck, it made some sense to us. After all, the regimen was really only a recipe with the dosage of each drug spelled out, much like it would be if you were going to bake a cake. So, where it is administered really shouldn’t make much difference.
In theory that’s correct, but as a practical matter it does make a difference. Making the change means meeting, establishing a relationship with a new doctor, and getting the chemo in a new environment under unfamiliar conditions. She would not be meeting with Dr. Carson before and after each treatment, as she had before, and that itself represented a significant change Joanie had to come to terms with to be comfortable.
As noted before, that comfort level between doctor and patient is extremely important when dealing with any kind of cancer treatment, especially something as harsh as chemotherapy and the side effects. It is, after all, a poison they are introducing into your body, in an effort to kill the cancer cells, but it comes with a price. It also kills healthy cells, especially white and red blood cells. The patient must believe this is the best possible treatment, she is comfortable with, and trusts, the doctor she is working with at the time, and believes it is going to work.
Joanie and I talked some about the choices she faced. For a brief moment we considered calling Carson and asking if she could do it in Minneapolis, as she had before, but we dismissed that right away. We both talked ourselves into the belief that it really didn’t make any difference where they delivered it, it would be the same regimen, and it had worked before. The next thing that took the foreground in her mind, was the meeting with the doctor who would be overseeing the treatment, and, in effect, be her main doctor for the duration of the treatment. We had been assured, that Carson would send the recipe for the chemo to Dr. Thomas, and he would be in touch with Carson throughout the six months the chemo was scheduled to run. As there was in 2003, there was to be one treatment every four weeks, for six months.
Joanie had an appointment with Dr. M. R. Thomas for March 9th, and it would be then we would get an idea of the doctor and staff we’d be dealing with for the foreseeable future.
We weren’t strangers to Mid-Dakota Clinic, or St. Alexius Medical Center, since Dr. Jan Bury was Joanie’s gynecologist, and it had been Dr. Christopher Adducci, a urologist, who had found the stones in her Miami pouch. Dr. Jim Hughes had done the bronchoscopy in 2003 that had found the cancer that had spread to her right lung. She had also had numerous CT scans, x-rays and PET scans done at Mid-Dakota and St. A’s. However, this was to be her first experience with the cancer department of Mid-Dakota, and she was just a bit apprehensive about it.
On the morning of the 9th, we checked her in and took seats in the waiting room in the Hematology/Oncology department just off the check in desks on the ground floor of Mid-Dakota Clinic. Joanie was nervous, and I was as well. We didn’t have to wait long before a nurse came out and called her name. The nurse happened to be Kathy Remboldt, someone Joanie knew. She was Dr. Thomas’ nurse, and, I would find out she was also his gatekeeper. The tension eased immediately, and I could see it in Joanie’s demeanor. At least she was dealing with someone who she was familiar with. It made me feel better as well.
When Kathy finished the preliminaries, she left with the words we’d heard so many times before, “The doctor will be with you shortly.”
We sat there, not saying much, and I refrained from my usual examining room improvisations. I think she had seen my routines to many time already anyway. It wasn’t long before the tap on the door came, it opened and Dr. Thomas walked in.
It was clear to me after only a few minutes, that Joanie was going to be comfortable with him, something that made me more comfortable. We made small talk for a while, and then got down to business. He told us he had talked to Dr Carson, and he was quite familiar with her file. He went over the results of the most recent CT scan and the PET scan, and, I think was trying to get an idea of how much we understood about her current situation, which was everything.
When it came to talking about what we were there for, he said they would like to start the chemotherapy next week. He went over what the regimen was going to be, and it was the first time I ever felt I knew as much as a doctor did about what was going to happen, but not really, I only knew about the experience from 2003 with the clinical trial.
There would be a change, something that caught our attention, when he told us Joanie would have to be admitted overnight for the infusion. This was a variance from the regimen from 2003, where the chemo was done in Minneapolis over a six to seven hour period, and it was supposed to be the same thing now.
Dr. Thomas made some comment about it being more convenient for her, and the difficulty of delivering Mesna in an outpatient setting. This was something we didn’t understand, but neither of us said anything. I knew they had delivered Mesna in the outpatient setting at the infusion center in Minneapolis with no problem, and so we had no idea of why that would be a problem here. Joanie, who by now, had begun to feel comfortable with Dr. Thomas and this new setting, didn’t seem to want to pursue the question, so I didn’t.
Mesna, as near as I could figure was one of those medicines that you have to use because another one, i.e., ifosfamide, makes it necessary. Actually, I thought it was used to help prevent bladder problems. I knew she got it in Minneapolis, and without a problem, but for some reason here they wanted her in the hospital for it.
Dr. Thomas also told her he would set up an appointment to have a port-a-cath put in prior to the infusion, and would let us know when that was. Joanie had one before, but had it removed in December of 2004, not expecting to have any further use for it.
It had been a stressful morning, with a lot to consider. Joanie’s attitude and demeanor that day were largely positive, as they always had been, but I could tell this was taking a toll on her. I suggested we go somewhere for a long lunch, which we did. While the regimen she would undergo, was familiar, there was an uneasy feeling, caused mainly by the reason she would have to go through it again, that weighed on both of us that morning.
After we ordered lunch, she looked at me and didn’t ask me this time what we would do next. We just talked about how well the chemotherapy during the clinical trial in 2003 had worked, and assumed it would work as well again, even with the change in the way they delivered the drugs here in Bismarck.
I dropped her off at her office after lunch, and before she got out of the car, I gave her a hug, squeezed her hand, and told her we’d get through this. She smiled and said, “I know we will.”